Headache With Sixth Nerve Palsy: Is This Always Related to Elevated Intracranial Pressure?

Sixth nerve palsy with magnetic resonance imaging (MRI) features of empty sella and cerebellar tonsillar ectopia in patients with headache are red flags and suspicious for increased intracranial pressure (ICP). However, this may not always be true and MRI features could be non-specific. Duane retraction syndrome is a congenital eye movement anomaly characterized by variable horizontal duction deficits without diplopia. We report an interesting case of Duane retraction syndrome with Chiari I malformation in a patient with headache, mimicking idiopathic intracranial hypertension (IIH)