Oftalmoplegichesky migraine — the repeating paroksizmalny tsefalgiya of migrenozny character which is followed by passing paresis of one or several nerves of glazodvigatelny group without signs of their intrakranialny defeat. Oftalmoplegichesky migraine differs in the big duration of a headache and even more long preservation of glazodvigatelny dysfunction (squint, doubling of sight, a ptoz, a midriaz). Diagnostics provides carrying out MRT of a brain with contrasting, an angiography or the MR-angiography. In treatment use triptana, nonsteroid anti-inflammatory, ergot medicines, antidepressants, b-blockers, antikonvulsant, glucocorticoids. In an individual order to the patient select medicines for knocking over of the migrenozny attack and means for its prevention.
Oftalmoplegichesky migraine is one of forms of associative migraine. The last is characterized by emergence at the beginning or at height of the migrenozny attack of the tranzitorny neurologic deficiency which is usually observed some time after the termination of a tsefalgiya. Treat other forms of associative migraine: afatichesky, gemiplegichesky, cerebellar, disfrenichesky, vestibular, bazilyarny.
Oftalmoplegichesky migraine meets rather seldom. Certain experts in the field of neurology suggest not to carry an oftalmoplegichesky form to migraine as typical for it the tsefalgiya proceeds more than 1 week, and the oftalmoplegiya arises later a certain latent period, usually for 1-4 day of an attack. Such approach the identification fact in certain cases speaks well for oftalmoplegichesky migraine on MRT with contrasting of accumulation of contrast in a tsisternalny part of a glazodvigatelny nerve that demonstrates existence in it of demiyeliniziruyushchy process.
Today exact genesis of both a migrenepodobny headache, and tranzitorny glazodvigatelny violations by which oftalmoplegichesky migraine is followed is not established. Carry the following periodically developing states to alleged causes of passing glazodvigatelny frustration: a spasm or puffiness of the artery providing blood supply of a glazodvigatelny nerve; expansion of a kavernozny sine; puffiness and/or expansion of an internal carotid.
It is known that the triggers causing hyper stimulation of sense organs (noise, a sharp sound, bright light or blinking, an unpleasant smell) and also a mental overstrain, a sleep debt, irritation can provoke the migrenozny attack. It is necessary to notice that for the specified causal factors direct dependence of their influence on subjective perception of the person is traced. Quieter and benevolent relation to current situation allows to avoid the increased sensitive and mental reaction which can be transformed to a migrenozny attack.
Symptoms of oftalmoplegichesky migraine
The basis of attacks which characterize oftalmoplegichesky migraine is made by a typical migrenepodobny tsefalgiya — the headache of the pressing or pulsing type extending to a half of the head. Its feature at an oftalmoplegichesky form of migraine is long, within 7 and more days, the current. At the beginning of the migrenozny attack, and it is more often delayed — for 1-4 day of an attack — there are ipsilateralny, i.e. localized on the party tsefalgiya, disorders of the movements of an eyeball and arising owing to their diplopiya (sight doubling).
Symptoms of dysfunction of a glazodvigatelny nerve (the III pair of craniocereberal nerves) are generally observed. Treat them: omission of an upper eyelid, the dispersing squint, (expansion of a pupil), a diplopiya. Less often oftalmoplegichesky migraine meets symptoms of damage of a block nerve (the IV couple of ChMN) or the taking-away nerve (the V couple of ChMN). In the first case doubling of the image at the direction of a look is noted down and the meeting squint, in the second — a diplopiya and the meeting squint. In some cases oftalmoplegichesky migraine can be followed by the combined dysfunction of several specified nerves.
The glazodvigatelny frustration mentioned above have exclusively tranzitorny character. They can remain for the period up to several months after the termination of a paroxysm of a tsefalgiya, but finally are completely leveled from 100% by restoration of the functions broken earlier. Similar long preservation of glazodvigatelny dysfunction does necessary a careful differentiation of an oftalmoplegichesky form of migraine from organic cerebral pathology and, first of all, from vascular disorders.
Diagnosis of oftalmoplegichesky migraine
The combination of a migrenozny headache to an oftalmoplegiya demands the alerted diagnostic approach. Perhaps the disease represents not oftalmoplegichesky migraine, but a tsefalgiya combination to a recidivous glazodvigatelny neuropathy which cornerstone many pathological processes can be (an inflammation, an intracerebral tumor, aneurism of cerebral vessels, small hemorrhage, an arteriovenozny malformation of a villiziyev of a circle).
Precisely helps to otdifferentsirovat the specified pathological states brain MRT with additional contrasting. KT of a brain has no diagnostic value as does not visualize a small hematoma, aneurism or vascular anomaly. In diagnostics of vascular malformation the angiography of cerebral vessels is most informative. Lately it is replaced with safer tomographic analog — the MR-angiography.
Oftalmoplegichesky migraine is diagnosed by the neurologist in the presence of 2 and more paroxysms of a migrenepodobny tsefalgiya with the paresis of several or one ChMN from glazodvigatelny group arising during from 1 to 4 days of an attack on condition of an exception of pathological processes of a back cranial pole, the top orbital crack and parasellyarny area.
Treatment and forecast
Treatment of any form of migraine includes knocking over of attacks and their prevention. As oftalmoplegichesky migraine is characterized by the big duration of attacks, in treatment usually apply agonists of serotoninovy 5HT1-receptors — triptana (, , , , etc.). They not only reduce intensity of a tsefalgiya, but also stop such symptoms as phono - and photophobia, nausea. Oftalmoplegichesky migraine proceeds without aura therefore patients have no opportunity to prevent an attack acceptance of medicine. However, the medicine is accepted earlier, the its efficiency will be bigger. If necessary repeated reception of a tablet is possible.
Act as contraindications to reception of triptan: high arterial hypertension, IBS, pregnancy, atherosclerosis of vessels of the lower extremities, sepsis, HPN, a liver failure, age is more senior than 65 years. At existence of contraindications instead of triptan purpose of medicines of an ergot (ergotamine, dihydroergotamine) or nonsteroid anti-inflammatory is possible (a naproksena, diclofenac). Preservation of glazodvigatelny dysfunction after the termination of a tsefalgiya is the indication to purpose of glucocorticoids. As a rule, apply Prednisolonum in a daily dose of 40 mg, then gradually reduce a dosage.
Medicamentous prevention of repeated attacks is performed by individual selection of one or several medicines from the following groups: blockers of calcic channels, b-blockers, nonsteroid anti-inflammatory, antidepressants (, , ), antikonvulsant (valproata, carbamazepine, ). Besides, normalization of the mode of a dream and wakefulness, decrease in psychoemotional loading, avoiding of the stressful moments, revision of the relation to various life situations has important value.
Ophthalmologic migraine, as well as other forms of migraine, often badly gives in to the carried-out therapy. Success of treatment, and, therefore, and the forecast, in many respects depend on efforts of the patient, his ability to change own attitude towards people and situations on more benevolent and quiet. In most cases oftalmoplegichesky migraine begins to alternate with migraine attacks with aura over time or is completely transformed to classical migraine.