What is ophthalmoplegic migraine?

Ophthalmoplegic migraine resolves on its own or causes no complications in most cases. However, it should not be neglected.

Last update: 16 October, 2022

Ophthalmoplegic migraine is a rare condition characterized by presence of a strong pain in one of the eyes. It is listed as a eye headachethat is, a headache caused by some problem in the eyes.

The truth is that it is not always accompanied by migraine pain. If this appears, she is felt only on one side of the skull and before the central episode.

Ophthalmoplegic migraine is also known as ophthalmic migraine, retinal either silent. However, several experts think that it should not be called a “migraine”, since in the strict sense it is not. The more accurate name for this condition is “recurrent painful ophthalmoplegic neuropathy.”

What is ophthalmoplegic migraine?

Ophthalmoplegic migraine is a rare disease. According to expert estimates, it affects around 0.7 people per million inhabitants in a year.

It is classified as a cranial neuralgia.

Doctors define it as the presence of at least 2 episodes in which there is pain on one side of the head, accompanied by paralysis one or more of the 3 oculomotor nerves. However, over time it has been discovered that not all affected people have migraine-type headaches.

This pathology is not easy to diagnose, since ophthalmoplegic migraine has symptoms similar to those of other conditions, such as cerebral aneurysms, myasthenia gravisthird cranial nerve schwannoma, pituitary apoplexy, Tolosa-Hunt syndrome, and idiopathic or ischemic cranial palsy.

The first manifestations appear during childhood or early adulthood. It is a chronic but cyclical condition. A person can go years without episodes and then have several in a row. Does not leave sequels.


Ophthalmoplegic migraine symptoms can vary greatly from person to person. It is common for there to be pain on one side of the head, which lasts up to 1 week or even 14 days.

Some people experience vision disturbances before the pain. This lasts between 20 and 30 minutes.

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

  • Blurry vision.
  • Eye pain.
  • Nausea and vomiting.
  • Diplopia or double vision.
  • Loss of vision in only one eye.
  • Unusual sensitivity to light or sound.
  • Weakness in the eye muscles. It appears immediately or up to 2 weeks after the onset of the headache. It lasts between two weeks and three months. It is caused by damage to the eye nerves.
  • Sparkling scotomas. They affect one or both eyes. They are small blind spots that appear in the central vision. They are sometimes accompanied by bright, flashing lights or zigzag lines of light.
Pain in one of the eyes is not always a migraine. Tiredness and pathologies of the eyeball also influence.

Causes of ophthalmoplegic migraine

Science has not established the exact cause of ophthalmoplegic migraine. Currently, it is not considered a migraine as such, but a nervous condition.

The ambiguity of the name reflects the confusion surrounding its true nature.

On some occasions, ophthalmoplegic migraine has been associated with diseases such as lupus, sickle cell anemia, epilepsy or depression. However, the most 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 reduced blood flow in specific brain regions.
  • Neuritis or demyelinating neuropathy: is a condition in which there is damage to the coverings of nerve fibers, resulting in abnormal nerve impulses.

People with a family history of migraine are more likely to develop ophthalmoplegic migraine. Also men and children under 10 years of age. There are factors that can intensify the symptoms, such as hormonal changes, stress, diet, change in weather or lack of sleep.


The usual thing is that the diagnosis of ophthalmoplegic migraine is made by ruling out. That is, a series of assessments and tests for other pathologies are carried out, before specifying that it is a recurrent painful ophthalmoplegic neuropathy.

The most frequently requested tests are the following:

  • Eye exams.
  • neurological reflexes.
  • Computed tomography (CAT).
  • Nuclear magnetic resonance (NMR).
  • Blood and cerebrospinal fluid tests.


If the episodes of ophthalmoplegic migraine are mild and sporadic, no treatment is carried out. In those cases, the usual thing is that it is only recommended to adopt some lifestyle patterns, such as the following:

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

As ophthalmoplegic migraine can appear suddenly, it is best to stay still until the symptoms subside. If the condition is very severe or worsens over time, drug treatment is usually indicated:

  • Corticosteroids: they are anti-inflammatories that allow the management of symptoms in some people, although they are not always effective.
  • Botulinum toxin: It is the famous Botox, which in this case can help reduce symptoms, but has no significant long-term effects.
  • Pregabalin: It is a drug used for muscle and nerve pain. It seems to be one of the most effective for treating cases of ophthalmoplegic migraine.
Botulinum toxin is one of the last-line treatments to treat refractory migraines.

Can it be prevented?

Many times, ophthalmoplegic migraine resolves on its own, but it can also get worse. In that case, there is a risk of mydriasis or persistent dilation of the pupils. Also ptosis, that is, permanent drooping of the upper eyelid.

It is best to choose a healthy lifestyle, as this is often very effective in preventing ophthalmoplegic migraine episodes. In any case, it is always important to be in contact with the doctor and follow his instructions.

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