Procerus Trigger Points

Introduction

The procerus is a small facial muscle responsible for wrinkling the skin between the eyebrows and contributing to facial expressions. When trigger points develop in this muscle, they can cause forehead tension, headaches, and eye strain, often mimicking tension headaches, sinus pressure, or migraines.

Name and Area

  • Name: Procerus

  • Area: Located between the eyebrows, running from the nasal bone to the skin of the forehead.

Indications

Procerus trigger points may contribute to:

  • Pain or Tension Between the Eyebrows (Mistaken for Sinus Pain or Tension Headaches)

  • Pain That Spreads to the Forehead and Temples (Can Mimic Migraines or Eye Strain)

  • Increased Wrinkling Between the Eyebrows ("Frown Lines" or "11s")

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

  • Headaches That Start Between the Eyebrows and Radiate to the Forehead

  • Pain or Tightness That Worsens with Stress, Squinting, or Poor Vision

Pain from this muscle is often mistaken for tension headaches, sinus pressure, or stress-related eye strain.

Muscle Action

  • Pulls the Eyebrows Downward: Creates the furrowing expression, often associated with frowning or concentration.

  • Wrinkles the Skin Between the Eyebrows: Works with the corrugator supercilii to form forehead creases.

  • Assists in Facial Expressions: Expresses anger, frustration, or intense focus.

The procerus is essential for facial communication, vision-related expressions, and forehead tension control.

Signs and Symptoms

Individuals with procerus trigger points often report:

  • Tension Between the Eyebrows That Feels Like a "Pressure Point"

  • Pain That Extends to the Forehead and Temples (Can Resemble Tension Headaches or Migraines)

  • Frequent Brow Furrowing or Squinting (Often Due to Stress or Poor Vision)

  • Eye Strain or Sensitivity to Bright Light (Common in Those Who Spend Long Hours on Screens)

  • Pain or Tightness That Worsens with Emotional Stress or Intense Focus

  • Aching Sensation in the Bridge of the Nose (Can Mimic Sinus Congestion or Sinus Headaches)

Pain worsens with stress, prolonged screen use, bright light exposure, or habitual frowning.

Perpetuating Factors

Common causes of procerus trigger points include:

  • Chronic Stress or Anxiety (Can Lead to Habitual Brow Furrowing and Facial Tension)

  • Excessive Screen Time (Prolonged Computer Use, Smartphone Use, or Gaming Without Breaks)

  • Frequent Squinting Due to Poor Vision (Common in Those Who Need Glasses or Have an Outdated Prescription)

  • Bright Light Exposure or Photophobia (Can Cause Increased Brow Tension and Headaches)

  • Chronic Sinus Issues or Allergies (Leads to Repeated Facial Muscle Strain and Increased Forehead Tension)

Trigger Point Referral Pattern

Trigger points in the procerus refer pain to:

  • The forehead and space between the eyebrows (Can Mimic Sinus Pressure or Headache Pain)

  • The temples and bridge of the nose (Mistaken for Sinus Headaches or Migraines)

  • The upper cheeks and eye sockets (Can Resemble Eye Strain or Trigeminal Nerve Pain)

Pain from this muscle is often confused with tension headaches, sinus headaches, or eye strain from digital devices.

Differential Diagnosis

Procerus 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 and Around the Eyes, Often Accompanied by Congestion)

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

  • Photophobia or Eye Strain (Pain and Fatigue from Excessive Screen Use or Poor Lighting)

A thorough forehead, eye, and sinus examination is necessary to rule out these conditions.

Associated Trigger Points

Procerus trigger points often co-exist with:

  • Frontalis (Forehead Pain and Tension, Common in Stress and Postural Imbalances)

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

  • Temporalis (Side Headaches and Jaw Pain, Can Resemble Migraines or Sinus Pressure)

  • Sternocleidomastoid (SCM) (Neck and Head Pain, Can Mimic Sinus Pressure or Tension Headaches)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Procerus Nasal bone, upper nasal cartilage Skin between the eyebrows Facial nerve (CN VII)

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

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the bridge of the nose and between the eyebrows.

  • Brow Mobility Testing: Assess pain or tightness when furrowing and relaxing the eyebrows.

  • Light Sensitivity and Screen Exposure Testing: Determine if prolonged screen time worsens symptoms.

  • Postural and Facial Expression Assessment: Rule out habitual squinting or forehead tension from poor vision.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the procerus, reducing forehead tension and improving eye comfort.

Manual Therapy

  • Trigger Point Release: Apply gentle sustained pressure along the brow line and upper nose.

  • Facial and Scalp Massage: Helps improve circulation and reduce muscle tension in the forehead.

Stretching

  • Eyebrow Relaxation Techniques: Gently massage the brow and forehead to reduce tension.

  • Facial Stretching Exercises: Move the brows upward and hold for a few seconds, then relax to relieve chronic tension.

Strengthening Exercises

  • Blinking and Eye Relaxation Drills: Helps reduce excessive forehead tension and promote relaxed facial movement.

  • Head and Neck Posture Correction: Encourages proper alignment to prevent excessive forehead strain.

Postural and Behavioral Adjustments

  • Follow the 20-20-20 Rule (Every 20 Minutes, Look 20 Feet Away for 20 Seconds to Reduce Eye Strain)

  • Use Proper Lighting (Avoid Working in Dim or Overly Bright Environments That Force Squinting)

  • Wear Proper Prescription Glasses (Reduces Unnecessary Eye Strain and Prevents Brow Furrowing)

Conclusion

The procerus plays a crucial role in facial expressions, vision-related muscle control, and forehead tension regulation, but trigger points in this muscle can cause significant headaches, eye strain, and facial discomfort. By incorporating dry needling, manual therapy, stretching, and vision care adjustments, individuals can reduce pain, improve facial relaxation, and prevent stress-related headaches.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

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.