Supraorbital Neuralgia or Goggle Headache: Etiology, Symptoms, Treatment- Painkillers

Pain occurring in the head causing an uncomforting sensation in the individual within the head is referred to as headache. The pain can be localized to one side or region of the head or it can be a global pain, i.e. pain involving the whole head.

Some individuals experience headaches with a pre-onset aura, which can typically lead them to believe that they are about to experience a headache. Patients who are chronic sufferers of headaches take their headache precautions (i.e. prescribed medication or resting) when they experience this aura. It could include olfactory hallucinations (an odd smell) or auditory hallucinations. Such people are on chronic medication regimes for their headaches.

Headaches caused due to pain within the supra-orbital nerve (nerve above the eye), which may be brought about by a number of reasons such as a hard blow to the head causing the nerve to be damaged or not function properly.

Earlier referred to as the “goggle headache”, it typically follows a pattern, which shows it to be affecting one side of the head only.

Supraorbital neuralgia can be diagnosed by simple testing done by the doctor to identify the source of the pain, which is located in the area of the supraorbital nerve.

A recent hospital based report describes that in a series of about five patients who have unilateral, almost chronic, severe forehead pain, that this could be briefly abated by anesthetic blockade of supraorbital nerve and more or less permanently cured by a ‘liberation’ procedure directed towards nerve exit area at supraorbital notch. However, epidemiological data on this disease is lacking. Among around 2000 inhabitants in Vaga between ages of 20-60, there were about 10% who presented following clinical picture.

• Unilateral forehead pain, which cannot be diagnosed as any other unilateral headache.
• Increased sense of tenderness with pressure over exit site of supraorbital nerve.
• Foregoing trauma in forehead area ipsilaterally. In about 50% of cases, there was moderate ipsilateral sensation loss. A significant finding was occurrence of jabs in symptomatic area synchronized with neuralgia pain.

As mentioned, trauma, inflammatory processes, infection, and tumors can affect the proper functioning of supraorbital nerve. Partial or total nerve injuries can be brought about by traumatic injury to skull or soft tissues in forehead. This results in numbness and paresthesias in forehead and anterior skull areas. A neoplastic process can directly or indirectly compromise supraorbital nerve in its course.

In two hospital based studies of supraorbital neuralgia, this disorder was primary. In a large extent of epidemiological study, however, most patients had preceding forehead injury. Symptomatic supraorbital neuralgia cases are generally posttraumatic and less frequently due to tumors and/or infections.

The main cause for this type of pain would include damage to the supraorbital nerve brought about by a blow to the head incurred by an accident or any trauma.

Risk factors would again include being involved in a trauma as a cause of which the particular nerve has been injured causing the symptoms to develop.

• The main complaint is usually a unilateral pain in the forehead. The pain is sometimes triggered by touch and is of the neuropathic type. The complaints often resemble those caused by inflammation of the frontal sinus.
• The examination typically includes pressing around the margins of the eye-socket, and usually over the inner third of the upper rim of the eye-socket, the tender supraorbital nerve is found.
• The combination of pain in the territory supplied by the supraorbital nerve, Tinel’s sign at the supraorbital notch, and hypoesthesia in the forehead, are all features pointing to a neuropathic pain stemming from the supraorbital nerve.

Posttraumatic supraorbital neuralgia generally has good prognosis since in most of reported cases symptoms dissipate within few years, although in several cases hypoesthesia continued. Primary cases display prolonged chronic evolution.

• Treatment usually firstly involves the removal of the triggering factor, for e.g., if it is brought on due to some distinct type of headgear worn by the patient, that is first removed.
• If a local anesthetic injection relieves the pain, a nerve block with methylprednisolone could provide longer term relief. Low dose anti-convulsants such as Gabapentin or Pregabalin are also useful.
• A nerve stimulator device could be applied to the supra-orbital nerve to relieve supraorbital neuralgia. The patients treated with nerve stimulation reduced their use of powerful, opioid (morphine-like) painkillers.
• Surgeries have been attempted to decompress the supraorbital nerve, but have not proven to be successful.