Hemifacial spasm

Overview

Hemifacial spasm is a condition where the muscles on one side of your face twitch or contract involuntarily. It happens when the nerve that controls your facial muscles gets irritated, often by a nearby blood vessel pressing on it.

No, hemifacial spasm is not common. It affects about 7 to 15 people in every 100,000.

It mostly affects middle-aged and older adults, and it is more common in women than in men. It rarely occurs in children.

Symptoms

Common symptoms

• Twitching or spasms around one eye that may spread to the cheek and mouth
• Forced closing of the eye on the affected side
• Spasms that happen more often when you are stressed or tired
• Spasms that may continue even during sleep

Symptoms in children

• Hemifacial spasm is very rare in children, but if it occurs, the symptoms are the same as in adults.

Symptoms in older adults

• In older adults, symptoms may be more noticeable because the spasms can become more frequent and involve more facial muscles over time.

Causes

Main causes

• A blood vessel pressing on the facial nerve at the base of the brain (most common cause)
• Sometimes a tumor or cyst pressing on the nerve
• In rare cases, damage to the facial nerve from injury or infection

Risk factors

• Being older (over 40 years)
• Being female
• High blood pressure (hypertension)
• Family history of hemifacial spasm (rare)

When to see a doctor

See a doctor urgently if:

• If you have sudden facial weakness or difficulty moving one side of your face
• If the spasms are so severe that your eye stays closed

Book a routine appointment if:

• If you notice frequent twitching or spasms on one side of your face that do not go away
• If the spasms affect your vision or ability to speak or eat

Diagnosis

A doctor, often a neurologist (a specialist in the nervous system), will diagnose hemifacial spasm based on your symptoms and a physical exam. They may also do tests to confirm the cause.

Tests that may be done

• Neurological exam to check facial muscle strength and reflexes
• Magnetic resonance imaging (MRI) of your brain to look for a blood vessel or other structure pressing on the facial nerve
• Electromyography (EMG) to measure the electrical activity of your facial muscles

What to expect at your appointment

The diagnosis is usually straightforward. The doctor will watch your face as you make different expressions. If an MRI is needed, you will lie still inside a machine that takes detailed pictures of your brain. The whole process is painless but can take up to an hour.

Treatment

Treatment for hemifacial spasm aims to reduce or stop the spasms. The best treatment depends on the cause and how much the spasms affect your daily life.

Self-care at home

• Reduce stress with relaxation techniques like deep breathing or meditation
• Get enough sleep and rest
• Avoid triggers that make spasms worse, such as caffeine or excessive screen time
• Wear sunglasses or use a brimmed hat if bright light worsens your symptoms

Medical treatments

The most common treatment is using botulinum toxin injections, which are given by a doctor to relax the overactive muscles. This treatment is effective and can be repeated every few months. Your doctor may also recommend oral medications that help calm the nerve, but these are less commonly used because of side effects and lower success rates. Always discuss the benefits and risks with your doctor.

When is surgery considered?

If other treatments do not work, surgery may be an option. The most common surgery is called microvascular decompression, where a surgeon moves the blood vessel away from the facial nerve. This can provide long-term relief, but it carries risks such as hearing loss or facial weakness. Your doctor will explain the details if surgery is considered.

Living with this condition

Living with hemifacial spasm can be frustrating, but most people can manage it well with treatment. You may need to adjust your daily activities to avoid triggers and schedule regular injection appointments if you choose that therapy.

Lifestyle tips

• Practice good sleep habits
• Manage stress through hobbies, exercise, or talking with friends
• Avoid stimulants like too much caffeine or energy drinks
• Protect your eyes if spasms affect your vision

Diet and exercise

A balanced diet and regular physical activity can help reduce stress and improve overall well-being. There is no specific diet that prevents or treats hemifacial spasm, but staying healthy supports your nervous system.

Mental health and emotional wellbeing

Having a visible condition like hemifacial spasm can affect your self-confidence and cause anxiety or depression. It's important to talk to your doctor if you feel sad, worried, or embarrassed. They can connect you with a counsellor or support group.

Prevention

Hemifacial spasm cannot be prevented, as it is usually caused by an artery pressing on a nerve. However, managing blood pressure and avoiding head injuries may reduce the risk.

Vaccines

Not applicable

Screening programmes

Not applicable

Complications

If left untreated

• Spasms may become more frequent and more severe over time
• The affected side of the face may develop mild weakness if the nerve is compressed for a long time
• Rarely, the spasm can spread to the neck or the entire face

Long-term outlook

Hemifacial spasm is not a life-threatening condition, and with proper treatment, most people experience significant relief. The spasms can be controlled, and you can maintain a good quality of life. Many people find that injections work well for years.

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