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The supraorbital nerve is a sensory nerve that brings sensation to the upper eyelid, forehead, and scalp. An acute trauma, like getting hit in the eye with a baseball, or a repetitive injury, like wearing swim goggles that are too tight, can easily damage this nerve.
An aggravated or injured supraorbital nerve can cause pain and tenderness in or above the eyebrow that may be persistent or intermittent. The pain is often described as a shooting, stabbing, or tingling sensation. Effective treatments include an injection of a local anesthetic or surgery.
This article takes a closer look at the anatomy and function of the supraorbital nerve, along with the causes of supraorbital nerve pain and potential treatment options.
Anatomy
People have both a right and a left supraorbital nerve, located by each upper eye bone. The supraorbital nerve extends from the frontal nerve, which also divides into the supratrochlear nerve.
Each supraorbital nerve branches from the notch you can feel along the rim of the frontal bone by your eyebrow. Usually, it is found 2.7 centimeters (cm) from the midline of the face.
Just above the orbital rim, the trunk of this nerve divides into two branches, one known as the superficial and the other as the deep branch.
The superficial branch goes over the frontalis muscle, providing sensation to your forehead and part of the scalp. Meanwhile, the deep branch supplies sensory input to the frontal parietal scalp and underlying tissues.
It's not uncommon for a person's supraorbital nerve to vary slightly from what's considered anatomically normal. This must be taken into account for any surgery in the area.
What Does the Supraorbital Nerve Do?
The supraorbital nerve provides sensory information to the skin of the forehead, the bridge of the nose, the middle part of the upper eyelid, and the front part of the scalp.
While it is important for the nerve to function well, there are times where it is also essential to numb this function. Blocking the supraorbital nerve can help achieve pain control in the event of:
- • Wound closure in the nerve area
- • Severe pain/headache
- • A patient who cannot have general anesthesia needs a procedure
- • Minor eyelid surgery
- • Biopsies in the area
Supraorbital Nerve Pain
If there is damage to the supraorbital nerve, you may experience supraorbital neuralgia (nerve pain) with pain above your eyebrow, and possibly extending to the scalp.
Supraorbital nerve pain can be the result of trauma, infection, tumor, or even inadvertent constriction of the nerve, in which the nerve presses against nearby structures.
The hallmarks of supraorbital neuralgia, a rare condition, include:
- • Forehead pain
- • Tenderness in the supraorbital notch (an opening in the bone just below your brow)
- • Complete relief from symptoms when supraorbital nerve function is temporarily blocked with treatment
The cause of supraorbital neuralgia can be the result of infection or trauma to the nerve, such as a punch in the eye or from hitting a car windshield during an accident. The cause may also be unknown.
Supraorbital Nerve Entrapment
Supraorbital nerve entrapment, in which the nerve becomes pinched, may be caused by scar tissue. This may not be present for several years after an accident until scar tissue has actually had a chance to form and tighten around the area. Only then may it begin to result in pain in the area, such as a recurring headache.
Swimmer’s Headache
Wearing tight-fitting goggles can aggravate the supraorbital nerve, causing a form of supraorbital neuralgia dubbed “swimmer's headache.” This can develop when poorly fitting goggles are tightened excessively, possibly to compensate for leaking underwater.
People with this condition may experience soreness of the scalp or may describe the sensation as “painful hair.” Avoiding the googles should alleviate the situation. It may then be possible to switch to a better-fitting pair that doesn’t cause the condition.
Treatment
Cases of supraorbital neuralgia can usually be treated with a "nerve block" in which the anesthetic lidocaine is injected into the supraorbital nerve. Lidocaine injections work by blocking the supraorbital nerve from sending pain signals to the brain.
If the pain persists or recurs, some other treatment possibilities include:
- • Acupuncture
- • Injection of botulism toxin or phenol/glycerol
- • Surgical treatment
The Nerve's Role in Migraines
Beyond neuralgia cases, surgical treatment of the supraorbital nerve has actually been found to be beneficial for some people with migraines.
By surgically decompressing this nerve—together with relieving pressure on another frontal nerve known as the supratrochlear nerve—these often painful headaches can sometimes be alleviated.
The first connection between migraine headaches and these structures was made by Bahman Guyuron, MD, in 2000 when he reported that following forehead rejuvenation surgery, 80% of patients described improvement or elimination of migraines.
Summary
The supraorbital nerve innervates the upper eyelid, forehead, and scalp. It can easily be damaged due to blunt force trauma to the eye or forehead, or a repetitive injury like wearing swimming goggles that are too tight.
Supraorbital pain is like other types of nerve pain in that it feels like a shooting, stabbing, or tingling sensation. Treatment options include the injection of a local anesthetic or botox. If conservative treatments do not relieve pain, surgery may be considered.
