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OPHTHALMOPLEGIC MIGRAINE (RECLASSIFIED): WHAT IT REALLY IS

What was once called “ophthalmoplegic migraine” is now recognised as a rare condition called recurrent painful ophthalmoplegic neuropathy. While it can look like a migraine, this is actually a nerve disorder not a true migraine at all.

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It mostly affects children and young adults, and typically starts with a headache on one side. That’s followed by issues with eye movement, drooping of the eyelid (ptosis), and sometimes a dilated pupil - all on the same side as the headache. The symptoms are due to temporary weakness or inflammation of the third cranial nerve, which controls most eye movements.

WHAT WE KNOW ABOUT THE CONDITION

  • It usually starts in early childhood, and episodes may come and go over several years.

  • Symptoms often resolve gradually, but in some cases, the nerve damage can become permanent.

  • Imaging like MRI often shows inflammation (enhancement) of the affected cranial nerve during an episode.

  • It’s no longer considered a form of migraine, but rather a type of cranial neuropathy possibly linked to inflammation or compression.

CONDITIONS TO RULE OUT

Several other disorders can look similar and should be excluded before diagnosis:

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  • Brain aneurysms

  • Tumours near the nerve

  • Myasthenia gravis

  • Tolosa-Hunt syndrome

  • Sinus or orbital infections

 

This is why proper imaging and a full neurological workup are so important.

HOW IT’S TREATED

There’s no single treatment that works for everyone. Some people respond to:

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  • Steroids to reduce inflammation

  • Calcium channel blockers in certain cases

 

Others may simply need careful monitoring, especially if episodes are infrequent and resolve on their own.

CLINICAL INSIGHT

Many cases once labelled as “complicated migraine” are now understood to be nerve disorders, not vascular or cortical ones. The shift in classification has helped avoid confusion and ensures people get the right diagnostic tests, not just migraine medications.

MIGRAINE AS A NEUROVASCULAR CONDITION

Migraine isn’t just about pain. It’s a complex brain-body interaction influenced by genetics, neurotransmitters, hormones, and even food. Understanding these pathways can help patients and healthcare providers choose more targeted, effective treatments.

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