Supraorbital neuralgia. On the clinical manifestations and a possible therapeutic approach

The clinical manifestations of supraorbital neuralgia are apparently only i ncompletely known. The lack of awareness of this head pain may possibly be due to its rarity and problems with making the diagnosis. In the present wo rk, the long-term result of minor, decompressive surgery of the supraorbita l nerve in five patients is re-ported. The immediate improvement was good a nd, after a mean observation time of more than 5 years, an improvement of 5 0% to 100% was observed (mean, circa 85%), In the two patients with the lon gest postoperative observation time, approximately 8 years, pain has not re curred. The pain was severe, leading to suicidal thoughts in several patients, The long-term course was intermittent or continuous. The pain was generally uni lateral, but uas bilateral in one patient. Generally, there was lack of, or only minor benefit from drug treatment, including carbamazepine and indome thacin. There was clearly tenderness over the supraorbital nerve, especiall y at its outlet, and in some subjects occasionally, a slight local loss of sensation, Definite trigger zones were not present. Supraorbital nerve bloc kade generally provided instant and considerable pain relief. The persisten ce of protracted unilateral forehead/ocular pain, tenderness over the nerve , and repeated blockade effect strongly suggests the diagnosis.