Temporalis Muscle-Originated Supraorbital Neuralgia Misdiagnosed as Trigeminal Neuralgia

In patients with pharmacotherapy-refractory supraorbital neuralgia, a myofascial etiology should be included in the differential diagnosis. The authors report a case of a 73-year-old man with left supraorbital pain triggered by mastication, initially misdiagnosed as trigeminal neuralgia (V1). Physical examination identified a myofascial trigger point (MTrP) in the ipsilateral temporalis muscle, leading to a revised diagnosis of temporalis muscle-originated supraorbital neuralgia. Management involved ultrasound-guided pulsed radiofrequency of the supraorbital nerve combined with dry needling of the temporalis MTrP. This combined approach resulted in significant and sustained pain relief, enabling successful discontinuation of carbamazepine. This highlights the role of myofascial assessment in atypical facial pain and presents a viable treatment strategy.