What is Hemifacial Spasm? Symptoms, Causes, and Treatment

Several neurological conditions mainly affect the face and jaw. One of such conditions is a hemifacial spasm. Hemifacial spasm is described as an involuntary and painless contraction of the facial muscles. It is often considered as a twitch of the muscle on one side of the face. A hemifacial spasm can even occur during sleep.

Mild cases of hemifacial spasm are not considered a health hazard. However, in severe cases, the eyes may involuntarily remain shut for a long time, which can be dangerous in situations such as driving. The prevalence of hemifacial spasm is more in middle-aged women. Typically, hemifacial spasm is caused by compression of the nerves by a tumor, nerve damage, or cluster of blood vessels.


Usually, this condition is diagnosed with the help of imaging tests to identify the cause, followed by an appropriate treatment regime. Treatment may include the use of Botox or surgical repair. Today’s article will highlight the prime characteristics of hemifacial spasm. Furthermore, we will discuss the causes and treatment of hemifacial spasm.

What is the hemifacial spasm?

Hemifacial spasm, also known as tic convulsive, is characterized as a contraction or twitching of the facial muscles that usually affect only one side of the face. Often, such contractions are not under the control of the individual. Typically, hemifacial spasm is caused by damage or irritation of the seventh cranial nerve – the facial nerve. (1)

Some of the common areas affected by hemifacial spasm include the cheek, mouth, and eyes. As the condition progresses, it involves the other parts of the face. Hemifacial spasm commonly occurs in middle-aged Asian women. Moreover, it tends to affect the left side of the face. Although this condition is painless, the constant twitching of the muscle caused by hemifacial spasm can be uncomfortable and irritating. In severe cases, such spasms can limit the functions of the eye and mouth. (2)

What causes the hemifacial spasm?

Often, hemifacial spasm is considered as an idiopathic condition as it is challenging to identify the exact cause of the spasm. However, it is mostly linked to the damage or irritation of the facial nerve. Some of the causes of facial nerve damage may include –

  • Compression of the nerve by a tumor or cyst
  • Compression of the nerve by a large blood vessel at the point where the facial nerve connects to the brain stem (3)
  • A side effect of bell’s palsy – a condition that temporarily paralyzes the facial muscles on one side of the face
  • Multiple sclerosis is also associated with hemifacial spasm

What are the clinical symptoms of hemifacial spasm?

As the name suggests, one of the prime symptoms of hemifacial spasm is the involuntary twitching of the facial muscles on one side of the face. Usually, the muscle contraction begins from the eyes, specifically the eyelids. Such type of contraction is referred to as blepharospasm. (4)

The contraction of the muscle becomes more pronounced when the individual is tired or anxious. In severe cases, it may lead to prolonged episodes of eye twitching. As the muscle contraction expands, it involves other parts of the face such as –

  • Eyebrows
  • Cheek and lips
  • Chin and jaws
  • Upper neck

Symptoms of muscle contraction may even continue during sleep. As the condition progresses, the individual may experience the following symptoms –

  • Hearing loss
  • Tinging in the ear (5)
  • Ear pain
  • Spasm of the entire face

What is the treatment for hemifacial spasm?

Although the physical symptoms of hemifacial spasm confirm the presence of this condition, a doctor may advise for imaging tests such as CT scan, MRI, and angiography to identify the cause of hemifacial spasm. Furthermore, imaging tests can locate the tumor or blood vessel and allow the doctor to plan the treatment. Typically, there are two types of treatments for hemifacial spasm –

Botox injections

Botox – botulinum shots are primarily used to paralyze the facial muscle and control the twitching. It is one of the conventional treatments for hemifacial spasm, and almost 85-95% of the people with hemifacial spasm are treated with Botox. (6) The effect of one Botox injection remains for at least three to six months. Therefore, people with hemifacial spasm may have to undergo follow-up treatments periodically.

Surgical repair

Surgical repair is invasive but a permanent solution to cure hemifacial spasm. A procedure called microvascular decompression is performed to relieve the pressure from the facial nerve. Furthermore, a Teflon is the padding placed to protect the nerve from damage. Surgical procedures are advantageous in young people at an early stage of hemifacial spasm. However, there is always a risk of hearing impairment during this procedure.

Although hemifacial spasm can only be cured with appropriate treatment, it is essential to reduce stress, fatigue, and anxiety – elements that can trigger an episode of facial twitching.

Take away message

Hemifacial spasm is a unique condition that is characterized by involuntary contraction of the facial muscles on one side of the face. It is typically caused due to facial nerve damage from a tumor or large blood vessel. Hemifacial spasm usually affects middle-aged women and increases the risk of hearing loss in advanced stages. Some contributing factors that may trigger the twitching include stress, anxiety, and fatigue. It is essential to prevent such situations and limit the contraction of the muscle.


Usually, diagnosis is made based on imaging studies that identify the cause and locate the position of the damage. Treatment depends on the patient’s comfort. Most patients are treated with Botox injections. However, surgical decompression of the facial nerve may provide a permanent solution to cure this unique condition.


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