13.7 Headache attributed to ischaemic ocular motor nerve palsy

Description:

Unilateral frontal and/or periorbital pain caused by and associated with other symptoms and/or clinical signs of ischaemic paresis of the ipsilateral IIIrd, IVth and/or VIth cranial nerve(s).

Diagnostic criteria:
  1. Unilateral frontal and/or periorbital headache fulfilling criterion C
  2. Clinical and imaging evidence confirming an ischaemic ocular motor nerve palsy1
  3. Evidence of causation demonstrated by both of the following:
    1. headache is ipsilateral to the motor nerve palsy
    2. headache has developed in temporal relation to the motor nerve palsy
  4. Not better accounted for by another ICHD-3 diagnosis.
Note:

13.7 Headache attributed to ischaemic ocular motor nerve palsy can occur prior to or concurrently with the onset of diplopia.

Comment:

The majority of ocular motor nerve palsies are painful, regardless of the presence or absence of diabetes. Pain is most frequent in patients with IIIrd nerve palsies, less so in those with VIth nerve paresis and least frequent in cases of IVth nerve paresis.