Frontalis Muscle Contracture

A frontalis muscle contracture is a condition in which the forehead’s primary muscle—the frontalis—becomes permanently shortened or stiffened, leading to restricted movement of the eyebrows and forehead skin. This tightening can cause visible forehead creases, eyebrow malposition, tension headaches, and difficulty with facial expressions. Contractures occur when muscle fibers, their tendons, or surrounding connective tissues develop excess fibrosis (scar-like tissue) and lose elasticity, preventing the muscle from fully relaxing or stretching WikipediaUPMC | Life Changing Medicine.

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Anatomy of the Frontalis Muscle

Structure & Location

The frontalis is the anterior belly of the occipitofrontalis muscle, lying just beneath the skin of the forehead. It has no bony attachments; instead, its fibers span from the scalp’s connective tissue to the skin above the eyebrows NCBIWikipedia.

• Origin: Anterior edge of the galea aponeurotica (epicranial aponeurosis) Radiopaedia.

• Insertion: Fibers blend into the skin of the eyebrows and the orbicularis oculi muscle Wikipedia.

Blood Supply & Nerve Supply

• Arterial Supply: Supratrochlear and supraorbital arteries (branches of the ophthalmic artery) traverse the forehead to nourish the muscle NCBIWikipedia.

• Venous Drainage: Accompanies the arterial branches, draining into the superior ophthalmic veins.

• Innervation: Temporal branch of the facial nerve (cranial nerve VII) Wikipedia.

Functions ( Major Actions)

1. Elevation of Eyebrows – Lifts eyebrows upward in expressions of surprise or attention.

2. Forehead Wrinkling – Creates horizontal lines across the forehead.

3. Anterior Scalp Movement – Pulls the scalp forward, counteracting the occipital belly.

4. Visual Field Enhancement – Raises brows to widen the upper field of vision.

5. Facial Expression – Integral to nonverbal cues like astonishment or concern.

6. Antagonism – Balances the orbicularis oculi during eyelid closure KenhubGetBodySmart.

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Types of Frontalis Muscle Contracture

1. Congenital Contracture: Present at birth due to abnormal muscle/connective tissue development.

2. Traumatic/Cicatricial Contracture: Follows forehead injuries, burns, or surgical scars that tighten the galea or skin.

3. Spastic Contracture: Results from upper motor neuron lesions (e.g., stroke, cerebral palsy), causing chronic muscle hypertonia.

4. Dystonic Contracture: A focal dystonia of the forehead (e.g., blepharospasm variants) that leads to involuntary, sustained contraction.

5. Iatrogenic Contracture: Secondary to repeated botulinum toxin injections or radiation therapy causing fibrosis.

6. Disuse Contracture: From prolonged immobilization (e.g., head bandaging) leading to tissue shortening Wikipedia.

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Causes

Contracture of the frontalis may arise from:

1. Burn injuries to the forehead skin

2. Surgical scars (e.g., browlift, craniotomy)

3. Facial trauma (lacerations, fractures)

4. Post-radiation fibrosis

5. Chronic frowning or sustained eyebrow elevation

6. Spasticity after stroke or traumatic brain injury

7. Cerebral palsy affecting facial muscles

8. Hemifacial spasm or facial nerve hyperactivity

9. Focal dystonia (blepharospasm variant)

10. Dupuytren-type fibromatosis of galea

11. Immobility from tight head dressings or helmets

12. Adhesive capsulitis of the scalp (rare)

13. Fibrotic myositis from infection

14. Ischemic injury (e.g., temporal artery vasculitis)

15. Metabolic disorders (e.g., amyloidosis)

16. Medication-induced dystonia (antipsychotics)

17. Connective tissue diseases (scleroderma)

18. Radiation therapy for scalp tumors

19. Genetic myopathies (e.g., Bethlem myopathy)

20. Age-related skin and tissue inelasticity WikipediaCleveland Clinic.

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Symptoms

1. Persistent forehead tightness

2. Horizontal forehead creases

3. Limited eyebrow elevation

4. Brow ptosis (drooping)

5. Tension-type headaches

6. Scalp discomfort or tenderness

7. Facial asymmetry

8. Difficulty frowning or raising brows

9. Visual field narrowing

10. “Hard” or “rope-like” tissue on palpation

11. Sleep disturbance from discomfort

12. Referred pain to temples

13. Overactive contraction at rest

14. Uneven wrinkle patterns

15. Skin indentation along the galea

16. Scalp itch or tightness

17. Reduced expressiveness

18. Psychosocial distress

19. Secondary neck muscle tension

20. Photophobia (light sensitivity) Cleveland ClinicPM&R KnowledgeNow.

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Diagnostic Tests

1. Comprehensive physical exam (inspection & palpation)

2. Active and passive range-of-motion testing of brows

3. Surface electromyography (EMG) of frontalis

4. Needle EMG for muscle fiber activity

5. Facial nerve conduction study

6. Ultrasound imaging of muscle and aponeurosis

7. Shear-wave elastography for tissue stiffness

8. High-resolution MRI of forehead soft tissues

9. CT scan to assess scar tissue depth

10. Dynamic video analysis of facial movements

11. Forced facial expression tests (e.g., raising brows against resistance)

12. Muscle biopsy for fibrosis evaluation

13. Serum creatine kinase and myositis panel

14. Autoantibody screening (e.g., ANA, anti-Scl-70)

15. Genetic testing for dystrophy syndromes

16. Thermography for local inflammation

17. Facial Action Coding System (FACS) analysis

18. Pain scale assessment (VAS)

19. Quality-of-life questionnaires

20. Photographic documentation for baseline/ follow-up PMCWikipedia.

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Non-Pharmacological Treatments

1. Passive stretching of the frontalis

2. Myofascial release massage

3. Trigger-point therapy

4. Heat therapy (warm compresses)

5. Cold therapy (ice packs)

6. Therapeutic ultrasound

7. Transcutaneous electrical nerve stimulation (TENS)

8. Low-level laser therapy

9. Dry needling

10. Acupuncture

11. Kinesiology taping

12. Scalp mobilization techniques

13. Progressive resistance exercises

14. Biofeedback training

15. Neuromuscular re-education

16. Occupational therapy for facial function

17. Craniosacral therapy

18. Ergonomic adjustment of head posture

19. Yoga and relaxation exercises

20. Mindfulness‐based stress reduction

21. Cupping therapy on forehead

22. Instrument-assisted soft tissue mobilization

23. Facial yoga (“brow lifts”)

24. Deep breathing techniques

25. Postural correction (neck/shoulder alignment)

26. Adaptive yoga for muscle lengthening

27. VR-guided stretching programs

28. Manual scar‐tissue remodeling

29. Scalp hydrotherapy (contrast baths)

30. Rehabilitative mirror exercises PM&R KnowledgeNowWikipédia, l’encyclopédie libre.

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Drugs

1. Botulinum toxin type A (focal chemodenervation)

2. Baclofen (GABA_B agonist)

3. Tizanidine (α₂-adrenergic agonist)

4. Diazepam (benzodiazepine muscle relaxant)

5. Cyclobenzaprine (central muscle relaxant)

6. Dantrolene (direct muscle relaxant)

7. Methocarbamol

8. Orphenadrine

9. Gabapentin (neuropathic pain)

10. Pregabalin

11. Ibuprofen (NSAID)

12. Naproxen (NSAID)

13. Acetaminophen

14. Topical diclofenac gel

15. Capsaicin cream

16. Lidocaine patch/cream

17. Oral corticosteroids (short-term bursts)

18. Anticholinergics (e.g., trihexyphenidyl for dystonia)

19. SSRIs/SNRIs (for associated pain modulation)

20. Magnesium supplements (adjunct for muscle relaxation) Cleveland ClinicWikipedia.

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Surgeries

1. Frontalis myotomy (muscle cut to release tension)

2. Selective temporal branch neurectomy

3. Epicranial aponeurosis Z-plasty

4. Scar excision and revision over galea

5. Subcutaneous fasciotomy

6. Endoscopic frontal release

7. Fascial grafting for lengthening

8. Tendon transfer procedures

9. Direct fasciectomy of fibrotic bands

10. Browlift with tissue expansion Mount Sinai Health SystemWikipédia, l’encyclopédie libre.

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Preventive Strategies

1. Early mobilization after forehead injury

2. Routine forehead stretching exercises

3. Scar massage post-surgery or burn

4. Avoidance of prolonged frowning

5. Stress management (to reduce involuntary tension)

6. Use of helmet padding to prevent pressure scars

7. Ergonomic posture for neck/head support

8. Periodic botulinum toxin prophylaxis in hyperactive muscles

9. Hydration and skin moisturization to preserve elasticity

10. Regular neuromuscular re-education sessions Cleveland ClinicWikipedia.

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When to See a Doctor

• Persistent tightness lasting > 2 weeks despite home stretches

• Severe pain or headaches unresponsive to OTC treatments

• Loss of eyebrow mobility affecting vision or expression

• Visible scar contracture causing skin indentation

• Neurological signs (e.g., facial weakness, spasms)

• Rapid onset of forehead stiffness after injury

• Psychosocial distress due to cosmetic changes UPMC | Life Changing MedicineWikipedia.

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FAQs

1. What exactly is a frontalis muscle contracture?
   A permanent shortening of the forehead muscle and its tissues causing stiffness and limited movement.

2. How common is frontalis contracture?
   It’s relatively rare and often follows trauma, surgery, or neurological conditions.

3. Can Botox injections cause contracture?
   Paradoxically, repeated injections may lead to local fibrosis and focal iatrogenic contracture.

4. Is frontalis contracture the same as temporal headache?
   No; while contracture can cause tension headaches, it is a distinct muscle shortening issue.

5. Are there genetic causes?
   Yes; some congenital myopathies and dystrophies involve contractural changes.

6. Can it resolve on its own?
   Mild cases from short-term spasm may improve, but true fibrosis–based contractures rarely self-resolve.

7. Is surgery always needed?
   No; many cases respond to physical therapy and chemodenervation.

8. Will stretching make it worse?
   When done gently and guided by a therapist, stretching is beneficial; aggressive force can exacerbate fibrosis.

9. Are there non-surgical ways to prevent it?
   Yes; early mobilization, massage, and stress reduction help maintain tissue elasticity.

10. Can physical therapy alone fix it?
    In early or mild contractures, consistent PT can restore full range of motion.

11. Does it affect facial expressions?
    Yes; limited forehead movement can impair non-verbal cues like surprise or worry.

12. Is it painful?
    Often; patients report tenderness and tension headaches.

13. How long does treatment take?
    Depending on severity, non-surgical treatment can take weeks to months; surgery adds recovery time.

14. Is there a risk of recurrence?
    Yes; ongoing care and preventive measures are crucial to avoid re-contracture.

15. Can children get frontalis contracture?
    Rarely; congenital or post-burn contractures in pediatric patients do occur and require early intervention.

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The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: April 27, 2025.

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