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Ophthalmoplegic Migraine Symptoms

By Dr. Tina M. St. John ; Updated August 14, 2017

Ophthalmoplegic migraines, also known as ocular migraines, are an uncommon type of migraine headache in which the eye region is the focal point of the pain. The headache is accompanied by temporary eye muscle weakness or paralysis, which may persist for days to weeks after resolution of the headache. The first occurrence of ophthalmoplegic migraine typically takes place during childhood. Intermittent attacks may persist into adulthood.

Severe Headache in the Eye Region

The hallmark symptom of ophthalmoplegic migraine is severe headache focused in the region around one eye. Ophthalmoplegic migraine symptoms have been observed in infants younger than 1 year of age. Although the first attack of ophthalmoplegic migraine usually occurs in childhood, the disorder may present in adulthood.

Eyelid and Pupil Changes

A drooping eyelid on the side affected by an ophthalmoplegic migraine proves a characteristic symptom of this uncommon disorder. The eyelid usually recovers normal function, although it may take weeks for this symptom to resolve completely. Ophthalmoplegic migraine involves the third cranial nerve, also known as the oculomotor nerve. This nerve controls muscles of the eye, including the muscle that determines the size of the pupil. Partial or complete paralysis of this muscle in association with an ophthalmoplegic migraine causes the pupil to become abnormally large. Normally, the pupil gets smaller in bright light. A pupil affected by ophthalmoplegic migraine may have no reaction or become only slightly smaller in response to bright light.

Eye Position and Vision Problems

Partial of complete paralysis of the muscles controlled by the oculomotor nerve causes the affected eye to assume an abnormal position. The characteristic position of the eye with oculomotor nerve paralysis is “down and out.” The eye position becomes fixed downward and to the side. Double vision or other sight problems may accompany an ophthalmoplegic migraine. These visual problems result because of the temporary partial or complete paralysis of the muscles controlled by the oculomotor nerve. Loss of control of these muscles on one side prevents the eyes from moving together in a coordinated fashion. The result is disjointed input from each eye, which is perceived as double vision or overlapping images. These visual disturbances resolve as the eye muscles regain normal function in the days to weeks following an ophthalmoplegic migraine.

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