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Extra info for Continuum Hedache 2006
Ultrastructural examination reveals abnormal patches of agranular osmiophilic material within the basal membranes of vascular smooth-muscle cells. Alternatively, a skin biopsy can be diagnostic, although most diagnoses are currently made by genetic testing. Ophthalmoplegic migraine is no longer classified by the IHS as a type of migraine and is now listed under the neuralgias. It characterized by at least two attacks associated with ocular cranial nerve palsy (usually the third cranial nerve with a dilated pupil) and unilateral migrainous eye pain.
Disability is a surrogate marker for disease severity, allowing for the decision as to when to use migraine-specific treatment versus nonspecific treatment in the absence of vascular disease. The evidence for efficacy of nonspecific treatments in migraine is mixed, due to variabilities in study designs, but they can be effective for moderate level migraine with low disability. Most studies for acute treatment with oral opioids have been poorly designed or negative. No randomized controlled trials have shown benefit for butalbital mixtures in the acute treatment of migraine.
Curr Pain Headache Rep 2003;7:224–228. Useful review of this uncommon but important disorder. " Sacks O. Migraine: understanding a common disorder. Berkeley: University of California Press, 1985. Extraordinary descriptions of the phenomenology of migraine. Sack’s unique perspective is both entertaining and challenging. " Selby G, Lance JW. Observation on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiatry 1960;23:23–32. The classic paper describing the symptoms of migraine.