1
|
Takkar A, Kumar KVA, Katoch D, Singh P, Minz R, Anand S, Kathirvel S, Ravishankar K, Lal V, Caplan LR. Serum Calcitonin Gene-Related Peptide Is Elevated in Patients With Migraine and Ophthalmoplegia. J Neuroophthalmol 2023; 43:399-405. [PMID: 36255114 DOI: 10.1097/wno.0000000000001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is ongoing debate about whether the oculomotor (III), trochlear (IV), or abducens (VI) nerve paresis in patients with migraine is directly attributable to migraine (ophthalmoplegic migraine [OM]) or is due to an inflammatory neuropathy (recurrent painful ophthalmoplegic neuropathy [RPON]). As migraine is associated with elevated serum calcitonin gene-related peptide (CGRP) levels, we studied serum CGRP levels among patients with OM/RPON to determine whether they are elevated during and between attacks. This is the first study assessing CGRP levels in the serum of patients with OM/RPON. METHODS The aim of this case-control study was to assess serum CGRP levels in patients with ophthalmoplegia and a headache consistent with migraine according to ICHD-3 criteria. Serum CGRP levels were measured during the ictal and interictal phases in 15 patients with OM/RPON and compared with age-matched and sex-matched controls without migraine (12 patients). RESULTS The median serum CGRP levels were significantly elevated ( P = 0.021) during the ictal phase (37.2 [36.4, 43.6] ng/L) compared with controls (32.5 [30.1, 37.3] ng/L). Serum CGRP levels during the attack correlated with the total duration of ophthalmoplegia. A CGRP level of 35.5 ng/L in the ictal phase of the attack had a sensitivity of 86.7% and specificity of 75.0% in diagnosing a patient with OM/RPON. CONCLUSIONS Elevated serum CGRP levels during the ictal phase of OM/RPON favor migraine as the underlying cause of episodic headache with ophthalmoplegia.
Collapse
Affiliation(s)
- Aastha Takkar
- Departments of Neurology (AT, VL), Internal Medicine (KVAK), Ophthalmology (DK), Radiodiagnosis (PS), Immunopathology (RM, SA), and Community Medicine and School of Public Health (SK), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India ; The Headache and Migraine Clinics (KR), Jaslok and Lilavati Hospitals, Mumbai, India; and Beth Israel Deaconess Medical Center (LC) (LRC), and Department of Neurology (LC), Harvard University, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Furia A, Liguori R, Donadio V. Recurrent Painful Ophthalmoplegic Neuropathy: A case report with atypical features and a review of the literature. Cephalalgia 2023; 43:3331024221133386. [PMID: 36694449 DOI: 10.1177/03331024221133386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Recurrent Painful Ophthalmoplegic Neuropathy, previously known as Ophthalmoplegic Migraine, is a poorly characterized disorder mainly because there are few cases described. We report a new case of Recurrent Painful Ophthalmoplegic Neuropathy and a review of the literature to contribute to increasing the knowledge of the clinical features of this disorder. CASE REPORT AND REVIEW OF LITERATURE A 45-year-old woman presented with adult-onset recurrent attacks of abducens and oculomotor palsy associated with diplopia followed by headache. Most notably, pain always presented many days after oculomotor impairment, a feature never described in the literature. A diagnosis of possible Recurrent Painful Ophthalmoplegic Neuropathy was made after excluding other possible mimicking disorders. Symptoms usually resolved gradually with corticosteroid therapy, albeit without a clear-cut benefit.Clinical data collected from 1989 to 2022 showed that adult onset in Recurrent Painful Ophthalmoplegic Neuropathy is not uncommon. While III cranial nerve palsy is typical, VI and IV nerve palsy have also been described. PATHOPHYSIOLOGY AND DIAGNOSIS Several hypotheses have been proposed, including nerve compression, ischemia or inflammation/demyelination, but none has been completely accepted.Diagnosis remains of exclusion; magnetic resonance imaging and blood exams are key in differential diagnosis. CONCLUSIONS Our case gives us the possibility to expand the clinical features of Recurrent Painful Ophthalmoplegic Neuropathy, also contributing to updating the pathophysiological hypotheses.
Collapse
Affiliation(s)
- Alessandro Furia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Italia
| | - Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| |
Collapse
|
3
|
Recurrent alternating ophthalmoplegia with ipsilateral headache: unusual but possible manifestation of recurrent painful ophthalmoplegic neuropathy. Neurol Sci 2020; 41:3357-3360. [DOI: 10.1007/s10072-020-04502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
|
4
|
Liu Y, Wang M, Bian X, Qiu E, Han X, Dong Z, Yu S. Proposed modified diagnostic criteria for recurrent painful ophthalmoplegic neuropathy: Five case reports and literature review. Cephalalgia 2020; 40:1657-1670. [PMID: 32722935 DOI: 10.1177/0333102420944872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Recurrent painful ophthalmoplegic neuropathy (RPON) is an uncommon disorder characterized by recurrent unilateral headache attacks associated with ipsilateral ophthalmoplegia. We intend to study the clinical picture in our case series along with the published literature to discuss the pathogenesis and propose modified diagnostic criteria for recurrent painful ophthalmoplegic neuropathy. Methods We reported five cases diagnosed as ophthalmoplegic migraine/RPON in our medical centers and reviewed the published literature related to RPON from the Pubmed database between 2000 and 2020. In one of these cases, a multiplanar reformation was performed to look at the aberrant cranial nerve. Results The mean onset age for RPON was 22.1 years, and the oculomotor nerve was the most commonly involved cranial nerve (53.9%) in 165 reviewed patients. In most patients, ophthalmoplegia started within 1 week of the headache attack (95.7%, 67/70). Additionally, 27.6% (40/145) of patients presented enhancement of the involved nerve(s) from MRI tests. Finally, 78 patients received corticosteroids, out of which 96.2% benefited from them. Conclusion This is the first time multiplanar reformation has been performed to reveal the distortion of the oculomotor nerve. Modified diagnostic criteria are proposed. We hope to expand the current knowledge and increase the detection of recurrent painful ophthalmoplegic neuropathy in the future.
Collapse
Affiliation(s)
- Yinglu Liu
- Medical School of Chinese PLA and Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Miao Wang
- Geriatric Neurological Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiangbing Bian
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Enchao Qiu
- Department of Neurology, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xun Han
- Medical School of Chinese PLA and Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhao Dong
- Medical School of Chinese PLA and Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Shengyuan Yu
- Medical School of Chinese PLA and Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|
5
|
Treatment of Recurrent Painful Ophthalmoplegic Neuropathy: A Case Where Pregabalin Was Successfully Employed. Case Rep Neurol Med 2019; 2019:9185603. [PMID: 30881712 PMCID: PMC6383397 DOI: 10.1155/2019/9185603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/27/2019] [Indexed: 01/03/2023] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy, previously known as ophthalmoplegic migraine, is a rare condition that affects children and young adults. Its cause and classification are still controversial and, consequently, there are no published treatment guidelines or consensus. Glucocorticoids seem to be beneficial for some patients, but there is no established treatment when failure of this therapy occurs. The aim of this study was to report a case where pregabalin was successfully used after failure of glucocorticoid therapy in a patient with recurrent painful ophthalmoplegic neuropathy.
Collapse
|
6
|
Relapsing Painful Ophthalmoplegic Neuropathy: No longer a “Migraine,” but Still a Headache. Curr Pain Headache Rep 2018; 22:50. [DOI: 10.1007/s11916-018-0705-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
7
|
Kobayashi Y, Kondo Y, Uchibori K, Tsuyuzaki J. Recurrent Painful Ophthalmoplegic Neuropathy with Residual Mydriasis in an Adult: Should it Be Classified as Ophthalmoplegic Migraine? Intern Med 2017; 56:2769-2772. [PMID: 28924127 PMCID: PMC5675941 DOI: 10.2169/internalmedicine.8842-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy (RPON) is a rare condition that manifests as headache and ophthalmoplegia. It typically occurs in children. Although migraine or neuropathy have been suggested as etiologies, the precise etiology remains unclear. In the International Classification of Headache Disorders 3rd edition-beta version (ICHD3β) (code 13.9), RPON was categorized into painful cranial neuropathies and other facial pains. We encountered a 48-year-old woman who had diplopia and right ptosis. The administration of prednisolone led to the immediate improvement of her oculomotor palsy, but residual mydriasis remained. Based on this case, the pathophysiology of RPON may involve temporary nerve inflammation with migraine. Repeated and severe migraine attacks may cause irreversible nerve damage. Thus, medication for migraine prophylaxis might be needed to prevent RPON.
Collapse
|
8
|
Wang L, Pan JF, Lu YY, Hu LH, Lu YN, Pan QQ, Wang Y. A recurrent headache circumscribed in a coronal line-shaped area around the head: a coronal linear headache. SPRINGERPLUS 2016; 5:315. [PMID: 27066346 PMCID: PMC4786508 DOI: 10.1186/s40064-016-1786-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/12/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Linear headache (LH) has recently been described as a paroxysmal or continuous head pain restricted in a linear trajectory of 5-10 mm in width, linking one endpoint in occipital or occipitocervical region with another endpoint in ipsilateral nasion or forehead region. The sagittal line-shaped pain area of LH is close and parallel to a sagittal venous sinus, the superior sagittal sinus (SSS). For some patients, the LH had some features resembling the pattern of migraine without aura. CASE DESCRIPTION A 45 year-old woman complained with a distinct headache for more than half years. The pain trajectory of the headache is confined to a coronal line-shaped area of 5-10 mm in width linking the two points in the bilateral temporal regions with the occipital protuberance. This coronal line-shaped pain area is close and parallel to a coronal cambered venous sinus complex, the combination of the confluences of sinus and the bilateral cavernous sinus (CS), superior petrosal sinus (SPS) linking the CS with transverse sinus (TS) and TS into which the SPS feeds. The patient had a past history of migraine without aura for 10 years and her son had a benign paroxysmal vertigo (BPV) for 12 years. Both of her coronal line-shaped headache and her son's vertigo had well response to sodium valproate. DISCUSSION AND EVALUATION Its clinical characteristics were distinctly different from those of other two headache entities defined with topographical criteria, nummular headache and epicrania fugax, and different from other existing headache entities except for migraine without aura. CONCLUSION The distinct coronal line-shaped headache is suggestive of a variant of LH, a coronal LH, and probably belongs to a subtype of migraine without aura as proposed for LH. This coronal LH reinforces the proposal of LH as a new headache syndrome or a subtype of a previously known headache syndrome, probably of migraine.
Collapse
Affiliation(s)
- Lei Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Jie-Feng Pan
- Department of Cardiology, The Second Division Korla Hospital of Xinjiang Production and Construction Corps, Jiaotong Road, Korla, 841000 Xinjiang China
| | - Yun-Yun Lu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Liang-Hui Hu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Ya-Nan Lu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Qing-Qing Pan
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Yu Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China ; Department of Neurology, The Second Division Korla Hospital of Xinjiang Production and Construction Corps, Jiaotong Road, Korla, 841000 Xinjiang China
| |
Collapse
|
9
|
Lu YN, Pan QQ, Pan JF, Wang L, Lu YY, Hu LH, Wang Y. Linear headache: clinical characteristics of eight new cases. SPRINGERPLUS 2016; 5:347. [PMID: 27057481 PMCID: PMC4799045 DOI: 10.1186/s40064-016-1991-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/10/2016] [Indexed: 01/03/2023]
Abstract
Background Linear headache (LH) has recently been described as a paroxysmal or continuous fixed head pain restricted in a linear trajectory of 5–10 mm in width, linking one endpoint in occipital or occipitocervical region with another endpoint in ipsilateral nasion or forehead region. For some patients, this headache had some features resembling migraine without aura. Methods We made a prospective search of patients presenting with a clinical picture comprised under the heading of LH and we have accessed eight new cases. A detailed clinical feature of the headache was obtained in all cases to differentiate with cranial neuralgia, paroxysmal hemicrania, cervicogenic headache, nummular headache and migraine. Results The eight LH patients complained of a recurrent moderate to severe, distending, pulsating, or pressure-like pain within a strictly unilateral line-shaped area. The headache duration would be ranged from 1 h to 2 days or persistent for 1–6 months with recurrent worsening of headaches. For some patients, this headache had couple of features similar to that of migraine pattern, such as accompaniments of nausea, vomiting, and phonophobia, diziness, triggering factors of noise, bright night, resting after physical activity, fatigue, menstruation, and response to anti-migraine therapy. Conclusions This description reinforces the proposal of LH as a new headache syndrome or a new variant of a previously known headache syndrome, probably of migraine.
Collapse
Affiliation(s)
- Ya-Nan Lu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Qing-Qing Pan
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Jie-Feng Pan
- Department of Cardiology, the Second Division Korla Hospital of Xinjiang Production and Construction Corps, Jiaotong Road, Korla, 841000 Xinjiang China
| | - Lei Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Yun-Yun Lu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Liang-Hui Hu
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China
| | - Yu Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China.,Department of Neurology, the Second Division Korla Hospital of Xinjiang Production and Construction Corps, Jiaotong Road, Korla, 841000 Xinjiang China
| |
Collapse
|
10
|
Abstract
Ophthalmoplegic migraine (OM)/recurrent painful ophthalmoplegic neuropathy (RPON) is a rare disease consisting of recurrent unilateral headache accompanied or followed by ipsilateral ophthalmoplegia. Because MRI findings suggest neuropathy and the relationship to typical migraine remains unclear, the disease has been renamed from "ophthalmoplegic migraine" to "recurrent painful oculomotor neuropathy" in the third edition of the International Classification of Headache Disorders (ICHD). However, it remains a fact that most cases of OM/RPON described in the literature have a history of migraine and that the headache during OM/RPON often has migrainous features. A more detailed clinical description of the headache during OM/RPON and additional results from imaging and possibly histology will be needed to better understand the pathophysiology of the disease and its relationship to typical migraine.
Collapse
|
11
|
Wang Y, Pan QQ, Lu YN, Tian MM, Wang XH. Linear interictal pain in epicrania fugax: a reply. J Headache Pain 2015; 16:23. [PMID: 25902847 PMCID: PMC4385277 DOI: 10.1186/s10194-015-0506-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 02/26/2015] [Indexed: 11/10/2022] Open
Abstract
This is a reply to the comments on our article "Linear headache: a recurrent unilateral head pain circumscribed in a line-shaped area" published in JHP 2014 Jun 26; 15:45. In the comments, the authors raise a question whether the linear headache (LH) we reported be a linear interictal pain in epicranial fugax (EF), based on a case they reported. We think that the LH is not a linear interictal pain in EF based on our observations and considerations.
Collapse
Affiliation(s)
- Yu Wang
- Department of Neurology, Epilepsy and Headache Group, the First Hospital of Anhui Medical University, Jixi Road 218, 230022, Hefei, China.
| | - Qing-Qing Pan
- Department of Neurology, Epilepsy and Headache Group, the First Hospital of Anhui Medical University, Jixi Road 218, 230022, Hefei, China.
| | - Ya-Nan Lu
- Department of Neurology, Epilepsy and Headache Group, the First Hospital of Anhui Medical University, Jixi Road 218, 230022, Hefei, China.
| | - Miao-Miao Tian
- Department of Neurology, Epilepsy and Headache Group, the First Hospital of Anhui Medical University, Jixi Road 218, 230022, Hefei, China.
| | - Xian-Hong Wang
- Department of Neurology, Epilepsy and Headache Group, the First Hospital of Anhui Medical University, Jixi Road 218, 230022, Hefei, China.
| |
Collapse
|
12
|
Wang Y, Tian MM, Wang XH, Zhu XQ, Liu Y, Lu YN, Pan QQ. Linear headache: a recurrent unilateral head pain circumscribed in a line-shaped area. J Headache Pain 2014; 15:45. [PMID: 24966056 PMCID: PMC4078094 DOI: 10.1186/1129-2377-15-45] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/13/2014] [Indexed: 01/10/2023] Open
Abstract
Background A headache circumscribed in a line-shaped area but not confined to the territory of one particular nerve had ever been described in Epicrania Fugax (EF) of which the head pain is moving and ultrashort. In a 25-month period from Feb 2012 to Mar 2014, we encountered 12 patients with a paroxysmal motionless head pain restricted in a linear trajectory. The head pain trajectory was similar to that of EF, but its all other features obviously different from those of EF. We named this distinctive but undescribed type of headache linear headache (LH). Methods A detailed clinical feature of the headache was obtained in all cases to differentiate with EF, trigeminal autonomic cephalalgias (TACs) and cranial neuralgia. Similarities and differences in clinical features were compared between LH and migraine. Results The twelve LH patients (mean age 43.9 ± 12.2) complained of a recurrent, moderate to severe, distending (n = 9), pressure-like (n = 3) or pulsating (n = 3) pain within a strictly unilateral line-shaped area. The painful line is distributed from occipital or occipitocervical region to the ipsilateral eye (n = 5), forehead (n = 6) or parietal region (n = 1). The pain line has a trajecory similar to that of EF but no characteristics of moving. The headache duration would be ranged from five minutes to three days, but usually from half day to one day in most cases (n = 8). Six patients had the accompaniment of nausea with or without vomiting, and two patients had the accompaniment of ipsilateral dizziness. The attacks could be either spontaneous (n = 10) or triggered by noise, depression and resting after physical activity (n = 1), or by stress and staying up late (n = 1). The frequency of attacks was variable. The patients had well response to flunarizine, sodium valproate and amitriptyline but not to carbamazepine or oxcarbazepine. LH is different from EF, trigeminal autonomic cephalalgias (TACs) and cranial neuralgia, but it had couple of features similar to that of migraine. Conclusions The clinical picture of LH might be a subtype of migraine, or represent a novel syndrome.
Collapse
Affiliation(s)
- Yu Wang
- Department of Neurology, Epilepsy and Headache group, The First Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China.
| | | | | | | | | | | | | |
Collapse
|