Hemifacial Spasm

Medically reviewed by Seunggu Han, MD on August 22, 2017Written by Tim Jewell on August 22, 2017

What is a hemifacial spasm?

Hemifacial spasms happen when the muscles on only one side of your face twitch without warning. These types of spasms are caused by damage or irritation to the facial nerve, which is also known as the seventh cranial nerve. Facial spasms occur when the muscles contract involuntarily because of this nerve irritation.

Hemifacial spasms are also known as tic convulsif. At first, they may appear only as small, barely noticeable tics around your eyelid, cheek, or mouth. Over time, the tics may expand to other parts of your face.

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.

Hemifacial spasms aren’t dangerous on their own. But a constant twitch in your face can be frustrating or uncomfortable. In severe cases, these spasms can limit function due to involuntary eye closing or the impact they have on speaking.

In some cases, these spasms may indicate that you have an underlying condition or an abnormality in your facial structure. Either of these causes can compress or damage your nerves and make your face muscles twitch.

What are the symptoms of hemifacial spasms?

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:

  • changes in your ability to hear
  • ringing in your ears (tinnitus)
  • ear pain, especially behind your ear
  • spasms that go down your entire face

What causes hemifacial spasms?

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

How can I treat hemifacial spasms?

You may be able to reduce your symptoms at home simply by getting plenty of rest and limiting how much caffeine you drink, which can calm your nerves. Having certain nutrients can also help reduce your spasms, including:

  • vitamin D, which you can get from eggs, milk, and sunlight
  • magnesium, which you can get from almonds and bananas
  • chamomile, which is available as a tea or as tablets
  • blueberries, which contain muscle-relaxing antioxidants

The most common treatment for these spasms is an oral muscle relaxer that keeps your muscles from twitching. Your doctor may recommend one or more of the following medications to relax your face muscles:

Botulinum toxin type A (Botox) injections are also commonly used to treat hemifacial spasms. In this treatment, your doctor will use a needle to inject small amounts of Botox chemicals into your face near the muscles that are twitching. Botox makes the muscles weak and can reduce your spasms for three to six months before you need another injection.

Talk to your doctor before taking any of these medications about any possible side effects or interactions with other medications you may already be taking.

If medications and Botox aren’t successful, your doctor may also recommend surgery to relieve any pressure on the facial nerve that may be caused by a tumor or a blood vessel.

A common surgery used to treat hemifacial spasms is called a microvascular decompression (MVD). In this procedure, your doctor makes a small opening in your skull behind your ear and puts a piece of Teflon padding between the nerve and the blood vessels pushing on it. This surgery only takes a few hours at most, and you’ll likely be able to go home after a few days of recovery.

Associated conditions and complications

Facial spasms can also be caused by a similar condition called trigeminal neuralgia. This condition is caused by damage or irritation to the fifth cranial nerve rather than the seventh. Trigeminal neuralgia can also be treated with many of the same medications and procedures.

An untreated tumor can cause further nerve damage as the tumor grows or becomes cancerous. Cancer can quickly spread to other parts of your head and brain and cause long-term complications.

As with any surgery, the MVD procedure can potentially cause complications, such as infections or trouble breathing. But MVD surgery rarely causes any serious complications.

Prognosis and outlook

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. The MVD procedure is frequently successful in decreasing or eliminating these spasms.

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.

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