Hemifacial spasm

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Update Date 11/05/2020 . 4 mins read
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What is hemifacial spasm?

Hemifacial spasm is a nervous system disorder in which the muscles on one side of your face twitch involuntarily. Hemifacial spasm may be caused by a blood vessel touching a facial nerve, a facial nerve injury or a tumor, or it may not have a cause.

How common is hemifacial spasm?

Hemifacial spasms can happen to men or women, but they’re most common in women over 40. They also tend to occur more often on the left side of your face. Please discuss with your doctor for further information.


What are the symptoms of hemifacial spasm?

The first symptom of a hemifacial spasm is involuntarily twitching on only one side of your face. Muscle contractions often begin in your eyelid as mild twitching that may not be too disruptive. This is known as a blepharospasm. You may notice that the twitching becomes more pronounced when you’re anxious or tired. Sometimes, these eyelid spasms can cause your eye to close completely or cause your eye to tear up.

Over time, the twitching may become more noticeable in the areas of your face that it already affects. The twitching may also spread to other parts of the same side of your face and body, including the:

  • Eyebrow
  • Cheek
  • Area around your mouth, such as your lips
  • Chin
  • Jaw
  • Upper neck

In some cases, hemifacial spasms can spread to every muscle in one side of your face. Spasms may also still happen while you’re sleeping. As the spasms spread out, you may also notice other symptoms, such as:

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes hemifacial spasm?

Your doctor may not be able to find out the exact cause of your hemifacial spasms. This is known as an idiopathic spasm.

Hemifacial spasms are often caused by irritation or damage to your facial nerve. They’re commonly caused by a blood vessel pushing on the facial nerve near where the nerve connects to your brain stem. When this happens, the facial nerve may act on its own, sending out nerve signals that cause your muscles to twitch. This is known as an ephaptic transmission, and it’s one of the main causes of these spasms.

An injury to your head or face can also cause hemifacial spasms because of damage or compression of the facial nerve. More uncommon causes of hemifacial spasms can include:

  • One or more tumors pushing on your facial nerve
  • Side effects from an episode of bell’s palsy, a condition that can cause part of your face to be temporarily paralyzed

Risk factors

What increases my risk for hemifacial spasm?

Please discuss with your doctor for further information.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is hemifacial spasm diagnosed?

If you are worried about twitching on one side of your face, you should see your GP. They will ask questions about what has happened and how it is affecting you. They may examine you. If they think it might be hemifacial spasm, they will refer you to a consultant who specialises in nerves (a neurologist). Some neurologists specialise in movement disorders such as hemifacial spasm.

How is hemifacial spasm treated?

Although there is no guaranteed cure currently, various treatments are available.


These can be helpful when the spasms are mild or infrequent. Anti-epileptic medicines such as carbamazepine and topiramate can be helpful in some people with hemifacial spasm. These medicines work by quieting nerve impulses. Benzodiazepine medicines such as diazepam and clonazepam are sedatives. They can relax muscle spasms but may also make you feel sleepy. The response to these medicines can vary and it may take time to get the right dose. They will need to be taken on a long-term basis.


Botulinum toxin is produced by the bacterium Clostridium botulinum. It is usually associated with causing food poisoning called botulism. However, when it is used in controlled doses, it is safely used to relax excessive muscle contraction. It is injected into the facial muscles and blocks the signal from the nerve. This helps to stop the spasms. The effects of the injection last for two to three months and it starts to work within a few days. About 7-8 people out of 10 with hemifacial spasm are helped by botulinum injections.

There can be side-effects of the injection. These are commonly drooping of the eyelid and double vision. They usually wear off after 1 or 2 weeks.


There are several surgical procedures that can be done. Microvascular decompression is one type. It involves removing the blood vessel that may be pressing on the facial nerve. They may be curative but they are often unsuitable for many patients with hemifacial spasm. There are some serious side-effects that may occur as a result of surgery. For this reason, surgery is usually reserved for cases where the spasms are severe and disabling. Surgery is also used when other treatments have failed to work or if you are particularly young.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage hemifacial spasm?

The following lifestyles and home remedies might help you cope with hemifacial spasm:

  • Hemifacial spasms can be controlled through home treatment, medications, or surgery. Follow your doctor’s instructions and you’ll likely be able to keep your muscle twitching to a minimum.
  • Untreated hemifacial spasms may be frustrating as they become more noticeable and disruptive over time, especially if they spread across an entire side of your face. Being honest with your friends and family about your spasms can help you feel more supported as you manage the symptoms of the condition. Joining a support group can help you learn how to treat and further manage your spasms.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

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