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Ocular Migraine

  • Description

    In opthalmoplegic migraine, lateralized pain (often around the eye) is accompanied by nausea, vomiting, and diplopia (double vision).

    Migraines are also known as vascular headaches. The exact cause of a migraine is unknown, although evidence suggests involvement of the blood vessels of your head. They usually begin in the early morning or during the day with intense, gripping pain on one side of the head that may gradually spread. It reaches the peak of severity in minutes to an hour or two, and lasts for hours to days, unless it treated. It is often terminated by sleep.

    Visual disturbances are common and can include visual hallucinations, such as sparks, light flashes, zigzags of light or visual field defects.

    Opthalmoplegic migraine is rare. It is due to a nerve palsy (weakness). More common causes of painful ophthalmoplegia are internal carotid artery aneurysms and diabetes.


    The biological causes of migraines are unknown, but many precipitating factors have been identified. stress, premenstrual changes, alcohol consumption, hunger, or the use of oral contraceptives can cause migraines in some persons.

    Certain foods may produce attacks; these include red wine, chocolate, aged cheese, milk, chicken livers, meats preserved in nitrates, or foods prepared with monosodium glutamate. Some persons report that exposure to sunlight or exercise can trigger attacks.


    Lateralized pain (often around the eye) is accompanied by nausea, vomiting and diplopia (double vision).

    In rare instances, the neurologic (or somatic) disturbances accompanying typical migrainous headaches become the sole manifestations of an attack (the migraine equivalent).

    Rarely, the patient may be left with a permanent neurologic deficit following a migrainous attack, presumably because of irreversible cerebral ischemic (low blood flow and oxygenation) damage.


    The management of a migraine consists of avoiding any precipitating factors, together with prophylactic or symptomatic pharmacologic treatment, if necessary.

    During acute attacks, many patients find it helpful to rest in a quiet, darkened room until symptoms subside.

    A simple analgesic (e.g., aspirin) taken right away often provides relief, but treatment with extracranial vasoconstrictors or other drugs is sometimes necessary.

    Cafergot, a combination of ergotamine tartrate and caffeine, is often particularly helpful. A drug called ergotamine has been used effectively for acute migraine. Sometimes, an analgesic painkiller is used in combination with it. Ergotamine can bring on headaches and other side effects, such as nausea, vomiting, cramps and tingling sensations. It should be used only a few times a week and not at all during pregnancy or while breastfeeding.

    Sumatriptan is a fast-acting agent that can abort attacks when given subcutaneously (under the skin) by an autoinjection device. It should be avoided in pregnancy.

    If migraine headaches occur more than two or three times a month, prophylactic treatment may be necessary. Medications include aspirin, propranolol or amitriptyline.


    Should an ophthalmologist or a neurologist be consulted?

    What medications can be taken to relieve the pain?

    How long before the pain subsides?

    Should tests be given to determine other conditions that could be related to this condition?

    Are there things that should be avoided, such as certain foods, bright lights, exercise, etc.?

    biofeedback has been shown to be helpful in some persons who suffer from migraine.