The supraorbital nerve is a sensory nerve that provides feeling to the forehead, upper eyelid, and scalp. When this nerve becomes irritated, compressed, or damaged, it can lead to supraorbital neuralgia, characterized by localized pain. Pain when the area is touched or pressed—known as allodynia or hyperalgesia—is a defining feature of this nerve irritation. This localized tenderness indicates that the nerve or surrounding tissue is the source of the discomfort.
Location and Manifestation of the Pain
The nerve exits the bony socket of the eye through a small opening or groove in the brow bone, called the supraorbital foramen or notch. This point is often the exact spot where tenderness is most noticeable upon gentle palpation.
After exiting the orbit, the nerve divides into superficial and deep branches that ascend across the forehead and into the scalp. Consequently, the pain can radiate upward from the eyebrow, sometimes reaching as far back as the top of the head. Patients often report the discomfort as sharp, shooting, or electric-shock like, which can occur in sudden bursts.
The irritation can also manifest as altered sensation within the nerve’s territory, even without a painful stimulus. These sensory changes may include numbness, a reduced ability to feel touch, or a persistent tingling or pins-and-needles feeling. In some cases, the sensitivity is so profound that even the light touch of hair or a hat can provoke a painful response, a phenomenon often described as having “painful hair.”
Common Causes of Supraorbital Nerve Irritation
The primary reason the supraorbital nerve becomes painful upon touch is physical compression or injury, often resulting in nerve entrapment. One of the most frequent causes is blunt force trauma directly to the forehead or brow ridge. This type of injury, whether from a fall, a sports accident, or a motor vehicle collision, can directly bruise or crush the nerve against the bone.
Chronic, repetitive microtrauma can also lead to nerve irritation over time. Activities requiring tight headgear, such as wearing restrictive swimming goggles, helmets, or welding masks, can exert sustained pressure on the nerve as it exits the notch. This constant pressure can cause inflammation and swelling, leading to the entrapment syndrome.
Compression can also arise from surrounding soft tissues, most commonly in the supraorbital foramen. The nerve may be squeezed by scar tissue that forms after a prior injury. Furthermore, certain facial surgeries, including cosmetic procedures like brow lifts, carry a risk of direct nerve injury or subsequent irritation from the formation of internal scar tissue around the nerve pathway.
Local inflammation from conditions like sinus infections or fluid retention can temporarily swell the tissues and compress the nerve against the bony structures. Muscle tension, particularly in the corrugator supercilii muscle located just above the brow, can also contribute to nerve impingement. When the nerve is persistently compressed, its protective sheath can become damaged, making it highly sensitive to any form of external pressure or movement.
Diagnosis and Management Approaches
Diagnosis relies on a targeted physical examination and the patient’s history of pain. A medical professional will carefully palpate the supraorbital notch to confirm localized tenderness, which often reproduces the patient’s characteristic pain. This sensitivity, coupled with pain radiating across the forehead, is a strong indicator of the condition.
The physician will also work to rule out other headache disorders, such as migraines or cluster headaches, which can sometimes present with similar frontal pain. Imaging studies like Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans may be used to exclude structural issues, such as tumors or fractures, that might be compressing the nerve.
The most definitive diagnostic tool is the supraorbital nerve block, which involves injecting a local anesthetic near the nerve exit point. If the injection provides immediate, though temporary, complete relief from the pain, it confirms that the supraorbital nerve is the source of the patient’s symptoms.
Management often begins with conservative methods, including the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce local swelling and inflammation. Applying cold or heat compresses to the affected area can offer temporary symptomatic relief. For pain that is more resistant, pharmacological treatments focused on calming nerve activity may be prescribed, such as anticonvulsants like gabapentin or certain tricyclic antidepressants.
If oral medications are insufficient, interventional procedures are often considered. The diagnostic nerve block can be made therapeutic by adding a corticosteroid to the anesthetic, aiming for longer-term pain reduction by decreasing inflammation around the nerve. Another option is pulsed radiofrequency treatment, which uses heat energy to modulate the nerve’s pain signaling capacity without causing permanent damage.
When pain is chronic and fails to respond to these non-surgical interventions, surgical decompression may be necessary, particularly in cases of clear entrapment. The goal of this procedure is to physically free the nerve by carefully removing any surrounding scar tissue, bone fragments, or tight muscle fibers that are placing pressure on it. In rare, refractory cases, a surgical excision of the damaged nerve segment may be performed, sometimes with the addition of a neural tube to prevent the formation of a painful neuroma at the nerve stump.