====== Supraorbital neuralgia ======

[[Trigeminal neuralgia]] (TGN) may present with [[pain]] in the distribution of the [[supraorbital nerve]];
however, the [[supraorbital nerve]] may be involved in supraorbital [[neuralgia]] (SON), a distinct [[syndrome]] with different clinical characteristics
((Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain, 2nd edition. Cephalalgia.
2004; 24:9–160))

===== Epidemiology =====

SON is a rare condition slightly more common in women, with onset typically 40–50 years of age
((Pareja JA, Caminero AB. Supraorbital neuralgia. Curr Pain Headache Rep. 2006
Aug;10(4):302-5. Review. PubMed PMID: 16834946.
))


===== Etiology =====

SON may be:

1. primary (no identifiable etiology): these cases lack any sensory loss

2. secondary (e.g., due to trauma to the area, or resulting from chronic pressure such as with wearing swim goggles): more common than primary SON. Most cases remit within one year
((Pareja JA, Caminero AB. Supraorbital neuralgia. Curr Pain Headache Rep. 2006
Aug;10(4):302-5. Review. PubMed PMID: 16834946.
))
with the elimination of the offending pressure

===== Clinical features =====

[[Supraorbital]] [[neuralgia]] is a rare disorder clinically characterized by the following triad: 

1) [[Forehead]] pain in the territory supplied by the [[supraorbital nerve]], without side shift.

2) [[tenderness]] on either the [[supraorbital notch]] or trajectory of the nerve; and 3) absolute, but transitory relief of symptoms upon supraorbital nerve blockade. The pain presents with a chronic or intermittent pattern. In addition, there may be signs and symptoms of sensory dysfunction (hypoesthesia, paresthesia, and allodynia), and typical "neuralgic features" (lightning pain and exteroceptive precipitating mechanisms). However, sensitive and neuralgic features are not constantly present and seem to be more frequent in the secondary, usually post-traumatic, forms
((Pareja JA, Caminero AB. Supraorbital neuralgia. Curr Pain Headache Rep. 2006
Aug;10(4):302-5. Review. PubMed PMID: 16834946.
)).

===== Differential diagnosis =====

1. [[Migraine]]: suggested by [[nausea]], [[vomiting]], and [[photophobia]]

2. Associated autonomic activity is rare with SON, and should prompt consideration of [[cluster headache]] or [[SUNCT]] 

3. [[Trigeminal neuralgia]] : typical TGN features lacking in SON include characteristic triggers and pain consisting
exclusively of paroxysmal/ultra-brief electric-shock–like pain

4. [[Hemicrania continua]]: continuous unilateral pain that tends to be located more posteriorly and is absolutely responsive to [[indomethacin]]
((Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain, 2nd edition. Cephalalgia.
2004; 24:9–160))

5. [[Trochleitis]]: inflammation of the trochlea/superior-oblique muscle complex, may mimic supratrochlear neuralgia with the pain of the medial upper orbit extending a short distance to the forehead
((Pareja JA, Pareja J, Yanguela J. Nummular headache, trochleitis, supraorbital neuralgia, and other epicranial headaches and neuralgias: the epicranias. Journal of Headache and Pain. 2003; 4:125–131))

===== Treatment =====

[[Supraorbital neuralgia treatment]].