JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2010.51.2.307 jkos-51-307 Original Article Three Cases of Ophthalomplegic Migraine ChoiJeong Hoon MD LeeJu Yeon MD KimYun Jeong MD Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Korea Address reprint requests to Yun Jeong Kim, MD Department of Ophthalmology, Hallym University Sacred Heart Hospital #896 Pyeongchon-dong, Dongan-gu, Anyang 431-796, Korea Tel: 82-31-380-3835, Fax: 82-31-380-3837, E-mail: bonamd@paran.com 09 2010 07 09 2010 51 2 307 311 20072009 09122009 Copyright © 2010 Korean Ophthalmological Society 2010 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

To report three cases of ophthalmoplegic migraine which is a rare condition characterized by the association of headaches with an oculomotor nerve palsy.

 Case summary:

A 44-year-old male and two eight-year-old females were presented with diplopia developed after headaches. All of the three patients showed abnormal eye movement and they had past episodes of transient diplopia with headaches. Visual evoked potential (VEP), cerebrospinal fluid (CSF) examination, laboratory findings, and other neurologic tests were all normal, also there was no tumor or cerebrovascular disease on brain MRA & MRI. The symptoms of all patients improved gradually within several weeks from first the visit, with complete recovery seen in all three.

 Conclusions

Any patient who has a headache with paresis of the extraocular muscle should be considered for ophthalmoplegic migraine. To diagnose ophthalmoplegic migraine, family history, past medical history, associated symptoms and signs, neurologic examinations and neuroimaging tests are needed.

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Photographs of patient 1 during the second attack show right esotropia and lateral gaze limitation.

Six months later photographs of patient 1 show improved ocular movement.

Photographs of patient 2 show left ptosis and upgaze, downgaze and medial gaze limitation.

Six months later photographs of patient 2 show improved ocular movement.

Hess chart of the patient 3 show left abduction limitation corresponding to sixth nerve palsy at the initial visit (A=field of the left eye; B=field of the right eye).