Skip to main content

Advertisement

SpringerLink
Log in

Migrainous facial palsy (MFP): the introduction of a new concept of neurovascular conflict and its preliminary clinical evidence

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Background

Facial palsy and migraine have frequently been reported to occur in conjunction. We report a case series and propound a theory to explain the same.

Aims and objectives

To postulate an anatomico-pathophysiological association in the causative factor of lower motor neuron type of facial palsy in cases with migraine without aura.

Materials and methods

Preliminary experiences and observations in 12 cases suffering from facial palsy following an attack of migraine without aura, mainly in the occipital and posterior auricular region, are elaborated.

Results

Facial palsy occurred on the ipsilateral side as the headaches in a majority of the cases (83.33%) and in rare cases of bilateral headaches (16.67%), it lateralised to the side the headaches were more severe. In most of these cases (75%), a complete clinical recovery was noted within 6 months.

Conclusion

We concluded that neurogenic inflammation of the facial nerve trunk caused by its proximity to the dilated posterior auricular/stylomastoid/occipital and superficial temporal arteries during a migraine attack leads to a temporary lower motor neuron type of paresis of the muscles supplied by the facial nerve.

Significance

This pathophysiological understanding of the disease mechanism could open new avenues as to the treatment of this condition. This proposition indicates in clearer light than before, a possible mechanism to explain the higher incidence and risk of facial palsy in migraineurs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

I, the principle author takes full responsibility and have full access to all of the data and the right to publish any and all data, separate and apart from the guidance of any sponsor.

References

  1. Shevel E (2011) The extracranial vascular theory of migraine--a great story confirmed by the facts. Headache. 51(3):409–417. https://doi.org/10.1111/j.1526-4610.2011.01844.x

    Article  PubMed  Google Scholar 

  2. Moskowitz MA, Reinhard JF Jr, Romero J et al (1979) Neurotransmitters and the fifth cranial nerve: is there a relation to the headache phase of migraine? Lancet 2:883–885

    Article  CAS  Google Scholar 

  3. Moskowitz MA (1984) The neurobiology of vascular head pain. Ann Neurol 16:157–168

    Article  CAS  Google Scholar 

  4. Moskowitz MA (1993) Neurogenic inflammation in the pathophysiology and treatment of migraine. Neurology 43(suppl 3):S16–S20

    CAS  PubMed  Google Scholar 

  5. Moskowitz MA (1992) Neurogenic vs vascular mechanisms of sumatriptan and ergot alkaloids in migraine. Trends Pharmacol Sci 13:307–311

    Article  CAS  Google Scholar 

  6. Frediani F, Villani V, Casucci G (2008) Peripheral mechanism of action of antimigraine prophylactic drugs. Neurol Sci 29(Suppl 1):S127–S130. https://doi.org/10.1007/s10072-008-0903-8

    Article  PubMed  Google Scholar 

  7. Zachariah J, Patel P (2003) Facial pain with recurrent facial palsy. Headache 43:700–701

    Article  Google Scholar 

  8. Gupta VK (2005) Recurrent facial palsy in migraine: mechanistic considerations. Headache 45:258–259

    Article  Google Scholar 

  9. Peng KP et al (2005) Increased risk of Bell palsy in patients with migraine: a nationwide cohort study. Neurology 84(2):116–124

    Article  Google Scholar 

  10. Kim SY, Lee C-H, Lim J-S et al (2019) Increased risk of Bell palsy in patient with migraine: a longitudinal follow-up study. Medicine 98(21):e15764. https://doi.org/10.1097/md.0000000000015764

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ettlin DA (2013) The International Classification of headache disorders, 3rd edition (beta version). Cephalalgia 33(9):629–808

    Article  Google Scholar 

  12. Peitersen E (2002) Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 549:4–30

    Article  Google Scholar 

  13. Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, Davenport RJ, Vale LD, Clarkson JE, Hammersley V, Hayavi S, McAteer A, Stewart K, Daly F (2007) Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med 357(16):1598–1607. https://doi.org/10.1056/NEJMoa072006

    Article  CAS  PubMed  Google Scholar 

  14. Bhaskar H, Kapoor P, Ragini (2010 Jul-Sep) Comparison of transdermal diclofenac patch with oral diclofenac as an analgesic modality following multiple premolar extractions in orthodontic patients: a cross over efficacy trial. Contemp Clin Dent 1(3):158–163

    Article  CAS  Google Scholar 

  15. Ray BS, Wolff HG (1940) Experimental studies on headache: pain-sensitive structures of the head and their significance in headache. JAMA Surgery 41(4):813–856. https://doi.org/10.1001/archsurg.1940.01210040002001

    Article  Google Scholar 

  16. Tfelt-Hansen PC, Koehler PJ (2008) History of the use of ergotamine and dihydroergotamine in migraine from 1906 and onward. Cephalalgia. 28(8):877–886. https://doi.org/10.1111/j.1468-2982.2008.01578.x

    Article  CAS  PubMed  Google Scholar 

  17. Graham J, Hg W (1938) Mechanism of migraine headache and action of ergotamine tartrate. Arch Neurol Psychiatr 39(4):737–763. https://doi.org/10.1001/archneurpsyc.1938.02270040093005

    Article  CAS  Google Scholar 

  18. Tunis MM, Wolff HG (1953) Long term observations on the reactivity of the cranial arteries in subjects with vascular headaches of the migraine type. Arch Neurol Psychiatr 70:551–557

    Article  CAS  Google Scholar 

  19. Peng K-P, Chen Y-T, Fuh J-L, Tang C-H, Wang S-J (2014) Increased risk of Bell palsy in patients with migraine. Neurology. https://doi.org/10.1212/WNL.0000000000001124

  20. Sacco S, Ricci S, Carolei A (2012) Migraine and vascular diseases: a review of the evidence and potential implications for management. Cephalalgia 32:785–795

    Article  Google Scholar 

  21. Zaproudina N, Teplov V, Nippolainen E et al (2013) Asynchronicity of facial blood perfusion in migraine. PLoS One 8:e80189

    Article  Google Scholar 

  22. Malhotra R (2016) Understanding migraine: Potential role of neurogenic inflammation. Ann Indian Acad Neurol. 19(4):175–182. https://doi.org/10.4103/0972-2327.182302

    Article  PubMed  PubMed Central  Google Scholar 

  23. Asghar MS, Hansen AE, Amin FM et al (2011) Evidence for a vascular factor in migraine. Ann Neurol 69(4):635–645. https://doi.org/10.1002/ana.22292

    Article  PubMed  Google Scholar 

  24. Jansen I, Uddman R, Hocherman M et al (1986) Localization and effects of neuropeptide Y, vasoactive intestinal polypeptide, substance P, and calcitonin gene-related peptide in human temporal arteries. Ann Neurol 20(4):496–501. https://doi.org/10.1002/ana.410200409

    Article  CAS  PubMed  Google Scholar 

  25. Goadsby PJ, Edvinsson L, Ekman R (1988) Release of vasoactive peptides in the extracerebral circulation of humans and the cat during activation of the trigeminovascular system. Ann Neurol 23(2):193–196. https://doi.org/10.1002/ana.410230214

    Article  CAS  PubMed  Google Scholar 

  26. Moreau S, Salame E, Delmas P (2001) Arterial anatomy of the facial nerve at the stylomastoid foramen. Morphologie. 85(269):19–22

    CAS  PubMed  Google Scholar 

  27. Trost O, Kadlub N, Cheynel N et al (2008) Contribution of the posterior auricular artery in the vascularization of the facial nerve in prestylian space: anatomical study and surgical applications. Morphologie. 92(299):171–175. https://doi.org/10.1016/j.morpho.2008.07.016

    Article  CAS  PubMed  Google Scholar 

  28. Upile T, Jerjes W, Nouraei SA et al (2009) The stylomastoid artery as an anatomical landmark to the facial nerve during parotid surgery: a clinico-anatomic study. World J Surg Oncol. 7:71. https://doi.org/10.1186/1477-7819-7-71

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kobayashi Y, Kondo Y, Uchibori K et al (2017) Recurrent painful ophthalmoplegic neuropathy with residual mydriasis in an adult: should it be classified as ophthalmoplegic migraine? Intern Med. 56(20):2769–2772. https://doi.org/10.2169/internalmedicine.8842-171

    Article  PubMed  PubMed Central  Google Scholar 

  30. Roomet A, Allen JS (1974) Temporal arteritis heralded by facial nerve palsy. Jama. 228(7):870–871

    Article  CAS  Google Scholar 

  31. Daoussis D, Chroni E, Tsamandas AC et al (2014) Facial nerve palsy, headache, peripheral neuropathy and Kaposi's sarcoma in an elderly man. World J Clin Cases. 2(6):235–239. https://doi.org/10.12998/wjcc.v2.i6.235

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. M.Ch (Neurosurgery), Craniofacial Pain & Neuro Health Foundation Clinic, Borivali, & Manav Kalyan Kendra, Dahisar, Mumbai, India

    Mohinish Bhatjiwale

  2. D.N.B. (Neurosurgery) Resident, Department of Neurosurgery, Narayana Hrudayalaya, Bengaluru, India

    Mrudul Bhatjiwale

  3. The Craniofacial Pain & Neuro Health Foundation Clinic, 006, D-31, Yogi Nagar, Borivali West, Mumbai, 400091, India

    Mrudul Bhatjiwale

Authors
  1. Mohinish Bhatjiwale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mrudul Bhatjiwale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mrudul Bhatjiwale.

Ethics declarations

Conflict of interests

None.

Ethical approval

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhatjiwale, M., Bhatjiwale, M. Migrainous facial palsy (MFP): the introduction of a new concept of neurovascular conflict and its preliminary clinical evidence. Neurol Sci 41, 2547–2552 (2020). https://doi.org/10.1007/s10072-020-04370-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-020-04370-0

Keywords

Search

Navigation