Understanding Supraorbital Neuralgia

What Is Supraorbital Neuralgia?

Supraorbital neuralgia is a rare disorder that accounts for about 4% of cases involving neuralgia, a type of nerve pain. It is characterized by localized pain in or above the eyebrow, in the area supplied by the supraorbital nerve [1]. According to the ICD-11, supraorbital neuralgia belongs to the “Painful cranial neuropathies or other facial pains” category [2].

Supraorbital neuralgia pain can present in a chronic or intermittent pattern and is often accompanied by tenderness on the supraorbital notch, a groove in the forehead bone through which the supraorbital nerve passes [1].

Supraorbital neuralgia can be diagnosed by persisting, unilateral pain on the forehead or surrounding the eyes or tenderness over the nerve. Critically, blocking the supraorbital nerve should relieve the pain [1].

While the exact cause of supraorbital neuralgia is not fully understood, it has been associated with trauma to the forehead or supraorbital rim area [3]. In the following section, these will be discussed in greater detail.

Treatment options for supraorbital neuralgia vary and can include medication, nerve blocks, and in some cases, surgical intervention to remove compression [1, 4].

Causes of supraorbital neuralgia?

• Trauma to the forehead: One of the primary causes of supraorbital neuralgia is trauma to the forehead, as observed in a study where five out of 18 patients had a history of ipsilateral forehead trauma [5].
• Nerve compression: In some cases, supraorbital neuralgia can result from nerve compression. This can occur due to tight muscles in the neck or an injury to the head or neck.
• Neck problems: Chronic neck tension is another common cause of supraorbital neuralgia[6].
• Tumours: In rare instances, supraorbital neuralgia can be caused by tumours affecting nerve roots, blood vessel inflammation, gout, or infection [6]. A study reported a case of trigeminal neuralgia caused by a contralateral cerebellopontine angle tumour, suggesting that similar mechanisms could contribute to supraorbital neuralgia [7].
• Genetics: Another study suggested that the primary cause of major trigeminal neuralgia, which could potentially extend to supraorbital neuralgia, is a single, active DNA sequence in the persistent but non-integrated genome of latent herpes simplex virus type 1 commonly observed in a few infected A-delta nerve fibres of the cheek [8].

However, it's important to note that the exact cause of supraorbital neuralgia often remains unknown, and further research is needed to understand the underlying mechanisms of this condition fully.

Prevalence Of Supraorbital Neuralgia

The prevalence of supraorbital neuralgia in the general population is not well-established. This is due to the condition's rarity and difficulty in diagnosing it, as its symptoms can be similar to other types of neuralgias and headaches.

In a cohort study including up to 2000 individuals, the prevalence of supraorbital neuralgia was 0.65% [9]. This is higher than estimated.

It's important to note that the prevalence of other types of neuralgias, such as trigeminal neuralgia, has been studied more extensively. For instance, the prevalence of trigeminal neuralgia in the general population has been reported to range from 0.03% to 0.3% [10], which makes the 0.65% reported in the above cohort study abnormally high.

In summary, while supraorbital neuralgia is a recognized medical condition, there may not be sufficient evidence to provide an exact prevalence rate in the general population. More extensive epidemiological studies and increased awareness of symptoms are needed to determine the prevalence of supraorbital neuralgia.

Treatments For Supraorbital Neuralgia

Supraorbital neuralgia can be challenging to manage. However, several treatment options have shown promising results:

• Supraorbital nerve stimulation: In a study, patients with refractory frontal headaches underwent a trial of supraorbital nerve stimulation. The results showed a decrease in headache scores and a reduction in opioid consumption, maintained up to 30 weeks after the device was implanted [11].
• Surgical management: This is an option mainly for patients with chronic, posttraumatic supraorbital neuralgia. A study reported that surgical excision of the supraorbital and supratrochlear nerves, which supply the ear regions, resulted in at least a 50% reduction in pain in five out of six patients. Incredibly, three patients experienced complete pain cessation postoperatively [4].
• Radiofrequency thermocoagulation: This option is for patients who respond poorly to conservative treatments. Radiofrequency thermocoagulation has shown excellent long-term pain relief with a gradual reduction in sensory numbness. The cumulative proportion of recurrence-free survival was 96.2% at 12 months, 88.4% at 24 months, with a median recurrence-free time of 97 months [12].
• Pulsed radiofrequency (PRF): In a multicentric, long-term perspective study, the cumulative pain-free survival at six months, one year, two years, and longer was estimated as 70%, 64%, and 59%, respectively, with a median pain-free time of 52 months [13].
• Pharmacotherapy: Carbamazepine or oxcarbazepine are often recommended for trigeminal neuropathy, which includes the diagnosis of supraorbital neuralgia. Other drugs like lamotrigine and gabapentin are also recommended in guidance [14].

Summary: What Is Supraorbital Neuralgia?

Supraorbital neuralgia is a type of neuropathy of the facial region characterized by pain in the forehead and eye regions. Its prevalence is not well established. It is caused by various insults to the nerve or genetic predispositions. Treatments involve surgical and radiation therapy, as well as specific medications.

If you experience recurring pain in the forehead region, consult your healthcare provider so they can assess and treat your condition accordingly.