What is an Ophthalmoplegic Migraine?

An ophthalmoplegic migraine usually resolves on its own and doesn't cause any complications. However, it should not be ignored.

Reviewed and approved by the nurse Leidy Mora Molina.

Written by Edith Sánchez

Last update: 27 October, 2022

An ophthalmoplegic migraine is a rare condition characterized by severe pain in one eye. It’s classified as an ocular headache, that is, a headache caused by a problem in the eyes.

The truth is that isn’t always accompanied by migraine pain. If it appears, it’s felt only on one side of the skull and before the central episode.

An ophthalmic migraine is also known as ophthalmic, retinal, or silent migraine. However, several experts think that it should not be called “migraine” since strictly speaking, it really isn’t one. The more accurate name for this condition is “recurrent painful ophthalmoplegic ophthalmic neuropathy.”

What is an ophthalmoplegic migraine?

An ophthalmoplegic migraine is a rare condition. According to expert estimates, it affects only about 0.7 people per million population in a year.

Physicians define it as the presence of at least two episodes in which there is pain on one side of the head, accompanied by paralysis of one or more of the three oculomotor nerves. However, over time, it has been discovered that not all affected persons have a migraine-type headache.

This condition isn’t easy to diagnose since ophthalmoplegic migraine has symptoms similar to those of other conditions, such as cerebral aneurysms, myasthenia gravis, schwannoma of the third cranial nerve, pituitary apoplexy, Tolosa-Hunt syndrome, and idiopathic or ischemic cranial palsy.

The first manifestations appear during childhood or early adulthood. This is a chronic but cyclical condition. A person may go years without episodes and then have several in a row. It leaves no sequelae.

The symptoms of an ophthalmoplegic migraine

Symptoms of ophthalmoplegic migraine can vary greatly from person to person. Pain on one side of the head is common, lasting up to 1 week or even 14 days.

Some people experience vision disturbances before the pain. This usually lasts 20 to 30 minutes.

Once the pain occurs, symptoms such as the following are triggered:

• Blurred vision.
• Pain in the eyes.
• Nausea and vomiting.
• Diplopia or double vision.
• A loss of vision in only one eye.
• Unusual sensitivity to light or sound.
• Weakness in the eye muscles. This may appear immediately or up to two weeks after the onset of the headache. It usually lasts from two weeks to three months. It’s caused by damage to the eye nerves.
• Scintillating scotomas. They affect one or both eyes. These are small blind spots that appear in the central vision. Sometimes they’re accompanied by bright, flashing lights or zigzag lines of light.

The causes of an ophthalmoplegic migraine

Science has not established the exact cause of ophthalmoplegic migraine. At present, it’s not considered a migraine as such, but a nerve condition.

The ambiguity of the name reflects the confusion surrounding its true nature. An ophthalmoplegic migraine has sometimes been associated with diseases such as lupus, sickle cell anemia, epilepsy, or even depression. However, more recent data indicate that this pathology could be associated with the following causes:

• Inflammation of the internal carotid or posterior cerebral artery: This condition generates a compression on the oculomotor nerves and causes the picture.
• Ischemia or reduction of blood flow in specific brain regions.
• Demyelinating neuritis or neuropathy: This is a condition in which there’s damage to the nerve fiber coverings, resulting in abnormal nerve impulses.

People with a family history of migraine are more likely to develop ophthalmoplegic migraines. Also, males and children under ten years of age are more likely to develop ophthalmoplegic migraines. There are also factors that can intensify symptoms, such as hormonal changes, stress, diet, climate change, or lack of sleep.

Diagnosis

The diagnosis of ophthalmoplegic migraine is usually made by ruling out other conditions first. That is, a series of assessments and tests for other conditions are usually performed before it’s determined that it’s a recurrent painful ophthalmoplegic ophthalmic neuropathy.

The most frequently requested tests are the following:

• Eye examinations
• Neurological reflexes
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Blood and cerebrospinal fluid tests

The treatment for ophthalmoplegic migraines

If the episodes of ophthalmoplegic migraine are mild and sporadic, no specific treatment is carried out. In such cases, it’s usually only recommended to adopt some lifestyle patterns, such as the following:

• Reduce your stress.
• Sleep well at least 7 to 8 hours a day.
• Decrease your consumption of alcohol, caffeine, and tobacco.
• Exercise regularly.
• Maintain a balanced diet.

Since an ophthalmoplegic migraine can come on suddenly, it’s best to stay still until the symptoms lose their intensity. If the condition is very severe or worsens over time, drug treatment is usually indicated:

• Corticosteroids: These are anti-inflammatory drugs that allow for the management of symptoms in some people, although they’re not always effective.
• The Botulinum toxin: This is the famous Botox, which in this case, can help to reduce symptoms, but doesn’t have significant long-term effects.
• Pregabalin: This is a drug used for muscle and nerve pain. It appears to be one of the most effective in treating cases of ophthalmoplegic migraines.

Can it be prevented?

Many times, an ophthalmoplegic migraine resolves on its own, but it can also worsen. If so, there’s a risk of mydriasis or persistent dilation of the pupils. Also, there may be a risk of ptosis – i.e., permanent drooping of the upper eyelid.

In any case, it’ss best to opt for a healthy lifestyle, as this is often very effective in preventing ophthalmoplegic migraine episodes. It’s also always important to be in contact with your doctor and follow his or her instructions.