Swimmer's headache, or supraorbital neuralgia.

A ssociated with the fitness movement in the USA is an increased number of participants in water sports. Swimmers wear goggles to allow better vision underwater and to protect their eyes from irritation from chlorine or salt. Goggles come in many sizes and shapes; usually a swimmer finds a particular brand and model most effective and comfortable. I recently saw a patient who complained of " painful hair. " He had been swimming for 6 years and had recently developed pain and tenderness on the right side of his scalp. Palpating along the tender areas, I outlined the distribution of the right supraorbital nerve. Just prior to the development of the scalp pain, he had developed a leak in his goggles that allowed water to enter the orbital area, causing eye irritation. As he had done before, he tightened the goggle strap to stop the leak. He continued with the swim workout and subsequent workouts 3 to 4 times per week. After approximately 1 week, the scalp pain began. A Medline search on this topic found 2 letters to the editor in the New England Journal of Medicine in 1983. The first related the experience of a neurologist who developed bitemporal headaches after 1 to 2 hours of swimming. The father of the neurologist, who was a sporting goods retailer, noted that some of his customers complained of headaches associated with the use of ill-fitting swim goggles. The headaches stopped after use of the swim goggles was discontinued and returned when the goggles were worn again. By using goggles that were made of a softer rubber compound and had a looser-fitting strap around the head, the neurologist was able to continue swimming without headaches (1). The second letter to the editor, in response to the first, was from another neurologist who developed neuralgia in the distribution of the supraorbital nerve. The headaches and su-praorbital-notch pain resolved 3 weeks after he abstained from wearing goggles (2). This neuralgia is similar to that experienced by my patient after he tightened the strap on his goggles. Swimmers with a supraorbital notch (<100% bony encasement of the nerve) rather than a supraorbital foramen have a greater risk of developing this problem due to the exposed portion of the nerve (3). The affected nerves in these cases of swimmer's headache are illustrated in the Figure. Prevention is the best treatment; however, if this condition does …