Head / Face
Supraorbital Neuralgia
안와상신경통
Stabbing forehead pain with sensory change in supraorbital nerve (V1) distribution
- How common
- Uncommon
- Typical age
- Ages 30–60
What is it?
Supraorbital nerve is irritated at the notch/foramen by compression, trauma, or scarring causing neuropathic pain in V1 distribution.
Commonly affected: Supraorbital nerve (frontal branch of V1)
How it develops
- Trauma/CompressionHelmets, glasses, direct trauma
- Nerve IrritationPerineural inflammation/scarring
- Peripheral SensitizationEctopic discharges, mechanical allodynia
- Persistent Neuropathic PainParesthesia, electric-shock jolts, burning
Symptoms
- Unilateral stabbing forehead painElectric-shock episodes of seconds to minutes
- Supraorbital notch tendernessReproduced by focal pressure over notch
- Persistent paresthesiaNumbness/burning in V1 territory
- AllodyniaPainful with brushing hair or wearing hat
How it is examined
- Tinel signTapping the notch reproduces electric jolts
- V1 sensory examHypo- or hyperesthesia over forehead/anterior scalp
- Diagnostic nerve blockSupraorbital block temporarily abolishes pain — confirms diagnosis
- Normal V2/V3Other trigeminal branches normal
Imaging
CT if fracture suspected; X-ray has limited role.
- Usually normal
- Possible supraorbital rim fracture after trauma
- Excludes osseous lesion
High-resolution (3T) MRI rules out compression, neuroma, sinus disease; often normal.
- Usually normal
- Possible focal nerve thickening
- Excludes sinus disease/tumor
Non-surgical care
- Remove aggravatorsAvoid hat/helmet/glasses compression
- Neuropathic agentsGabapentin, pregabalin, amitriptyline
- Supraorbital nerve blockLocal anesthetic ± steroid injection
- PT/desensitizationLocal desensitization, scalp myofascial release
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Conservative failure with confirmed entrapment on imaging/block
Procedures that may be discussed
- Supraorbital nerve decompression
- Neurectomy (refractory)
Outlook
Most improve with blocks and medication; some require surgery.