Fig. 18. Ophthalmoplegic migraine. This 3-year-old experienced an episode of nausea, vomiting, and headache of several hours' duration. After 12 hours of sleep, child awoke with left ptosis but felt absolutely well. A and B. Examination revealed complete left oculomotor palsy. The pupil was slightly dilated but reactive. C. Five weeks later all deficits had cleared. No diagnostic studies beyond skull x-rays were performed. One year later a second episode occurred exactly duplicating the first. D. A 60-year-old man with history of multiple episodes of left hemicrania in childhood, relieved by onset of left ptosis. At age 18 years, the left oculomotor palsy became fixed following typical attack. Residua include mild ptosis, left exotropia, elevation deficit, and small nonreactive pupil (fixed to all pharmacologic agents except strong mydriatics).