Infratrochlear neuralgia: A prospective series of seven patients treated with infratrochlear nerve blocks

Abstract

Background Infratrochlear neuralgia is a recently described painful cranial neuropathy that causes pain in the internal angle of the orbit and the medial upper eyelid, the upper bridge of the nose and/or the lacrimal caruncle. We aim to present seven new cases of infratrochlear neuralgia treated with anaesthetic nerve blocks. Methods Over an 18-month period, we prospectively identified seven cases of infratrochlear neuralgia among the patients attending the Headache Unit in a tertiary hospital. Anaesthetic blocks were performed by injecting 0.5 cc of bupivacaine 0.5% at the emergence of the nerve above the internal canthus. Results All patients were women, and the mean age was 49.1 years (standard deviation, 17.9). The pain appeared at the internal angle of the orbit and/or the medial upper eyelid in six cases, and the whole territory of the infratrochlear nerve in one case. Six patients had continuous pain and one had episodes lasting 8-24 hours. All patients showed sensory disturbances within the painful area and tenderness upon palpation of the infratrochlear nerve. Nerve blocks resulted in complete and long-lasting relief in four patients and short-lasting relief in the other three patients. Conclusions Infratrochlear neuralgia should be considered among the neuralgic causes of orbital and periorbital pain. Anaesthetic blocks may assist clinicians in the diagnosis and may also be an effective therapy.

Diagnosis and Management of Trochleodynia, Trochleitis, and Trochlear Headache

“…Baseline pain generally follows nerve topography involving the forehead, eyebrow and internal angle of the orbit that is constant with exacerbations experienced transiently as severe pain with a sharp, shock-like quality. Pain can be elicited with pressure at the supraorbital notch (supraorbital) (43), medial third of supraorbital rim (supratrochlear) (44), or internal angle of the orbit above medial canthus (infratrochlear) (45). A key difference from trochleodynia is lack of pain exacerbation with vertical eye movements or ophthalmoplegia.…”

“…A key difference from trochleodynia is lack of pain exacerbation with vertical eye movements or ophthalmoplegia. Periorbital neuralgias respond well to oral medications used for neuropathic pain, such as gabapentin, and local anesthetic blockade (43–45). Lacrimal and infraorbital nerve neuralgias have clearly distinct pain topography from trochleodynia (53, 54) and are not further discussed.…”

Supratrochlear Neuralgia: A Prospective Case Series of 15 Patients

“…The current description of supratrochlear neuralgia completes the spectrum of periorbital neuralgias. Cranial neuralgias that may cause periorbital pain include supraorbital neuralgia, supratrochlear neuralgia, infratrochlear neuralgia, lacrimal neuralgia, and infraorbital neuralgia . While all these disorders are considered trigeminal branch neuralgias, they are distinct from trigeminal neuralgia .…”

“…Infratrochlear neuralgia is a newly described condition characterized by a paroxysmal or persistent pain in one of the three different locations innervated by the infratrochlear nerve, that is, the internal angle of the orbit and the medial upper eyelid, the upper bridge of the nose, and/or the lacrimal caruncle. 16,17 Pain is typically associated with tenderness on palpation of the infratrochlear nerve at the internal angle of the orbit, above the internal canthus. In infratrochlear neuralgia, pain is specifically relieved by anesthetic block of the infratrochlear nerve.…”

Zygomaticofacial Neuralgia: A New Cause of Facial Pain

“…The diagnosis of terminal branch neuralgias is based on pain location and is further confirmed by pain relief after local anesthetic blockade . Some of these neuralgias are well characterized while others have been described only very recently . We aim to present a patient with a distinct pain condition that apparently corresponds to zygomaticofacial neuralgia.…”