• Among the painful ophthalmoplegias, ophthalmoplegic migraine and Tolosa-Hunt syndrome share many features. Our 6-year-old patient had three episodes of ophthalmoplegia. Two episodes were painful and promptly resolved with oral prednisone. She had no evidence of parasellar or systemic disease. A review of published cases of ophthalmoplegic migraine demonstrated that the clinical history, the cornerstone of diagnosis in migraine, does not differentiate ophthalmoplegic migraine from Tolosa-Hunt syndrome. Other features helpful in the diagnosis of Tolosa-Hunt syndrome were not usually investigated in reports of ophthalmoplegic migraine. Until better criteria are available for differentiating the two entities, we suggest that children who fulfill the clinical criteria for Tolosa-Hunt syndrome receive a trial of steroid therapy.