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Migraine secondary to superior oblique myokymia.
No full textSuperior oblique myokymia (SOM) is characterized
by intermittent, small-amplitude, monocular, paroxysmal,
high-frequency oscillations. These oscillations
are mainly torsional in the primary gaze
position and in abduction and evoke oscillopsia
during paroxysms (1). The term SOM was first used
by Hoyt and Keane in 1970 (2), but the first case
recognizable as SOM was described by Duane in
1906 (3). The pathophysiology of this condition is
not clear. Often the patients are otherwise healthy,
but sometimes vascular compression of cranial
nerve IV may be responsible (4, 5), and rarely it is
associated with other neurological diseases, such as
adrenoleukodystrophy (6), retinitis pigmentosa,
astrocytoma, multiple sclerosis and cerebellar
tumour (7). The disorder may have spontaneous
remissions, which can last for days or up to years,
and relapses (1). There have been several reports
that anticonvulsants, especially carbamazepine,
have a therapeutic effect (8, 9). In recent years,
gabapentin has also been reported to be effective
(10, 11). When medication is unsuccessful, surgery,
involving tenotomy or a tenectomy of the superior
oblique muscle, combined with inferior oblique
myectomy may be performed (1). Recently, surgical
decompression of cranial nerve IV has been found
to be beneficial when vascular compression is con-
firmed on magnetic resonance imaging (MRI), but
there is the danger of superior oblique palsy (4).
The choice of treatment is related to the intensity
and duration of the visual symptoms and to the
degree of disability the disorder may have caused.
Pareja et al. (12), in a recent and exhaustive review
of primary trochlear headache and other trochlear
painful disorders, have considered the possible
causes of headache secondary to involvement of the
trochlear region, including superior oblique muscle
myofascial pain, but migraine secondary to SOM
was not reported
Il trattamento farmacologico della cefalea ipnica: revisione della letteratura e di una casistica personale di 41 pazienti
No full textIl trattamento sintomatico dellâ€TMemicrania in un centro cefalee: preferenza dei pazienti per i farmaci impiegati.
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