Supraorbital Neuralgia

ICD-10 CODE G50.0

Clinical Syndrome

The pain of supraorbital neuralgia is characterized as persistent pain in the supraorbital region and forehead with occasional sudden, shock-like paresthesias in the distribution of the supraorbital nerves. Sinus headache involving the frontal sinuses, which is much more common than supraorbital neuralgia, can mimic the pain of supraorbital neuralgia. Supraorbital neuralgia is the result of compression or trauma of the supraorbital nerves as the nerves exit the supraorbital foramen. Such trauma can be in the form of blunt trauma directly to the nerve, such as when the forehead hits the steering wheel during a motor vehicle accident, or repetitive microtrauma resulting from wearing welding or swim goggles that are too tight. This clinical syndrome also is known as swimmer’s headache.

Signs and Symptoms

The supraorbital nerve arises from fibers of the frontal nerve, which is the largest branch of the ophthalmic nerve. The frontal nerve enters the orbit via the superior orbital fissure and passes anteriorly beneath the periosteum of the roof of the orbit. The frontal nerve gives off a larger lateral branch, the supraorbital nerve, and a smaller medial branch, the supratrochlear nerve. Both exit the orbit anteriorly. The supraorbital nerve sends fibers all the way to the vertex of the scalp and provides sensory innervation to the forehead, upper eyelid, and anterior scalp ( Fig. 2.1 ). The pain of supraorbital neuralgia is characterized as persistent pain in the supraorbital region and forehead with occasional sudden, shock-like paresthesias in the distribution of the supraorbital nerves. Occasionally, a patient suffering from supraorbital neuralgia complains that the hair on the front of the head hurts ( Fig. 2.2 ). Supraorbital nerve block is useful in the diagnosis and treatment of supraorbital neuralgia.

Testing

Magnetic resonance imaging (MRI) of the brain provides the best information regarding the cranial vault and its contents. MRI is highly accurate and helps identify abnormalities that may put the patient at risk for neurological disasters secondary to intracranial and brainstem pathological conditions, including tumors and demyelinating disease ( Fig. 2.3 ). Magnetic resonance angiography (MRA) also may be useful in helping identify aneurysms, which may be responsible for the patient’s neurological findings. In patients who cannot undergo MRI, such as a patient with a pacemaker, computed tomography (CT) is a reasonable second choice. Radionuclide bone scan, CT, and plain radiography are indicated if sinus disease, fracture, or bony abnormality such as metastatic disease is considered in the differential diagnosis.