Frontalis Trigger Points

Introduction

The frontalis is a key facial muscle responsible for raising the eyebrows and creating forehead expressions. When trigger points develop in this muscle, they can cause forehead pain, tension headaches, and eye strain, often mimicking migraines, sinus headaches, or eye fatigue.

Name and Area

  • Name: Frontalis

  • Area: Located on the forehead, running from the eyebrows to the top of the scalp, forming part of the occipitofrontalis muscle.

Indications

Frontalis trigger points may contribute to:

  • Forehead Pain and Tightness (Mistaken for Sinus Pressure or Tension Headaches)

  • Pain That Radiates to the Scalp or Behind the Eyes (Can Mimic Migraines or Eye Strain)

  • Eyebrow Heaviness or Drooping (Due to Chronic Muscle Tension)

  • Frequent Wrinkling of the Forehead (Can Exacerbate Frown Lines or "Worry Wrinkles")

  • Pain That Worsens with Stress or Extended Screen Time

  • Sensitivity to Light and Screens (Common in Those Who Work on Computers for Long Hours)

Pain from this muscle is often mistaken for migraines, tension headaches, or sinus headaches.

Muscle Action

  • Raises the Eyebrows: Creates expressions of surprise or curiosity.

  • Wrinkles the Forehead: Forms horizontal forehead lines.

  • Assists in Facial Expressions: Works with the orbicularis oculi and corrugator supercilii for eye and brow movement.

The frontalis is essential for facial communication and expressions, but excessive use can lead to chronic tension and forehead pain.

Signs and Symptoms

Individuals with frontalis trigger points often report:

  • Deep, Aching Pain Across the Forehead

  • Pain or Tension That Spreads to the Scalp or Behind the Eyes

  • Frequent Frowning or Eyebrow-Raising (Due to Stress or Habitual Muscle Tension)

  • Tightness in the Forehead That Worsens with Stress or Anxiety

  • Increased Wrinkles or Creasing in the Forehead (From Chronic Muscle Contraction)

Pain worsens with prolonged facial expressions, stress, or extended screen use.

Perpetuating Factors

Common causes of frontalis trigger points include:

  • Chronic Stress or Anxiety (Leading to Habitual Forehead Tension and Wrinkling)

  • Excessive Use of Screens (Straining the Eyes and Increasing Forehead Muscle Activity)

  • Frequent Squinting or Frowning (Due to Vision Issues or Emotional Stress)

  • Sleeping in a Tensed Position (Clenching the Jaw or Furrowing the Brows During Sleep)

  • Poor Posture (Forward Head Position Can Increase Facial Tension)

Trigger Point Referral Pattern

Trigger points in the frontalis refer pain to:

  • The forehead and scalp (Can Resemble Tension Headaches or Sinus Pressure)

  • The eyebrows and upper eyelid (Can Mimic Eye Fatigue or Vision Strain)

  • The temples and behind the eyes (Mistaken for Migraines or Sinus Headaches)

Pain from this muscle is often confused with headaches, sinus pressure, or stress-related tension.

Differential Diagnosis

Frontalis trigger points may be mistaken for:

  • Tension Headaches (Dull, Aching Pain That Wraps Around the Forehead and Temples)

  • Migraines (Severe, Pulsating Headaches That May Include Light Sensitivity and Nausea)

  • Sinus Headaches (Pain and Pressure in the Forehead, Often With Nasal Congestion)

  • Trigeminal Neuralgia (Sharp, Shooting Facial Pain That Can Resemble Nerve Compression)

  • Eye Strain (Pain and Fatigue from Staring at Screens or Poor Lighting Conditions)

A thorough forehead, eye, and scalp assessment is necessary to rule out these conditions.

Associated Trigger Points

Frontalis trigger points often co-exist with:

  • Corrugator Supercilii (Deep Forehead Pain and Brow Tension, Related to Frowning or Squinting)

  • Orbicularis Oculi (Eye Fatigue, Twitching, and Tension Around the Eyes)

  • Temporalis (Side Headaches and Jaw Tension Related to Clenching or Grinding Teeth)

  • Sternocleidomastoid (SCM) (Neck Tightness That Can Contribute to Headaches and Eye Pain)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Frontalis Galea aponeurotica (scalp) Skin of the forehead and eyebrows Facial nerve (CN VII)

The frontalis is innervated by the facial nerve (cranial nerve VII), which controls facial expressions and forehead movement.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the forehead and near the hairline.

  • Eyebrow Mobility Testing: Assess pain or tightness when raising and lowering the eyebrows.

  • Light Sensitivity Testing: Determine if bright light worsens symptoms.

  • Forehead Wrinkle Examination: Check for excessive wrinkling or furrowing from chronic tension.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the frontalis, reducing muscle tightness and improving relaxation.

Manual Therapy

  • Trigger Point Release: Apply sustained pressure along the forehead and scalp.

  • Facial Massage and Myofascial Release: Loosens tight forehead and scalp muscles.

Stretching

  • Forehead Relaxation Exercise: Place fingertips on the eyebrows and gently push outward while relaxing the face.

  • Scalp Massage: Gently move the scalp in circular motions to release tension.

Strengthening Exercises

  • Eyebrow Control Drills: Raise and lower the eyebrows without engaging the forehead too much to promote relaxation.

  • Blinking Exercises: Helps reduce excessive eye strain and maintains natural lubrication.

Postural and Behavioral Adjustments

  • Avoid Excessive Frowning or Squinting (Use Sunglasses or Corrective Lenses if Needed)

  • Take Frequent Breaks From Screen Time or Reading (Follow the 20-20-20 Rule: Every 20 Minutes, Look 20 Feet Away for 20 Seconds)

  • Use Relaxation Techniques to Reduce Stress-Induced Facial Tension (Deep Breathing, Meditation, or Face Yoga)

Conclusion

The frontalis muscle plays a key role in facial expressions, eyebrow movement, and forehead tension, but trigger points in this muscle can cause forehead pain, tension headaches, and eye strain. By incorporating dry needling, manual therapy, stretching, and relaxation techniques, individuals can reduce pain, improve mobility, and prevent chronic facial tension.

➡️ Learn more about Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.