Ophthalmoplegic Migraine

An ophthalmoplegic migraine causes severe headache. It also may affect the person's vision. Generally, migraines are believed to be caused by changes in the blood flow in the vessels of the head. Changes in blood flow to different areas of the brain can produce a variety of symptoms. The exact process that causes this type of migraine, however, is not well understood. One possible cause is inflammation of the blood vessels around the eye. Allergic reactions are another possible cause.

A person who has ophthalmoplegic migraine has specific symptoms involving the eyes. These symptoms may differ from person to person but most likely include the following:

• double vision
• droopy eyelid, known as ptosis
• eye paralysis
• other types of vision changes
• severe headache pain

A migraine occurs when cells in the brain become overly sensitive to stimulation. This type of migraine may start with an allergic reaction, or it may begin with inflammation of the blood vessels around the eye. Factors that may trigger a migraine are as follows:

• alcohol
• certain foods, including chocolate and some cheeses
• change in hormone levels
• fatigue
• food additives
• foods containing tyramine, such as red wine and organ meats
• light or noise
• too much or too little sleep
• weather changes

A person can lower the risk for migraine by identifying and avoiding triggers. People who are sensitive to tyramine, for example, should not drink red wine. For certain patients, medicines can be used to prevent migraines and include the following:

• anticonvulsants, such as gabapentin (i.e., Neurontin),carbamazepine (i.e., Tegretol), topiramate (i.e., Topamax) and valproic acid (i.e., Depakote, Depakene)
• beta-blockers, such as atenolol (i.e., Tenormin) and propranolol (i.e., Inderal, InnoPran)
• calcium channel blockers, such as diltiazem (i.e., Cardizem, Tiazac, Dilacor) and verapamil (i.e., Calan, Covera, Verelan)
• lithium carbonate
• methysergide maleate (i.e., Sansert) and methylergonovine maleate (i.e., Methergine)
• nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (i.e., Advil, Motrin) and naproxen sodium (i.e., Aleve, Anaprox, Naprosyn)
• selective serotonin reuptake inhibitors (SSRIs), including paroxetine ( i.e., Paxil)and fluoxetine HCl (i.e., Prozac)
• tricyclic antidepressants, such as amitriptyline (i.e., Elavil) and nortriptyline (i.e., Pamelor)
• other antidepressants, such as trazodone (i.e., Desyrel) and venlafaxine ( i.e., Effexor)

Diagnosis of ophthalmoplegic migraine begins with a medical history and physical exam. Other eye disorders need to be ruled out before a diagnosis of ophthalmoplegic migraines can be made.

Rarely, a person may have permanent vision problems after ophthalmoplegic migraines.

Ophthalmoplegic migraines are not contagious. They pose no risk to others.

Treatment for acute migraine attacks includes:

• nonsteroidal anti-inflammatory drugs called NSAIDs, such as ibuprofen (i.e., Advil, Motrin) and naproxen (i.e., Aleve, Anaprox, Naprosyn)
• barbiturate combinations, such as butalbital with caffeine and acetaminophen (i.e., Fiorcet)
• ergot alkaloids and derivatives, such as ergotamine (i.e., Ergomar, Cafergot, Bellamine) and dihydroergotamine mesylate as a shot (i.e., DHE 45) or nasal spray (i.e., Migranal)
• isometheptene agents, with combinations of isometheptene (i.e., Midrin, Duradin, Migquin)
• narcotic analgesics, such as codeine and butorphanol (i.e., Stadol)
• pain medicines, such as ibuprofen (Advil®, Motrin®) and acetaminophen (Tylenol®)
• 5-HT-1 agonists (called triptans), such as sumatriptan (i.e., Imitrex as tablets, nasal spray or self-administered injection), zolmitriptan (i.e., Zomig), naratriptan (i.e., Amerge), rizatriptan (i.e., Maxalt), almotriptan (i.e., Axert), frovatriptan (i.e., Frova) or eletriptan (i.e., Relpax)

Alternative and complementary therapies for migraine include:

• acupuncture, a therapy used to relieve pain by putting thin needles into certain parts of the body
• aromatherapy, which uses oils to stimulate pleasant sensations and relieve stress
• biofeedback, a process in which a person is taught how to relax when the body starts to show the signs of a headache
• chiropractic, which involves manipulation of the spinal bones
• cognitive-behavioral therapy, which helps a person change perceptions and behaviors related to the headache
• exercise
• herbal remedies
• hypnosis, which uses suggestion to affect the person's subconscious
• relaxation training, which reduces stress and eases emotional strain
• stress management
• transcutaneous electrical nerve stimulation, or TENS, which relieves pain by stimulating nerves

Medicines used to treat migraine may cause drowsiness, allergic reactions, or rebound headache. Rebound headaches are caused by regular use of pain medicines.

After treatment, the first symptoms of ophthalmoplegic migraine may subside. People sometimes report feeling tired after coping with migraine symptoms.

Ophthalmoplegic migraines are monitored with ongoing vision tests. These are used to rule out any other type of eye disease. Any new or worsening symptoms should be reported to the healthcare professional.