We present the case of a migrainous girl who suffered an episode of mi
graine-like headache associated with ophthalmoplegia. MRI showed rever
sible enhancement and thickening of the cisternal portion of the oculo
motor nerve. This finding suggests a mechanism different from diabetic
ischaemic neuropathy, as similar MRI abnormalities were rarely report
ed in diabetic ophthalmoplegia. The MRI findings are most in favour of
an inflammatory cause.