====== Supraorbital neuralgia treatment ======

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Refractory cases may respond to [[rhizotomy]] with alcohol (providing an average of 8.5 months of relief
((Stookey B, Ransohoff J. Trigeminal Neuralgia: Its
History and Treatment. Springfield, IL: Charles C
Thomas; 1959))) 
or with [[radiofrequency]] [[ablation]].

Persistent cases may require [[exploration]] and [[decompression]] of the nerve by lysing bands overlying the [[supraorbital notch]],
((Sjaastad O, Stolt-Nielsen A, Pareja JA, et al. Supraorbital neuralgia: on the clinical manifestations and a
possible therapeutic approach. Headache. 1999;
39:204–212))
or, ultimately, to [[neurectomy]] which provides an average of 33.2 months of relief
((Grantham EG, Segerberg LH. An evaluation of palliative surgical procedures in trigeminal neuralgia.
Journal of Neurosurgery. 1952; 9:390–394)).

===== Gabapentin for Supraorbital neuralgia =====

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[[Gabapentin]] (800–2400 mg/d) or [[pregabalin]] (150 mg/d) is helpful for some
((Pareja JA, Caminero AB. Supraorbital neuralgia. Curr Pain Headache Rep. 2006
Aug;10(4):302-5. Review. PubMed PMID: 16834946.
)).

===== Pregabalin for Supraorbital neuralgia =====

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===== Capsaicin =====

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Topical [[capsaicin]] applied to the symptomatic area may help.


==== Rhizotomy ====
(e.g., with [[alcohol]] or [[radiofrequency]]). 
==== Supraorbital neurectomy ====

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For [[neurectomy]], these nerves are exposed through a 2 cm [[skin incision]] parallel to and just above the medial portion of the [[eyebrow]] (never through the eyebrow as this can create an unsightly “bi-brow”; shaving the eyebrow is also discouraged since it occasionally does not grow back). The incision is carried down to the [[bone]] and the [[periosteum]] is elevated caudally towards the [[supraorbital foramen]] or [[notch]]. The nerves will be visible on the undersurface of the periosteal flap. The [[supraorbital nerve]] is freed in its foramen/notch and is then avulsed by grasping it with a mosquito hemostat and twisting the [[clamp]]. The nerve avulses “like pulling a worm out of a hole.” The distal portion of the nerve should be located at the site where the periosteum was incised and it, too, should be avulsed. The process can be repeated for the more medially situated [[supratrochlear nerve]].

==== Supraorbital Nerve Stimulation ====

[[Supraorbital Nerve Stimulation]]