Facial Pain With Recurrent Facial Palsy

Recurrent Facial Palsy in Migraine: Mechanistic Considerations

“…The site of lesion of the facial palsy in this case 1 is clearly infranuclear. Also, normal magnetic resonance angiography in this patient 1 practically excludes a primary brain stem ischemic etiology. The ischemic mononeuropathy hypothesis 8,9 faces three principal objections: (1) rarity of OM; (2) occurrence of recurrent ischemic damage to the same cranial nerve(s) in the absence of critical flow‐limiting obstructive vascular lesion(s); and (3) therapeutic responses to corticosteroids in some cases 9 .…”

“…Possible mechanisms of cranial nerve involvement in migraine include the ischemic or the compressive hypothesis 8,9 . The site of lesion of the facial palsy in this case 1 is clearly infranuclear. Also, normal magnetic resonance angiography in this patient 1 practically excludes a primary brain stem ischemic etiology.…”

“…Zachariah and Patel present a case of recurrent facial palsy closely linked to migraine attacks 1 . Except for the incidental vascular anomaly, magnetic resonance imaging (MRI) was found normal, although contrast enhancement was not used 1 .…”

“…Zachariah and Patel present a case of recurrent facial palsy closely linked to migraine attacks 1 . Except for the incidental vascular anomaly, magnetic resonance imaging (MRI) was found normal, although contrast enhancement was not used 1 . Swelling and contrast enhancement of the affected nerve that resolves spontaneously or after steroid treatment has been reported on MRI in most but not all patients with ophthalmoplegic migraine (OM) 2–6 .…”

“…Striking clinical features of cranial nerve involvement in migraine include: (1) rarity of the complication, strongly indicating that an aberrant neurological phenomenon underlies nerve damage; (2) association of cranial nerve involvement with predominantly ipsilateral 1,3,5,8,9 headache, favoring a peripheral site of damage; (3) association of severe and unusually prolonged headache, often lasting for a week or more; 5,8,9,15 and (4) the propensity for recurrences of nerve palsy affecting the same cranial nerves 1,9,16 . In effect, antidromic inflammation in the efferent limb of migraine 14 can be expected to be of exaggerated or maximal intensity and duration in migraine complicated by cranial nerve involvement.…”