Supraorbital and supratrochlear nerves: anatomy of the forehead
- Nerve
- Highlighted area
Quick facts
- Origin
- Branches of the frontal nerve, which comes from the ophthalmic division (V1) of the trigeminal nerve.
- Exit
- Supraorbital through the supraorbital notch or foramen; supratrochlear more medial, near the upper inner corner of the orbit.
- Function
- Sensory: skin of the forehead, upper eyelid and scalp up to the top of the head.
- Accompanying vessels
- Supraorbital and supratrochlear arteries and veins, of the same name.
- Relevance in facial harmonization
- Explain forehead sensation, numbness after trauma and the vascular risk of the region.
The supraorbital and supratrochlear nerves are the sensory nerves of the forehead. Both are branches of the frontal nerve, which comes from the ophthalmic division (V1) of the trigeminal nerve. They leave the orbit at its upper border, together with the arteries and veins of the same name, and carry sensation from the skin of the forehead, upper eyelid and scalp. They do not move muscles: forehead expression belongs to the facial nerve.
Where do they exit and where do they go?
| Nerve | Exit | Sensory territory |
|---|---|---|
| Supraorbital | Supraorbital notch or foramen, on the upper rim, usually near the pupil line | Lateral and central forehead, upper eyelid and scalp up to the top of the head |
| Supratrochlear | Upper inner corner of the orbit, medial to the supraorbital | Medial forehead, glabella, nasal root and medial part of the upper eyelid |
The supraorbital nerve usually splits into a superficial branch, which crosses the frontalis muscle to the skin, and a deep branch, which runs more laterally along the periosteum. The supratrochlear nerve passes through the region of the corrugator muscle before reaching the skin. The position of the notch or foramen varies between people and between sides, and sometimes there is more than one exit.
Why do they matter in facial harmonization?
- Sensation and comfort: the forehead and glabella are richly innervated, which explains the pain of the injection when applying botulinum toxin and the use of comfort measures, at the professional's discretion.
- Numbness and tingling: nerve trauma from a needle or cannula, or compression from volume, can cause paresthesia in the forehead or scalp. It is usually transient, but should be recorded and followed.
- Bundle with arteries: the nerves run with the supraorbital artery and the supratrochlear artery, branches of the ophthalmic artery. Where there is a nerve, there is a vessel tied to the eye's circulation.
- Relation to migraine: the surgical literature describes compression of these nerves by the glabellar muscles as a possible trigger in some migraine cases. This is a medical topic and does not justify promising pain relief from an aesthetic procedure.
Forehead pain after toxin: what to consider?
After toxin in the forehead and glabella, some people report a feeling of heaviness or a headache in the first days, usually mild and short-lived. A bruise at the injection site can also hurt. What is not expected: intense and growing pain, skin color change, a visual complaint or numbness that does not improve. These signs call for reassessment. The overview of effects is in botulinum toxin complications.
How does it show up in the assessment?
- Palpation of the upper orbital rim: in many people the supraorbital notch can be felt.
- History: forehead or eyelid surgery, trauma and prior complaints of numbness.
- Sensory record: noting any sensory change in the patient record before the procedure avoids confusion later.
Also called: nervus supraorbitalis, nervus supratrochlearis, frontal nerves of the forehead.
Frequently asked questions
Is it normal to feel pain in the forehead after botox?
Pain from the injection and a feeling of pressure or a mild headache in the first days are commonly reported and usually go away on their own. Severe pain that gets worse, with skin changes or any visual complaint, is not expected and calls for immediate assessment by the professional.
Does the supraorbital nerve move the forehead?
No. It is sensory. What moves the forehead is the frontalis muscle, controlled by the temporal branch of the facial nerve. Injury to the supraorbital nerve causes numbness or tingling, not a frozen forehead.