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

Abstract

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. To postulate an anatomico-pathophysiological association in the causative factor of lower motor neuron type of facial palsy in cases with migraine without aura. 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. 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 6months. 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. 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.