Understanding Chronic Pain

Neurogenic Inflammation

[From Chapter 16 of Understanding Chronic Pain]

Mac, retired from the insurance business, had a beautiful wife and an outstanding daughter. He also had migraine. Darvon gave him excellent relief, and he used the drug with some frequency, even to help him sleep at night. It was Mac's good fortune to have his disease well under control before the syndrome of analgesic rebound headache entered the diagnostic tables. Had Mac been withdrawn from his occasional use of Darvon, his life would have been, I am sure, much more complicated.

I attended Mac for many years. His migraine was never really an issue, at least until the day he called me to report an unusual event. He had just experienced one of his headaches and was already getting better with Darvon, but something very strange was happening to him. One of his eyelids was drooping, covering the pupil. Mac was able to see out of the eye only by manually lifting the lid.

Paralysis of the eyelid is usually due to damage to the third cranial nerve. It is often a sign of pressure on that nerve, most commonly due to an expanding aneurysm. I directed Mac to the emergency room, and a cerebral arteriogram to outline the brain's blood vessels was performed. There was no aneurysm. Thankful for that, I bedded Mac down for the night to observe the progress of his third nerve palsy. It occasionally occurs, partially or completely, with migraine, certainly a product of some kind of inflammation within the nerve.

The following morning, Mac had progressed to a total paralysis of eye movement. The globe was immobilized within the orbit, unable to move right or left, up or down. Not only was the third nerve gone, but also the fourth and sixth! When the paralyzed lid was lifted, Mac's visual images were doubled, for the two eyes could no longer move in concert. Some time during the following night, Mac experienced a mirror image effect. When he awoke from sleep, the other eye was also paralyzed. When the lids were lifted, Mac could see without diplopia, for both eyes were stuck in the midposition. He recovered in just a few days. Whether it was due to the cortisone I gave him, I am not sure.

You can read the rest in Dr. Cochran's book, Understanding Chronic Pain

Last Updated: Nov 19, 08:32 AM

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Migraine Attention Deficit Disorder