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Ophthalmoplegic Migraine: Inflammatory Neuropathy with Secondary Migraine?

Published online by Cambridge University Press:  02 December 2014

H J McMillan ,
D L Keene ,
P Jacob  and
P Humphreys
H J McMillan
Affiliation:
The Department of Pediatrics, Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
D L Keene
Affiliation:
The Department of Pediatrics, Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
P Jacob
Affiliation:
The Department of Pediatrics, Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
P Humphreys
Affiliation:
The Department of Pediatrics, Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Abstract

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Background:

This critical review provides a summary of the clinical presentation, neuroimaging, treatment and prognosis in pediatric ophthalmoplegic migraine (OM). The features of OM are not in keeping with its classification as a migraine-variant.

Method:

We review 3 new and 37 reported pediatric OM cases.

Results:

Headache was an inconsistent feature, with 25% patients showing no evidence of pain at the initial OM episode.

Patients demonstrated:

1) prolonged time for symptom resolution to occur (median time 3 weeks); 2) tendency for recurrent episodes to have more severe and persistent nerve involvement; 3) evidence of permanent neurological sequelae with recurrent episodes (30% of patients); 4) rapid improvement and shortened duration with corticosteroid therapy and; 5) transient, reversible MRI contrast enhancement of the affected cranial nerve (86% of patients). These features would not be expected in primary migraine headache.

Conclusion:

A detailed understanding of the natural history of OM is essential for the clinical. This review provides support that OM may result from cranial nerve inflammation with headache a secondary and later feature of this condition.

Résumé:

RÉSUMÉ:

La migraine ophtalmoplégique : s'agit-il d'une neuropathie inflammatoire avec migraine secondaire?

Contexte:

Cette revue présente un sommaire du tableau clinique, de la neuroimagerie, du traitement et du pronostic de la migraine ophtalmoplégique (MO) pédiatrique et une analyse critique ce ces données. Bien qu'on classifie la MO comme une forme variante de la migraine, ses manifestations ne cadrent pas avec cette classification. Méthode : Nous rapportons 3 nouvelles observations cliniques pédiatriques de MO et nous révisons 37 observations pédiatriques déjà rapportées. Résultats : La céphalée n'était pas toujours présente et 25% des patients n'avaient pas de douleur au moment du premier épisode de MO. Ànoter que : 1) les symptômes s'estompaient lentement (temps médian de 3 semaines) ; 2) au moment des rechutes, l'atteinte nerveuse avait tendance à être plus sévère et plus persistante ; 3) les patients ayant présenté plusieurs épisodes pouvaient avoir des signes de séquelles neurologiques permanentes (30% des patients) ; 4) la corticothérapie provoquait une amélioration rapide et des épisodes plus courts et 5) un rehaussement transitoire réversible du nerf crânien atteint était observé à l'IRM avec produit de contraste (chez 86% des patients). On ne retrouve pas ces observations dans la céphalée migraineuse primaire. Conclusion : Le clinicien doit posséder une compréhension détaillée de l'histoire naturelle de la MO. Cette revue appuie l'hypothèse selon laquelle la MO résulte d'une inflammation d'un nerf crânien et la céphalée est secondaire et postérieure à cette pathologie.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 3 , August 2007 , pp. 349 - 355
Copyright
Copyright © The Canadian Journal of Neurological 2007

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