Hemifacial spasm

Hemifacial spasm is a neurological disorder that causes one side of the face to twitch involuntarily. It can be caused by several factors: facial nerve injury, a blood vessel touching a facial nerve, or a tumor. Although the face twitching can be uncomfortable, it usually isn’t serious. However, if left untreated, hemifacial spasm can cause additional facial muscles to twitch and spasm.

Hemifacial spasm is treated by a doctor who specializes in neurological disorders called a neurologist. Neurologists at Penn Medicine are among the leading neurology providers in the Philadelphia region. With decades of expertise, we’re committed to helping you treat and manage hemifacial spasm.

Twitching in the eyelid muscle is usually the first symptom of hemifacial spasm. Most people experience occasional eye twitching; however, people with hemifacial spasm notice that the twitching moves to other parts of the face, as well. 

As the disorder progresses, you may experience spasms in the muscles of the lower part of your face. Sometimes, facial twitching causes your mouth to be slightly pulled to the side, which may lead to discomfort and pain. In addition, if you are stressed or tired, the spasms may get worse. 

While the cause of hemifacial spasm is sometimes unknown, it’s most often caused by the following:  

• A blood vessel pressing on a facial nerve
• A facial nerve injury
• A tumor pressing on the nerves

People assigned female at birth are most likely to have hemifacial spasm, though anyone can get it. Hemifacial spasm can be triggered by:

• Anxiety
• Being tired
• Moving your facial muscles
• Stress 

To diagnose hemifacial spasm, your doctor will ask about your symptoms, review your medical history, and do a neurological exam. Hemifacial spasm is diagnosed based on clinical presentation: the characteristic twitch or tic is the best evidence of the condition. However, your doctor may also order a magnetic resonance imaging (MRI) test to help see if any vessels are touching your facial nerve.

There are several treatment options to help manage hemifacial spasm symptoms. Some patients in the initial stages respond well to medication that interrupts the electrical signals that cause twitching and reduces inflammation of the facial nerve. Others require additional treatments. Your provider will recommend treatment based on the severity of your symptoms.

There is no cure for hemifacial spasm, but most people get relief from the facial twitching after treatment. People who undergo Botox or take medication must continue treatment long term to continue being symptom-free. People who undergo surgery usually remain symptom-free, though there is a chance the facial twitching will return.

People with hemifacial spasm can minimize their symptoms by taking these steps: 

• Avoiding fatigue
• Decreasing stress
• Getting plenty of rest
• Limiting caffeine
• Managing anxiety