Supraorbital Neuralgia. On the Clinical Manifestations and a Possible Therapeutic Approach 0. Sjaastad, MD, PhD; A. Stolt-Nielsen, MD; J.A. Pareja, MD, PhD; T.A. Fredriksen, MD, PhD; M. Vincent, MD, PhD The clinical manifestations of supraorbital neuralgia are apparently only incompletely known. The lack of awareness of this head pain may possibly be due to its rarity and problems with making the diagnosis. In the pres- ent work, the long-term result of minor, decompressive surgery of the supraorbital nerve in five patients is re-port- ed. The immediate improvement was good and, after a mean observation time of more than 6 years, an improve- ment of 50% to 100% was observed (mean, circa 85%). In the two patients with the longest postoperative obser- vation time, approximately 8 years, pain has not recurred. The pain was severe, leading to suicidal thoughts in several patients. The long-term course was intermittent or continuous. The pain was generally unilateral, but was bilateral in one patient. Generally, there was lack of, or only minor benefit from drug treatment, including carbamazepine and indomethacin. There was clearly tenderness over the supraorbital nerve, especially at its outlet, and in some subjects occasionally, a slight local loss of sensa- tion. Definite trigger zones were not present. Supraorbital nerve blockade generally provided instant and consid- erable pain relief. The persistence of protracted unilateral forehead/ocular pain, tenderness over the nerve, and repeated blockade effect strongly suggests the diagnosis. Key words: neuralgia, supraorbital neuralgia, entrapment, trigeminal neuralgia, SUNCT syndrome Abbreviations: TD tic douloureux, SUNCT short-lasting unilateral neuralgiform pain with conjunctival injection and tearing (Headache 1999;39:204-2 12) A multitude of cranial neuralgias have been described.‘-* Supraorbital neuralgia is another cranial neu- ralgia that has been recognized, but, admittedly, uncer- tainty prevails as to its manifestations.9 The prototype of the facial/cranial neuralgias is trigeminal neuralgia-or tic douloureux (TD). The symptoms and signs of every cranial neuralgia should, therefore, be weighed against those of TD. lo-12 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA From the Departments of Neurology (Drs. Sjaastad and Pareja) and Neurosurgery (Drs. Stolt-Nielsen and Fredriksen), Regionsykehuset i Trondheim, Trondheim University Hospitals, Norway and Service de Neurologia, Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, Brazil (Dr. Vincent). Address all correspondence to Dr. 0. Sjaastad, Department zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFE of Neurology, Regionsykehuset i Trondheim, Trondheim University Hospitals, 7006 Trondheim, Norway. Accepted for publication June 11,1998. First division TD, the type that presumably would be most reminiscent of supraorbital neuralgia (SN) as for localization, is supposedly extremely rare, but it seems to exist,11*13J4although some authors apparently doubt even that. 15The burning question then is: is supraorbital neu- ralgia only a variant of or even identical to TD? In the elaboration of the clinical manifestations of a disorder, the correct clinical diagnosis is of the utmost importance. We have followed a small group of patients with neuralgiform pain in the ocular area, with clinical characteristics seemingly differing from those of the SUNCT syndrome,16J7 and first-division TD. The clear, long-term reduction/discontinuation of symptoms after a minor surgical intervention has provided evidence for the validity of the diagnosis of SN. This case series may, therefore, aid in outlining the clinical manifestations of SN. 204 March, I999