13.6 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 or VIth cranial nerve.

Diagnostic criteria:
A. Unilateral headache fulfilling criterion C
B. Clinical and imaging findings confirming an ischaemic ocular motor nerve palsy
C. Evidence of causation demonstrated by both of the following:

    1. headache has developed in temporal relation to the motor nerve palsy
    2. headache is localized around the ipsilateral brow and eye

D. Not better accounted for by another ICHD-3 diagnosis.

Comments:
The majority of ocular motor nerve palsies are painful, regardless of the presence or absence of diabetes. 13.6 Headache attributed to ischaemic ocular motor nerve palsy can occur prior to or concurrently with the onset of diplopia.

Pain is most frequent in patients with IIIrd nerve palsies, less so in VIth nerve paresis and least frequent in cases of IVth nerve paresis.