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Hemifacial Spasm

What is Hemifacial Spasm?

Hemifacial spasm is a neuromuscular condition marked by frequent involuntary contractions of the muscles on one side of the face. It is rarely seen on both sides of the face. Both men and women may suffer from hemifacial spasm, but the condition occurs more often in middle-aged and elderly women, and more frequently in the Asian population.

While it is not usually painful, hemifacial spasm can interfere with normal facial expressions. In some people, it can affect vision and interfere with daily activities such as driving, working, and sleeping, and in other ways negatively affect quality of life.

Causes of Hemifacial Spasm

Facial nerve injuries or tumors may cause hemifacial spasm, but most often it is caused by a blood vessel pressing on the facial nerve where it leaves the brainstem. The condition also may have no apparent cause.

Symptoms of Hemifacial Spasm and Diagnosis

Hemifacial spasm typically begins with intermittent twitching of the eyelid and muscles around the eye that causes the eye to close. The spasm may spread gradually to the muscles in the lower face and can pull the mouth to one side. Eventually, the spasm may involve all of the muscles on one side of the face almost continuously. Other less common symptoms include a clicking sound in the ear, hearing loss, ear pain, and vision impairment.

Because the symptoms of hemifacial spasm can also occur with other medical conditions, a variety of tests usually are necessary to ensure an accurate diagnosis. They may include a neurological exam of the eyes, vision, muscle strength, and reflexes; electromyography that records and measures electrical activity of the muscles; MRI and/or CT scan; and angiography, an x-ray of the blood vessels using contrast dye.


Some people become relatively free of symptoms with injections of botulinum toxin A (Botox®).  Microvascular decompression, a surgical treatment, can relieve pressure on the facial nerve and improve hemifacial spasm. As with all surgeries, the risks have to be carefully weighed against the benefits.

The Face Pain and Headache Clinic at UTHealth Houston Neurosciences brings together a multidisciplinary team of board-certified, fellowship-trained neurosurgeons, neurologists, researchers, and pain management specialists who work together to provide relief for even the most complex problems. People who suffer from migraine, cluster headache, trigeminal neuralgia, hemifacial spasm, pineal cyst, and other disorders benefit from collaborative, highly specialized expertise focused on managing chronic headaches and face pain.

What You Can Expect at UTHealth Houston Neurosciences

At UTHealth Houston Neurosciences, neurologists, neurosurgeons, interventional pain management specialists, neuro-oncologists, radiation oncologists, and neuropathologists work together to determine the care each patient needs, discussing treatment options as a group. This approach saves our patients time and money and allows our specialists to share each other’s insights, leading to better treatment decision-making and outcomes.

We first investigate options for nonsurgical treatment, including medical management, pain management, physical therapy, rehabilitation, and watchful waiting. When surgery is needed, our neurosurgeons routinely employ innovative minimally invasive techniques. Throughout the treatment process, our team works closely with the doctor who referred you to ensure a smooth transition back to your regular care plan. While you are with us, you can expect expert care, excellent communication, and genuine compassion.

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Contact Us

At UTHealth Houston Neurosciences, we offer patients access to specialized neurological care at clinics across the greater Houston area. To ask us a question, schedule an appointment, or learn more about us, please call (713) 486-8000, or click below to send us a message. In the event of an emergency, call 911 or go to the nearest Emergency Room.