Occipitofrontalis

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The Occipitofrontalis is a cranial muscle.

Anatomical Attachments: The Occipitofrontalis has two bellies. The posterior belly is referred as the occipitalis and the anterior belly is referred to as the frontalis. The belly of the occipitalis takes its origin from the lateral 2/3 of the superior nuchal line and mastoid process of the temporal bone. Superiorly, it attaches to the galea aponeurotica; which transverses, anchors and glides across the vertex of the cranium to, approximately, the coronal suture. At which time it serves as the attachment for the frontalis. The frontalis attaches to the skin over the eyebrow and according to most authors; interdigitates with the orbicularis oculi.

Action: Elevates the eyebrow; contracts and retract the scalp.

Synergist: Frontalis – Occipitalis, Corrugator Occipitalis - Frontalis

Antagonist: Frontalis – Procerus, Orbicularis oculi.

Nerve Supply: Occipital belly is supplied by the posterior auricular branch of the facial nerve (Cranial nerve VII). Frontalis belly is innervated by the temporal branch of the facial nerve (Cranial nerve VII).

Nerve Entrapment: Medial half entraps the supraorbital nerve.

Vascular Supply: Occipital artery; Frontalis is supplied by the frontal branch of the superficial temporal artery.

• Primary: Frontalis referral – refers pain on the ipsilateral side of the forehead and remains defined to that region. Occipitalis referral – refers pain not only over the ipsilateral posterior aspect of the head, but also, deep into the cranial vault. Ipsilateral posterior orbit pain has a spillover pattern which develops numerous other triggers, causing a multiple group dysfunction and an obscure clinical presentation. The reader should note that anytime an individual is referring to posterior eye or ipsilateral cranial pain, an aneurysm or cerebral hemorrhage should be ruled out.
• Satellite or associated triggers: Frontalis – Clavicular division of the SCM. Occipitalis – posterior cervical muscle, eye muscle and occasionally; Temporalis.

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Trigger Point Signs and Symptoms: Occipitalis – posterior head pain escalating into posterior cervical, suboccipital or posterior orbit pain. Occasionally the individual is aware of moderate pain at the back of the skull and as it progresses, refers into the suboccipital with severe, lancinating pain to the back of the eye. This creates concern that the individual may be having a stroke. Frontalis – pain over the forehead.

Trigger Point Activating and Perpetuating Factors: Occipitalis – frequently becomes dysfunctional during periods of sustained contraction; Frontalis – constant contraction of eyes.

Differential Diagnosis: Tension headaches, Tension headaches from muscles other than Occipitofrontalis (i.e. Suboccipitals, Cervical Paraspinals, Temporalis, and eye muscles), Occipital neuralgia, Histamine or Vascular headaches, Migraine or Cluster headaches, Cerebral Aneurysm and/or Thrombosis (or possible Hemorrhage), Encephalitis, Meningitis, Temporomandibular Joint dysfunction, Trigeminal Neuralgia (Tic douloureux), Persistent eye strain, Brain tumor, CNS disorders secondary to nutritional deficiencies or toxicity, Osteoarthritis, Osteoporosis, Tetanus, Systemic infections or inflammation, Metabolic imbalance, Side effects of medication.

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