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 Table of Contents  
Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 142-144

Myofascial pain syndrome of the occipitofrontalis muscle and its ophthalmological implications

1 School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
2 Department of Physiotherapy, Sardar Bhagwan Singh University, Dehradun, Uttarakhand, India

Date of Submission06-Apr-2022
Date of Acceptance04-Aug-2022
Date of Web Publication20-Jan-2023

Correspondence Address:
Shilpa Jain
Delhi Pharmaceutical Sciences and Research University, Sector - 3, Pushp Vihar, New Delhi - 110 017
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_887_22

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Myofascial pain syndrome associated with occipitofrontalis muscle most of the time undergo underdiagnosed after eye surgery, and the exact cause remain to be ascertained. The present study is a case report which indicates that it may be one of the reasons for eye pain and/or headache that is misinterpreted as glaucoma or increased intraocular pressure. A systematic study is warranted to avoid the use of medicine in similar cases.

Keywords: Manual therapy, myofascial pain syndrome, occipitofrontalis muscle

How to cite this article:
Jain S, Goyal RK, Ajmera P, Mozhi RA. Myofascial pain syndrome of the occipitofrontalis muscle and its ophthalmological implications. Indian J Ophthalmol Case Rep 2023;3:142-4

How to cite this URL:
Jain S, Goyal RK, Ajmera P, Mozhi RA. Myofascial pain syndrome of the occipitofrontalis muscle and its ophthalmological implications. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:142-4. Available from: https://www.ijoreports.in/text.asp?2023/3/1/142/368227

Myofascial pain syndrome is characterized by the presence of myofascial trigger points that cause tenderness in the muscle, leading to its shortening, stiffness in specific areas including fascia, and pain that may radiate to different areas known as referred pain.[1],[2] Many a times, headache can be present without a medical cause which may be tightening in nature,[3] aggravated by the activation of certain trigger points causing myofascial pain syndrome of the occipitofrontalis, suboccipitalis and temporalis muscles.[4] Intervention techniques of myofascial release have been found to be significantly effective in correcting many ailments including headache. The present study reports a case of eye pain and headache which was corrected by the intervention of myofascial release technique.

  Case Report Top

A male patient 65 years of age presented with headache and pain in the eyes. The patient had a history of glaucoma in both eyes and retinal detachment in the left eye, and he had undergone surgeries for glaucoma for each eye and additional surgery for retinal detachment in the left eye. For the present condition, the patient complained to the ophthalmologist about the recurrence of pain in the eye. The eye surgeon or ophthalmologist examined both eyes meticulously and found nothing in the eyes that could have induced the headache.

The case was referred to a physiotherapist for diagnosis of headache. The patient was using intraocular pressure (IOP)-lowering eye drops of timolol regularly. He was examined by the physiotherapist and it was noted that the patient used a computer for more than 8 hours a day. On palpation, tenderness was found all around at the frontal, temporal, and occipital region. Visual Analogue Scale (VAS) was used to assess pain intensity, which was recorded as 9 on the scale, as baseline.[4] The occipital area was tender over palpation. The pain pressure threshold (PPT) at the left side was recorded at 9.3 N and right side was recorded at 9.8 N using digital algometer (Orchid Scientific ALGO- DS), when put up on the occiput area.[5] On further examination, the active range of motion (AROM) for the neck for all movements was found to be painful and observed to be restricted or less than the normal, which was measured by universal goniometer.

The purpose and the details of the intervention were explained to the patient and he was asked to sign the informed consent form. The study was done in accordance with the National Ethical Guidelines for Biomedical and Health Research Involving Human Participants-Indian Council of Medical Research (ICMR) (Revised 2017) and guidelines of Helsinki declaration 2013. The present study was a single-blinded case study. The present study has been registered in the clinical trial Registry-India (CTRI Registration number: CTRI/2021/09/036774).

Myofascial release (epicranial release/hair pull) technique was given for releasing occipitofrontalis and temporalis muscles.[3] Occipitofrontalis muscle is a combination of the frontalis and occipital belly connected by a thick fibrous connective tissue sheath known as crania aponeurotica or galea aponeurotica.[6] The occipitalis and suboccipitalis were released by cranial base release technique with deep kneading at mastoid process.[3] The frontalis was released by skin rolling or the focused release at forehead area [Table 1].
Table 1: Physiotherapy intervention at tender areas

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Immediately after the manual therapy, the patient showed a great relief in the symptoms and this significantly improved the outcomes of pain intensity, neck AROM, and pain pressure threshold measured by VAS, goniometer and algometer, respectively, at baseline and immediately after the intervention. The scores at VAS reduced with a significant difference both immediately after the treatment and also 45 minutes later. The PPT and range of motion for all the neck ranges also showed a significant improvement after the intervention. In the present study, all the measures showed significant level of differences in all the parameters [Table 2]. All the records of the variables for PPT and range of motion were documented as average of the three readings.
Table 2: Outcome measures: pre and post intervention

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The patient revisited the clinic after seven days with much lesser pain which indicated recovery, and the same intervention of manual therapy including techniques of myofascial release was repeated on him. It has been over seven months from the second intervention; presently the patient is normal with no pain in the eyes and has stopped taking drugs for curing increased IOP.

  Discussion Top

This is the case which opens many vistas in physiotherapy practices. Glaucoma is a common condition and retinal detachment occurs many times and the patient may be advised to undergo eye surgery which is common. During the surgery, the injection is given retrobulbar and peribulbar where orbicularis occuli muscle is the one in which local anesthesia is injected for blocking the cilliary nerves and cranial nerve Ⅲ and Ⅳ. The muscle is sometimes left injured at the fiber level, after the injection. The healing of the injured fibers may not be resolved with complete healing with true collagen. There may be a formation of fibrous tissue which in turn gives rise to chronic stiffness in the long-term and myofascial pain syndrome. The techniques may help in returning the elasticity and original length of the fascia and muscle.[1],[7],[8],[9] Thus, myofascial pain syndrome may be one of the reasons and a common phenomenon for headache due to eye problems that may be associated. It is recommended that awareness should be brought regarding the thorough examination which must be done to differentially diagnose the root cause of the headache and pain behind the eye ball where location and symptoms are common but the cause and diagnosis are different. Furthermore, systematic research may be carried out with ophthalmologists to find out the prevalence of myofascial pain syndrome associated with occipitofrontalis muscle, causing headache and pain in the eye.

  Conclusion Top

The headache or pain in the frontalis part of the occipitofrontalis muscle, referred to the eye ball experienced by the patients who underwent cataract or other eye surgeries should consider the myofascial pain syndrome as one of the possible etiologies that can be treated with appropriate physiotherapy intervention.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Jain S, Goyal RK, Ajmera P, Aggarwal G, Dhiman S. Recent advances in diagnosis and management of myofascial pain syndrome: A narrative review. J Clin Diagn Res 2021;15:4-8. 5.  Back to cited text no. 1
Money S. Pathophysiology of trigger points in myofascial pain syndrome. J Pain Palliat Care Pharmacother 2017;31:158-9.  Back to cited text no. 2
Ajimsha M. Effectiveness of direct vs indirect technique myofascial release in the management of tension-type headache. J Bodywork Movement Ther 2011;15:431-5.  Back to cited text no. 3
Pérez-Martínez C, Gogorza-Arroitaonandia K, Heredia-Rizo AM, Salas-González J, Oliva-Pascual-Vaca Á. INYBI: A new tool for self-myofascial release of the suboccipital muscles in patients with chronic non-specific neck pain: A randomized controlled trial. Spine 2020;45:E1367-75.  Back to cited text no. 4
Castro Sánchez AM, García López H, Fernández Sánchez M, Pérez Mármol JM, Aguilar-Ferrándiz ME, Luque Suárez A, et al. Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds, quality of life, fatigue, pain intensity, quality of sleep, anxiety, and depression in patients with fibromyalgia syndrome. Null 2019;41:2235-46.  Back to cited text no. 5
Kushima H, Matsuo K, Yuzuriha S, Kitazawa T, Moriizumi T. The occipitofrontalis muscle is composed of two physiologically and anatomically different muscles separately affecting the positions of the eyebrow and hairline. Br J Plast Surg 2005;58:681-7.  Back to cited text no. 6
Jain S, Arora M. Effect of microcurrent facial muscle toning on fine wrinkles & firmness of face. IAMR J Phys 2012;1:13.  Back to cited text no. 7
Jain S, Bhat A, Tonk R. Active stretching of hip flexors increases hip extension range of motion more than passive stretching. Int J Dev Res 2018;8:19654-9.  Back to cited text no. 8
Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil 2008;89:16-23.  Back to cited text no. 9


  [Table 1], [Table 2]


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