Background Recurrent painful ophthalmoplegic neuropathy (RPON) is an uncommon disorder characterized by recurrent unilateral headache attacks associated with ipsilateral ophthalmoplegia. We intend to study the clinical picture in our case series along with the published literature to discuss the pathogenesis and propose modified diagnostic criteria for recurrent painful ophthalmoplegic neuropathy. Methods We reported five cases diagnosed as ophthalmoplegic migraine/RPON in our medical centers and reviewed the published literature related to RPON from the Pubmed database between 2000 and 2020. In one of these cases, a multiplanar reformation was performed to look at the aberrant cranial nerve. Results The mean onset age for RPON was 22.1 years, and the oculomotor nerve was the most commonly involved cranial nerve (53.9%) in 165 reviewed patients. In most patients, ophthalmoplegia started within 1 week of the headache attack (95.7%, 67/70). Additionally, 27.6% (40/145) of patients presented enhancement of the involved nerve(s) from MRI tests. Finally, 78 patients received corticosteroids, out of which 96.2% benefited from them. Conclusion This is the first time multiplanar reformation has been performed to reveal the distortion of the oculomotor nerve. Modified diagnostic criteria are proposed. We hope to expand the current knowledge and increase the detection of recurrent painful ophthalmoplegic neuropathy in the future.

Tension-type headache (TTH) is the most common type of primary headaches, and its chronic form, chronic tension-type headache (CTTH), is affecting 0.5 to 4.8 % of the worldwide population. Although the mechanism underlying CTTH remains unclear, the role of central versus peripheral mechanisms has always been discussed while explaining the pathogenesis of CTTH. There is always a debate on differential diagnosis between CTTH and chronic migraine without aura which are regarded as different aspects of chronic daily headache spectrum because of many similarities and fuzzy boundaries. Compared with pharmacological treatments, non-pharmacological treatments have been popular as alternative interventions for CTTH in recent years. This review summaries the update knowledge on CTTH and discusses the most interested questions regarding pathogenesis and therapeutic strategies of CTTH.

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