Recurrent sixth nerve palsy in childhood ophthalmoplegic migraine: A case report

Ophthalmoplegic migraine is a rare disorder characterized by childhood onset recurrent attacks of migraineous headaches with paresis of ocular cranial nerves. The third cranial nerve is commonly involved. Involvement of fourth and sixth cranial nerve is uncommon. We present a child with opthalmoplegic migraine with recurrent sixth cranial nerve palsy on two occasions. Neurology Asia 2013; 18(1) : 95 – 98 Address correspondence to: Dr. Neera Chaudhry, B-142, Sarita Vihar, New Delhi 110076, India. Tel: 9718599307, E mail: [email protected] INTRODUCTION Migraine is second commonest cause of primary headache after tension-type headache. Migraine can begin at any age, but the initial attack most commonly occurs during adolescence, and the peak prevalence being between ages of 25-45 years. Although migraine is common, migraine with ophthalmoplegia is rare, with an incidence of approximately 0.7 per million. Ophthalmoplegic migraine is commonly seen in pediatric age group and majority of patients are <5 years with a female prepordance. The International Classifi cation of Headache Disorders (second edition) (ICHDII, 2004) defi nes ophthalmoplegic migraine as recurrent attacks of headache with migrainous characteristics associated with paresis of one or more ocular cranial nerves in the absence of any demonstrable intracranial lesion, other than MRI changes within the affected nerve. Ophthalmoplegia usually involve third cranial nerve. Involvement of fourth, sixth or multiple cranial nerves is rare and occurs more in adults than in children. Here we describe a case of a 13 year old female who presented with two episodes of migraine with ophthalmoplegia, involving the sixth cranial nerve each time.