The ocular manifestations of migraine in its various forms may be obvious or subtle. Of the major features, best known, although still of unclear mechanism, are the visual prodromes—scotomas and scintillations—of classic migraine. Rare but no less impressive is the occurrence of temporary or persisting paresis of an extraocular muscle as part of "ophthalmoplegic" migraine.
The present report concerns certain less dramatic eye signs: the red and wet eyeball, the small pupil, and the drooping lid, all representing additional clues to the nature of migraine. These minor manifestations are particularly prominent in association with headache occurring in cluster pattern, a form of vascular headache described in this century under many different names. It affects mainly adult males and consists of bouts of high intensity pain of relatively brief duration, rarely lasting over 2 hours. It is almost consistently unilateral and anterior in location, usually surrounding the orbit. Most characteristic is
KUNKLE EC, ANDERSON WB. Significance of Minor Eye Signs in Headache of Migraine Type. Arch Ophthalmol. 1961;65(4):504-508. doi:10.1001/archopht.1961.01840020506007