Matsuo Kiyoshi, Kaneko Ai, Otsuka Tae
Plastic Surgery/Oculoplastic Surgery, Matsuo Plastic and Oculoplastic Surgery Clinic, Hamamatsu, JPN.
Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, JPN.
Cureus. 2025 Mar 17;17(3):e80743. doi: 10.7759/cureus.80743. eCollection 2025 Mar.
To maintain a vertical visual field, fast-twitch fibers in the levator palpebrae superioris muscle (LPSM) stretch mechanoreceptors in the superior tarsal muscle (STM), which contracts the slow-twitch fibers in both the LPSM and the occipitofrontalis muscle (OFM). Exceeding the upgaze limit without head movement increases reflex contraction of the OFM to raise the eyebrows and pull the scalp backward while also causing involuntary contraction of the upper trapezius muscle (UTM) to extend the head backward, resulting in tension-type headaches (TTH) and neck pain. Due to aponeurosis disinsertion from the tarsus, we hypothesized that increased mechanoreceptor stretching in the STM reflexively contracts both the OFM and UTM. We report a case series of five patients whose aponeurosis disinsertion caused tonic eyebrow-raising, TTH, and neck pain. In the first case, asymmetrical disinsertion with dominance on the left side led to a more pronounced contraction of the OFM and UTM, resulting in TTH and neck pain on that side. After surgery to reduce mechanoreceptor stretching, symptoms resolved. The second and third cases, which involved symmetrical disinsertion, showed that unilateral eyebrow lifting using tape to alleviate mechanoreceptor stretching reduced ipsilateral UTM contraction in length and hardness. The fourth case, also with symmetrical disinsertion, experienced symptom relief post-surgery. In the fifth case, the eyebrows were maximally raised due to severe aponeurosis disinsertion, and the head was extended backward and protruded. Bilateral aponeurosis reinsertion lowered the eyebrows and reduced the extension/protrusion of the head, relieving TTH and neck pain. These cases suggest that increased mechanoreceptor stretching in the STM reflexively contracts the slow-twitch fibers of the OFM and UTM, contributing to TTH and neck pain as part of coordinated eye, eyebrow, and head movements.
为维持垂直视野，提上睑肌（LPSM）中的快肌纤维拉伸睑板上肌（STM）中的机械感受器，后者会使LPSM和枕额肌（OFM）中的慢肌纤维收缩。在不移动头部的情况下超过上视极限会增加OFM的反射性收缩，从而抬高眉毛并向后拉动头皮，同时还会导致上斜方肌（UTM）不自主收缩，使头部向后伸展，进而引发紧张型头痛（TTH）和颈部疼痛。由于腱膜从睑板分离，我们推测STM中机械感受器拉伸增加会反射性地使OFM和UTM收缩。我们报告了一组五例患者的病例系列，其腱膜分离导致了强直性抬眉、TTH和颈部疼痛。在第一个病例中，左侧占优势的不对称分离导致OFM和UTM收缩更明显，从而导致该侧出现TTH和颈部疼痛。在进行减少机械感受器拉伸的手术后，症状得到缓解。第二和第三个病例涉及对称分离，结果表明使用胶带单侧抬眉以减轻机械感受器拉伸可减少同侧UTM在长度和硬度上的收缩。第四个病例同样是对称分离，术后症状缓解。在第五个病例中，由于严重的腱膜分离，眉毛被最大限度地抬高，头部向后伸展并前凸。双侧腱膜重新附着降低了眉毛高度，减少了头部的伸展/前凸，缓解了TTH和颈部疼痛。这些病例表明，STM中机械感受器拉伸增加会反射性地使OFM和UTM的慢肌纤维收缩，在协调眼睛、眉毛和头部运动的过程中导致TTH和颈部疼痛。
