(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy) Abstract: A 40-year-old patient, Brother Li, came to the clinic and reported severe headache starting 1 week ago due to exertion, followed by ocular motility disorder, with episodic symptoms and no symptoms of infection such as cold and fever before the disease. No significant abnormality was seen in the head MRI scan, mild atherosclerosis of cerebral arteries, and painful oculomotor palsy was considered. After administering targeted medication, the patient’s ocular motility disorder, headache, nausea, vomiting and other discomfort symptoms were relieved. The patient’s symptoms were relieved after the administration of targeted medication. (Treatment cycle] Hospitalization for 8 days [Treatment effect] Headache, nausea, vomiting symptoms alleviated, blurred vision and double vision improved I. Initial interview Patient Li had headache after exertion 1 week before admission, bilateral temporal distension, throbbing pain, pins and needles pain, accompanied by nausea and vomiting, vomiting several times, the vomit is the contents of the stomach, vomiting after the headache has been reduced; 5 days before admission, double vision, especially when the eyes move to the right side. He denied that his limbs were weak and numb, and denied that his speech was clumsy. He was worried about cerebral hemorrhage, so he came to our hospital for consultation. The examination showed that the patient was clear, temperature was 36.1℃, blood pressure was 120/80mmHg, heart rate was 70 times/minute, respiration was 19 times/minute, Kirschner’s sign was negative, and the right eye was restricted. The patient was told that cerebral hemorrhage could be excluded, but further inpatient examination was needed to clarify the diagnosis, to which the patient agreed. We learned that the patient had no previous hypertension, no diabetes mellitus, and no recent history of infection. After admission, the patient was advised to undergo magnetic resonance examination of the head, including arterial veins, etc. The results showed that no significant abnormality was seen; repetitive electrical nerve stimulation of bilateral orbicularis oculi muscle showed that no abnormality was seen, and myasthenia gravis was basically excluded. We explained to the patient and his family about his condition: we considered painful ocular muscle palsy, the cause of the disease was not fully understood, and hormones could be used for treatment. After analyzing the pros and cons of hormones with the patient’s family, the family agreed to use them. The patient was then given cerebral protection by wake-up call injection, brain protein hydrolysate for injection to improve brain metabolism, glycerol fructose injection to reduce intracranial pressure, and methylprednisolone sodium succinate for injection to relieve edema and reduce pain and ocular muscle paralysis. III. Treatment effect The patient’s symptoms such as headache, nausea and vomiting began to be reduced after the drug was administered. After 8 days of treatment, the patient’s headache was basically relieved and only occasional headache occurred at night, nausea and vomiting were also significantly reduced, and there were no convulsions. Before discharge, the patient was advised to take prednisone acetate tablets orally as prescribed by the doctor, and to take vitamin D drops for calcium, potassium citrate granules for potassium, and omeprazole enteric capsules for gastric mucosa protection after discharge. After the drug treatment, the patient’s condition improved day by day, which is very gratifying for the doctor. However, after discharge, it is recommended that patients should pay attention to stay away from electronic products, long-term use of electronic products is easy to produce eye fatigue, which is not conducive to the recovery of eye muscle paralysis. In terms of diet, it is recommended that you can usually eat some nutrient-rich and light foods, such as carrots and wolfberries, which help to nourish the eyes and promote recovery. You also need to pay attention to your lifestyle, try not to stay up late, pay attention to eye hygiene, and try to avoid rubbing your eyes with your hands, especially unclean hands. When the eyes feel tired, you can massage the eyes locally to promote blood circulation in the eyes. V. Personal insight This case is typical of painful ocular muscle palsy, which is a kind of cavernous sinusitis ocular muscle palsy, the etiology is not completely clear, may be related to infection, non-specific inflammation of the cavernous sinus, the disease can develop in all age groups, the incidence of men and women is similar. Most patients are induced by cold and exertion, as in this case. Therefore, people should pay attention to rest and avoid overexertion in daily life. In addition, the disease needs to be differentiated in clinical work from patients with headache with oculomotor paralysis caused by neuritis, temporal bone apophysis syndrome, cranial trauma, and intracranial tumors.