Journal of Neurology & Stroke Adult Variant of Ophthalmologic Migraine with Recurrent 6 th Cranial Nerve Palsy in 25yrs Old Ethiopian Patient: Case Report Submit Manuscript | http://medcraveonline.com Presentation of the Case A 25- years- old female patient with a history of migraines like headaches since ten years back, presented to Black lion specialized hospital Neurology Referral clinic with a three week history of the left temporal throbbing type of headache, with associated photophobia, but no associated nausea and vomiting. The patient denies preceding aura. Three days following the headache patient developed double vision and difficulty moving left eye laterally. She visited a different physician for her current condition, but didn’t have improvement where she was finally referred to us. Six years back patient had the same episode of headache associated with double vision, which improved by itself within 4 weeks. Since then she had an episodic unilateral headache 3-4 times annually otherwise she has no dropping of eyelids, decreased vision, extremity weakness or numbness of extremity. She denies having vomiting, loss of consciousness or abnormal body movement. Her mother had the migraine like headache, but not frequently bothering her. The patient never took any anti-migraine and Prophylactic treatment. Examination The patient is comfortable, but complaining of mild left side temporal throbbing type of headache otherwise not in any form of distress. BP was 110/70mmHg, and height of 158cm, weight was 51kg, BMI of 20.4. On extra ocular muscle examination patient had difficulty abducting the left eye (left side abducent palsy), normal occulomotor and trochlear nerves. Normal sized and reactive pupil bilaterally, no ptosis, and the rest of cranial nerves are normal. Fundoscopic examination was unremarkable and there was no exophthalmos. Normal cognitive function deficit, normal motor and sensory function in all extremities. Normal coordination and gait. She has Negative meningeal signs. Laboratory work up Complete blood counts, erythrocyte Sedimentation rate, blood sugar, liver function, renal function were in normal limits. Serology for HIV and VDRL were negative. CSF analysis were non remarkable. MRI of the brain (plain and with contrast) were normal (Figure 1). The patient was put on migraine prophylaxis; Amitriptyline 25mg po nocturnal, after 10 weeks follow up patient diplopia completely resolved and 6 th cranial nerve palsy resolved. Discussion Gubler in 1860 describe the first case; a 19-year-old female with repeated episodes of headache and third nerve palsy, but it was Charcot who use the term ‘‘migraine ophtalmoplegique’’ in 1890 to describe the series of cases with this feature [1-3] Ophthalmoplegic migraine was a rare condition, which commonly Volume 4 Issue 6 - 2016 Department of Neurology, Addis Ababa University, Ethiopia *Corresponding author: Biniyam Alemayehu Ayele, Department of Neurology, Addis Ababa University, Ethiopia, Tel: +2510939934785; Email: Received: May 25, 2016 | Published: June 24, 2016 Case Report J Neurol Stroke 2016, 4(6): 00158 Abstract According to ICHD-3 opthalmoplegic migraine (OM) is classified under Painful Cranial Neuropathies and other Facial Pains and the name is changed from Ophthalmoplegic migraine to Recurrent Painful Ophthalmoplegic Neuropathy (RPON). Frist described by Gubler In 1860, who described a patient who had recurrent episodes of 3 rd Cranial nerve Paresis during otherwise typical migraine attacks. The paresis persisted beyond the headache phase of the attack, as evidence support more than 24hrs. After three decades in 1890, Charcot called this condition “Ophthalmoplegic Migraine”. It’s characterized by repeated attacks of paresis of one or more ocular cranial nerves (commonly the oculomotor Nerve), occasionally cranial IV and VI with ipsilateral headache. Ophthalmoplegic ‘migraine’ incidence was rare in the general population, more happened in children, with incidence of 0.7 per 1,000,000 in general population. Different pathogenesis is postulated currently including, ischemia, compressive and demyelinating causes. Though frequent involvement of 6 th cranial nerve is not common according to previously published articles, we report a 25yrs old female patient who presented with two episode of 6 th cranial nerve palsy preceded by unilateral throbbing type of headache in which the first episode occurs 6yrs back and resolve within 4 weeks, the current left side abducent palsy is preceded by 3 days history of ipsilateral throbbing headache pain, in which patient complexly recovered after 10 weeks treatment of amitriptyline 25mg daily. Keywords: Ophthalmoplegic migraine; Painful cranial neuropathies and other facial pains; Recurrent painful ophthalmoplegic neuropathy