Hemifacial spasm, or face twitching, causes involuntary contraction or twitching of the muscles on one side of the face. It can be caused by injury, compression, or damage to the facial nerve.
The facial nerve controls muscles that move your eyebrows, close your eyes, and move your mouth and lips. Typically, you control when the facial nerve contracts these different muscles. But in hemifacial spasm, the nerve contracts these muscles without your control.
The twitching can range in severity from subtle eye twitching to contractions of the whole face. If the twitching happens frequently enough, it can also lead to weakness on that side of the face. Many people with hemifacial spasm are also self-conscious about their appearance.
In most cases, hemifacial spasm cannot be completely cured, but treatments can help reduce the spasms and prevent the symptoms from getting worse.
Most common symptoms
Hemifacial spasm usually causes painless, involuntary movements of the facial muscles on one side of the face. They may get worse over time. For example, for most people with the condition, twitching usually begins in the eye and then gradually affects the muscles that move the mouth or eyebrow.
These contractions also happen during sleep. Over time, this involuntary twitching can lead to sustained spasm of one side of the face causing facial asymmetry or a “grimacing” expression.
Try to get a video recording of your symptoms. Sometimes the twitches are continuous and your doctor will be able to see them during your visit. But if they are not there all the time, a few videos of what is happening can be extremely helpful. —Dr. Karen Hoerst
According to a study in Scientific World Journal, hemifacial spasm is a rare condition that occurs more frequently in women than men. A prior study by the Mayo Foundation study found that most people develop symptoms in adulthood, between 40 to 60 years of age. It does not appear to run in families.
Hemifacial spasm can be caused by injury, compression, or damage to the facial nerve. This leads to abnormal firing of the facial nerve that causes involuntary muscle contractions.
The facial nerve starts in the base of the brain and branches along the side of the face to control the facial muscles. Anything that irritates or interrupts this pathway can cause hemifacial spasm to develop.
The most common cause of hemifacial spasm is the compression of the facial nerve by abnormally developed or irregular blood vessels. Structural differences in the shape of the skull can also compress the facial nerve.
Hemifacial spasm can also be caused by other underlying illnesses (called secondary hemifacial spasm), including:
- Neurologic disorders such as demyelinating disease, which can break down nerves, or a stroke, which can slow blood flow to structures in the brain.
- Masses or tumors in the ear, under the chin, or in the brainstem that compress the facial nerve.
- Ear infections can lead to facial nerve irritation or compression since the facial nerve exits the skull below the ear.
Hemifacial spasm is one of the only neurological movement disorders that continues during sleep. —Dr. Hoerst
Face twitching and stress
Many patients with hemifacial spasm notice that their symptoms are worse when they feel increased stress, fatigue, or anxiety. Relaxation techniques and stress-reducing strategies can help reduce the intensity of symptoms.
Make an appointment to see your doctor in order to get the appropriate diagnosis. Although hemifacial spasm is not usually painful and may be infrequent at first, do not ignore your symptoms or attempt to treat them on your own. There may be a serious underlying cause for your symptoms such as a tumor or neurologic condition that should be treated.
In severe cases without appropriate treatment, hemifacial spasm can progress and cause permanent facial asymmetry, nerve damage, and even blindness from constant closure of the eye.
The main goal of treatment for a facial spasm is reducing the spasm through the use of medication or surgery, based on the underlying cause and how severe they are.
In mild cases, medications might be tried first. In other situations, It might be reasonable to go right to injections with botulinum toxin. Symptom treatment can be very effective. When surgery is needed, it can also make a world of difference. —Dr. Hoerst
- Botulinum toxin (Botox). Although best known for getting rid of facial wrinkles, botulinum toxin is one of the most effective treatments for hemifacial spasm. Botox injections work by paralyzing muscles, which reduces involuntary muscle contraction. A UCSF department of neurology study found that 85% to 95% of patients reported improvement in their symptoms after treatment. Injections need to be repeated every 3 to 4 months or symptoms will return.
- Anticonvulsants. Many anticonvulsant medications are also used to combat nerve irritation and abnormal firing. Your doctor may prescribe medications such as gabapentin or carbamazepine, especially if Botox does not improve symptoms.
If your hemifacial spasm is caused by compression of a blood vessel on the facial nerve, surgery can fix the problem. The surgery is called microvascular decompression. The surgeon releases the facial nerve from the blood vessel at the point where the facial nerve exits the brainstem. Studies done by the China-Japan Friendship Hospital reported that 80% to 88% of patients experienced a significant, if not complete, reduction in their spasms within the first year after the surgery.
If a tumor is pressing on the nerve, surgery may also be needed.
People with hemifacial spasm require close follow-up with their healthcare team regardless of the type of treatment.
If you get injections of botulinum toxin, you will need to have regular injections every 3 to 4 months. For those taking medications, you may need to adjust dosages and types in order to properly manage symptoms.
If you’ve had surgery, you’ll need to follow up regularly to monitor for any complications following the procedures. For example, post-operative risks of microvascular decompression include hearing loss and delayed facial paralysis.
Hemifacial spasm generally cannot be prevented. However, since the condition can be exacerbated by stress and anxiety, you may be able to improve your day-to-day symptoms by trying the following lifestyle changes:
- Decrease stress. Reducing stress is much easier said than done, but taking up activities such as yoga or meditation can give you the tools to help deal with life’s stressors in healthy ways.
- Eat a healthy, balanced diet. Replacing beverages such as caffeine or alcohol with water can help to reduce stress and anxiety.
- Get adequate sleep. Hemifacial spasm also occurs while you sleep and can make getting a good night’s rest a challenge. Work with your doctor to develop a bedtime regimen, whether that includes medication or relaxation techniques. Getting enough sleep will help manage your symptoms and improve your symptoms over time.
Dr. Gambrah-Lyles is a resident pediatrician at the Children's Hospital of Philadelphia. She is a graduate of the University of Pennsylvania Perelman School of Medicine (2019). She graduated cum laude and received her undergraduate degree in Biochemistry and Spanish from Washington University in St. Louis (2013). Her research explores the intersections between neurology, public health, and infectious disease. She has investigated nutrition and cerebral palsy in Botswana, and completed a year-long project in Brazil, researching growth and developmental outcomes of Zika virus infection in pediatric patients as a Doris Duke International Scholar. Dr. Gambrah-Lyles speaks four languages, loves staying active, and enjoys sharing her love for medicine through teaching and writing.