Understanding Hemifacial Spasms: Everyday Challenges and Tips for Relief

Share this on:Copied!

Living with hemifacial spasm — involuntary facial twitching — can cause daily challenges. People with this rare neurological condition may face physical and mental symptoms. They may struggle to complete everyday activities.

Treatment can help people manage their symptoms.

Learn more about hemifacial spasm. The following includes what causes it and typical symptoms. It also includes how to live with it.

What Is Hemifacial Spasm?

Hemifacial spasm is a cranial nerve disorder. It causes involuntary twitching and occurs because of dysfunction with the facial nerve. The facial nerve carries signals from the brain to muscles in the face.

“The facial nerve allows us to move our faces,” says Georgios Zenonos, MD, neurosurgical director, UPMC Center for Cranial Base Surgery.

When someone has hemifacial spasm, the facial nerve tells the muscles in the face to contract without a reason. These contractions lead to involuntary twitching.

What Causes Hemifacial Spasm?

The most common cause of hemifacial spasm is an enlarged or abnormal artery that presses on the facial nerve as it leaves the brain stem. This pressure causes the facial nerve to behave irregularly. The medical term for this is primary hemifacial spasm.

Hemifacial spasm can also occur due to other medical conditions disrupting the facial nerve, including but not limited to:

• Bell’s palsy.
• Ear infections.
• Facial trauma.
• Multiple sclerosis.
• A tumor pressing on the facial nerve.

The medical term for these causes is secondary hemifacial spasm.

What Are the Symptoms of Hemifacial Spasm?

The most common symptom of hemifacial spasm is involuntary facial twitching. It typically happens on one side of the face.

“It can start very insidiously,” Dr. Zenonos says. “It usually starts around the eye in a muscle called the orbicularis oculi. So, it starts around the eye, but over time, it can extend to involve most of the face.”

The twitching is usually painless. It’s also generally intermittent at first but can occur more often over time. The twitching starts around the eye but eventually may involve other parts of the face, such as the cheek or mouth.

Many people exhibit what’s called “the reverse Babinski sign”: an involuntary eyebrow raise as the eyelid closes.

Some people may hear a clicking sound. Hemifacial spasm can also affect one of the muscles of the ear.

Doctors can diagnose hemifacial spasm through a physical examination, medical history, or magnetic resonance imaging (MRI). They can also perform specialized neurophysiologic tests. These can include lateral spread electromyography (EMG) response.

Coping With Hemifacial Spasm

The twitching from hemifacial spasm is painless. But living with hemifacial spasm can still feel challenging. It can affect:

• Activities of daily living — People with hemifacial spasm may have trouble with activities like reading, driving, or eating because of their twitching.
• Mental health — Many people with hemifacial spasm suffer mental health burdens because of the condition. They may feel anxious or self-conscious about their facial twitches. A 2025 study in Scientific Reports reported that people with hemifacial spasm had higher levels of anxiety, depression, and social phobia.
• Sleep — Facial twitching from hemifacial spasm can make it difficult to get to sleep or stay asleep. A 2024 study in the Annals of Movement Disorders reported a link between hemifacial spasm and poor sleep.

Hemifacial Spasm Lifestyle Tips

Common triggers for hemifacial spasm include fatigue, stress, and anxiety. Avoiding these triggers may help you manage your symptoms.

Some tips include:

• Focus on sleep — Fatigue can trigger hemifacial spasm, but hemifacial spasm can also make sleep more difficult. If you’re struggling with sleep and are looking for solutions, talk to your doctor about tips for better sleep.
• Manage stress — Stress and anxiety are both triggers for hemifacial spasm. Finding ways to manage your stress, such as through exercise, meditation, or other means, can prove beneficial.
• Talk to a mental health professional — Research has linked hemifacial spasm to higher levels of mental health challenges. Examples of these can include anxiety, depression, and social phobia. Finding and talking to a licensed mental health professional may help.

If you find that you’re still struggling with the challenges of hemifacial spasm, you may wish to seek medical treatment.

Treatment for Hemifacial Spasm

Treatment can help address the twitching brought on by primary hemifacial spasm. It can include botulinum toxin (BOTOX®) injection, which is a temporary measure, and surgery.

In the case of secondary hemifacial spasm, treating the underlying cause can help reduce the hemifacial spasm.

Botox injections

Botox injections have long served cosmetic purposes, such as reducing wrinkles. But it can also treat hemifacial spasm. Botox paralyzes the facial muscles, preventing them from twitching.

“If you use it strategically, it can keep the nerve from actually reaching the muscle to instruct it to contract,” Dr. Zenonos says. “So even though the nerve is telling the muscle to contract, the muscle is not because it’s paralyzed. This can help with some of the symptoms.”

However, the improvement in hemifacial spasm from Botox injections is often temporary and incomplete. In addition, many patients don’t like that the Botox causes facial paralysis. Think of it as silencing the symptoms rather than treating their cause.

Surgery for hemifacial spasm

Surgery can address the underlying cause of primary hemifacial spasm by separating the facial nerve from the artery that’s putting pressure on it. This happens during a procedure known as microvascular decompression.

In microvascular decompression, a neurosurgeon makes a small incision behind the ear and a small hole in the skull.

When a small artery is causing pressure on the facial nerve, the surgeon places a small Teflon pad between them to separate them. For larger arteries, they use a sling technique. They place a loop around the artery and secure it to the skull to gently lift the artery away.

Although it can take a few weeks for patients to feel the full effects, microvascular decompression can cure hemifacial spasm. According to a 2025 article in the Journal of Neurology, microvascular decompression can benefit up to 90% of people with hemifacial spasm.

“This is extremely effective, and it’s usually the only thing that can get to the root of a problem,” Dr. Zenonos says. “If you have a primary hemifacial spasm, usually microvascular decompression is the answer.”

The UPMC Department of Neurosurgery, part of the UPMC Neurological Institute, specializes in treating cranial nerve disorders like hemifacial spasm. We have treated more than 22,000 patients with cranial nerve disorders.

“A lot of these procedures have been refined to be quite minimally invasive,” Dr. Zenonos says. “We have decreased the morbidity and the footprint on the patients significantly, and we’ve made them a very safe and effective option for patients. The field keeps evolving, and we keep wanting to make things better, but we’re very lucky to be able to treat patients here.”

For more information on the UPMC Department of Neurosurgery, visit our website.