The Anatomy of the Supraorbital Nerve

The supraorbital nerve is a sensory nerve responsible for bringing sensation to the upper eyelid, forehead, and scalp. This is a terminal branch of the frontal nerve, which is an offshoot of the ophthalmic branch of the trigeminal nerve.

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 emerges 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 located on the forehead and extends up toward your hairline.

This provides sensation to your forehead and part of the scalp. The deep branch supplies sensory input to the frontal parietal scalp and underlying vascular connective tissue.

Anatomical variations of the supraorbital nerve are common. This must be taken into account for any surgery in the area.

Function

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 circumvent this function. Blocking this supraorbital nerve can help with achieving pain control as part of:

• Area wound closure
• Alleviating pain/headache
• Procedures involving patients who can’t have general anesthesia
• Minor eyelid surgery
• Biopsies in the area

Associated Conditions

If there is damage to the supraorbital nerve, you may experience supraorbital neuralgia with pain above your eyebrow, possibly even extending to the scalp. This can be the result of trauma, infection, tumor, or even inadvertent constriction of the nerve.

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 alleviation of symptoms when a blockade is used on the supraorbital nerve

The cause of supraorbital neuralgia can be the result of infection or a 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.

It can also occur from supraorbital nerve entrapment. Such entrapment 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.

If the supraorbital nerve does become entrapped, some may mistakenly believe that the resulting supraorbital neuralgia is caused by sinusitis from inflammation of the nasal passages.

Wearing tight-fitting goggles can aggravate the supraorbital nerve and may cause a form of supraorbital neuroglia 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.” Discontinuing use of 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 by an injection of lidocaine in the area, which can be expected to relieve the pain in 80% of cases for a considerable amount of time. There may in a few cases be a limited benefit to drug treatment with carbamazepine and indomethacin.

If the pain persists or recurs, some other treatment possibilities include:

• Use of acupuncture
• Injection of botulism toxin or phenol/glycerol
• Surgical treatment

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.