From the Guidelines
Forehead twitching above the eyes is typically a benign condition called eyelid myokymia or hemifacial spasm, which involves involuntary muscle contractions in the forehead area, and according to the most recent evidence 1, it is often related to unilateral hyperactivity of the facial nerve. These twitches are usually temporary and often caused by stress, fatigue, excessive caffeine consumption, or eye strain. No specific medication is typically needed as these twitches generally resolve on their own within a few days. To address this issue, try:
- Reducing stress through relaxation techniques
- Getting adequate sleep (7-8 hours nightly)
- Limiting caffeine intake
- Taking regular breaks from screens to reduce eye strain Staying hydrated and ensuring proper nutrition, particularly with magnesium-rich foods like nuts, seeds, and leafy greens, may also help. These muscle twitches occur when nerves connected to your facial muscles fire spontaneously, causing the muscle fibers to contract. If twitching persists beyond two weeks, becomes painful, spreads to other parts of your face, or is accompanied by other symptoms like facial weakness, consulting a healthcare provider is recommended to rule out more serious neurological conditions, such as facial nerve paralysis or hemifacial spasm, which can be caused by vascular compression of the facial nerve 1.
From the Research
Forehead Twitching Above the Eyes
- Forehead twitching above the eyes can be a symptom of blepharospasm, a focal dystonia characterized by involuntary eyelid closure due to spasmodic contractions of the orbicularis oculi muscles 2, 3, 4, 5, 6.
- Blepharospasm can cause significant disability through functional blindness, and botulinum toxin type A (BtA) is considered the first line of therapy for this condition 2, 3, 4, 5, 6.
- The treatment of blepharospasm with BtA has been shown to produce robust clinical improvement, which is stable throughout the treatment time, with a moderate to large improvement in blepharospasm-specific severity and disability 2, 6.
- Adverse effects of BtA treatment for blepharospasm are rare, mild, and always transient, but may include vision complaints and eyelid ptosis 2, 6.
- The duration of effects of BtA treatment for blepharospasm has been estimated to be around 10 weeks, but there is no evidence from randomized controlled trials (RCTs) evaluating the effectiveness and safety of repeated BtA injection cycles 6.
Causes and Treatment
- The exact cause of forehead twitching above the eyes in blepharospasm is not fully understood, but it is thought to be related to abnormal brain activity and muscle contractions 3, 4.
- Treatment options for blepharospasm include botulinum toxin type A (BtA) injections, oral medications such as trihexyphenidyl, baclofen, clonazepam, and tetrabenazine, and surgical procedures such as myectomy of the eyelid protractors or frontalis suspension of the eyelid 4.
- BtA injections are the most commonly used treatment for blepharospasm, and have been shown to be effective in reducing symptoms and improving quality of life 2, 3, 6.
Diagnosis and Assessment
- Diagnosis of blepharospasm is typically made based on clinical evaluation and observation of symptoms, and may involve the use of rating scales such as the Jankovic Rating Scale (JRS) to assess severity and disability 5, 6.
- Assessment of blepharospasm may also involve evaluation of the impact of symptoms on daily life and quality of life, as well as monitoring for potential adverse effects of treatment 6.