With ophthalmoplegic migraine syndrome, the headache localises around one eye and it is followed hours later by a IIIrd or VIth nerve palsy on that side. The nerve palsy gradually improves over several days or weeks.
A Horner's syndrome may develop after several episodes.
This very rare migraine syndrome must be distinguished from a posterior communicating artery aneurysm. The aneurysm can compress the IIIrd cranial nerve.