What Is Ophthalmoplegic Migraine?

Ophthalmoplegic migraine is a nervous system problem that affects the eyes and head.

People with this rare condition get headaches and pain around their eyeballs. The muscles around their eyes get weak and hard to move. They can also have double vision.

The condition isn’t technically a migraine, although it can cause a similar type of headache. It’s a problem with specific nerves in the brain that control the eyes -- most often, the third cranial, or oculomotor, nerve, which helps us move our eyes and raise our eyelids. In some cases, it also affects the sixth cranial nerve, which turns our gaze out, and the fourth cranial nerve, which moves our eyes up and down.

The condition often starts in childhood, but it can also begin in young adulthood. Most people who have it are women.

Symptoms

People with this condition often have episodes that come and go. Symptoms can last from hours to weeks. In rare cases, they may be permanent. The most common ones include:

  • Weak or paralyzed muscles in or around one or both eyes
  • Pain around the eyeballs
  • Eyes that drift or move out of alignment
  • Double vision
  • Pupils that are different sizes
  • Sensitivity to light
  • A headache that:
    • May or may not throb and feel like a migraine
    • Usually happens on the same side of the head or face
    • Comes several days or even weeks before eye muscles get weak
  • Upper eyelids that droop or fall
  • Nausea or vomiting

Causes

Doctors don’t know why some people get ophthalmoplegic migraine. But they often have a trigger. It might be stress, alcohol, or even certain foods.

One theory is that the coating around our nerves, called myelin, breaks down for some reason and the nerve gets inflamed. The myelin then repairs itself, and after that, symptoms ease within days or weeks. But then, they come back days, weeks, or months later.

Another possible cause is that not enough blood reaches the eye muscles, maybe because blood vessels there haven’t developed correctly.

Doctors once thought the condition was an unusual form of migraine. But now, more and more consider it to be a nerve-related pain, called neuralgia. These days, many call it ophthalmoplegic cranial neuropathy.

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Diagnosis

There aren’t any tests for the condition, so doctors usually diagnose an ophthalmoplegic migraine after they rule out other disorders.

The doctor will first ask about your or your child’s symptoms and health history, and will do a physical exam that includes an eye exam. She may dilate the eyes, or put drops in them to make the pupils bigger. That will help her better see inside the eyes.

Lymphoma, infections like meningitis, an inflammatory disease called sarcoidosis, or blood clots can also cause eye muscles to get weak or become paralyzed, so your doctor will need to make sure those conditions aren’t causing your symptoms. To do that, she may suggest:

  • A blood test to check for a clot or infection
  • Magnetic resonance imaging (MRI), a test that makes detailed pictures of your organs. It will help her rule out a tumor and look at your cranial nerves.
  • A spinal tap to check for meningitis, lymphoma, leukemia, or infectious disorders
  • A chest X-ray and blood tests to check for sarcoidosis
  • Angiography, which makes pictures of your blood vessels. It will help her rule out a weak or bulging blood vessel, called an aneurysm.

If the doctor rules out those conditions, she may then diagnose you or your child with ophthalmoplegic migraine if there have been at least two episodes of a migraine-like headache followed by eye muscle weakness or paralysis.

Treatment

There’s no cure for ophthalmoplegic migraine, but there are some medicines that may help. You or your child may have to try a few to see if any of them work well for you. You’ll need to work closely with your doctor to figure out the best treatment.

Steroids like methylprednisolone or prednisone, which you can get through a tube into a vein, or IV, have been helpful for some people, but not all.

Doctors have also tried different types of blood pressure medicines, called beta-blockers and calcium-channel blockers, with some success. But there’s no proof that medicines that treat or prevent migraine help.

Like other types of migraine, it helps to try to figure out what triggers your ophthalmoplegic migraines and avoid it. For some, that may mean they don’t drink alcohol or eat certain foods. For others, lowering stress is important.

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What Else Should I Know?

While many doctors now believe ophthalmoplegic migraine is a nerve disorder, some do still believe it could be linked to migraine.

Researchers in a recent study suggested that migraines cause a sudden narrowing of the arteries that send blood to the third, fourth, and sixth cranial nerves, which keeps them from getting enough blood.

But doctors need more research to fully understand why ophthalmoplegic migraine happens.

WebMD Medical Reference Reviewed by Alan Kozarsky, MD on December 17, 2018
© 2018 WebMD, LLC. All rights reserved.

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