Post-traumatic headache: don't forget to test the supraorbital nerve!

Stewart, Michael; Boyce, Samantha; McGlone, R

doi:10.1136/bcr-2012-006936

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…The persistence of post-traumatic headaches, which can last more than a year after the injury [22], may be due to processes related to acute and/or chronic damage to periosteal afferents or local inflammation, two processes which could lead to the ongoing activation and sensitization of these afferents. The supraorbital nerve, which our study shows innervates a large portion of the calvarial periosteum in the rat, and likely also in humans [16], has been proposed to play a role in post-traumatic headache [30]. It will be of interest to examine whether manipulations that lead to blockade of the sensory innervation of the calvarial periosteal innervation, whether having trigeminal or cervical origins, can be effective in reducing post-traumatic headaches.…”

Section: Discussionmentioning

confidence: 94%

The sensory innervation of the calvarial periosteum is nociceptive and contributes to headache-like behavior

Zhao

Levy

2014

Pain

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Headaches are thought to result from the activation and sensitization of nociceptors that innervate deep cephalic tissues. A large body of evidence supports the view that some types of headaches originate intracranially, from activation of sensory neurons that innervate the cranial meninges. However the notion of an extracranial origin of headaches continues to be entertained, although the identity of deep extracranial cephalic tissues which might contribute to headaches remains elusive. Here we employed anatomical, electrophysiological, and behavioral approaches in rats to test the hypothesis that the sensory innervation of the calvarial periosteum is nociceptive. Neural tracing indicated that the calvarial periosteum overlying the frontal and parietal bones is innervated primarily by small and medium-sized neurons in the trigeminal ganglion’s ophthalmic division. In vivo single unit recording in the trigeminal ganglion revealed that calvarial periosteal afferents have slowly conducting axons, are mechanosensitive and respond to inflammatory mediators, consistent with a nociceptive function. Two distinct neuronal populations were distinguished based on their peripheral axonal trajectory: one that reached the periosteum through extracranial branches of the trigeminal nerve, and another that took an intracranial trajectory, innervating the cranial dura and apparently reaching the periosteum via the calvarial sutures. In behavioral studies, inflammatory stimulation of these afferents promoted periorbital tactile hypersensitivity, a sensory change linked to primary headaches. Activation and sensitization of calvarial periosteal afferents could play a role in mediating primary headaches of extracranial and perhaps also intracranial origin, as well as secondary headaches such as post-craniotomy and post-traumatic headaches. Targeting calvarial periosteal afferents may be effective in ameliorating these headaches.

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Section: Discussionmentioning

confidence: 94%

The sensory innervation of the calvarial periosteum is nociceptive and contributes to headache-like behavior

Zhao

Levy

2014

Pain

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“…Injury of the supraorbital branch of the first trigeminal division as it passes through the supraorbital foramen just inferior to the medial eyebrow can cause supraorbital neuralgia . Similarly, infraorbital neuralgia can result from trauma to the inferior orbit.…”

Section: Expert Opinionmentioning

confidence: 99%

Sports and Headaches

Evans

2018

Headache

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“…Supraorbital neuralgia has been defined as a separate entity from trigeminal neuralgia in a few posttraumatic cases, and responds to supraorbital nerve block [16,93]. Only two pediatric cases were found, and one self-resolved at follow-up [92,95]. If refractory to medical treatment, cryoablation or surgical nerve decompression have been reported [16].…”

Section: Other Cranial Nerve Neuralgiasmentioning

confidence: 99%