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Hemifacial Spasm Treatment & Diagnosis

Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju
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Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju

A hemifacial spasm is a unilateral involuntary painless contraction of one muscle. It can also affect several groups of facial muscles. Most often, the disorder begins with a twitching of the circular muscle of the eye and passes to half of the face. The diagnosis of hemifacial spasm is simple. The entire half of the face has irregular, uncontrolled contractions. They are usually caused by speech, laughter, or emotional distress. The appearance is so typical that no other methods are necessary to make the diagnosis. But, physicians often prescribe radiological examinations to diagnose. It helps to determine the underlying cause of the compression and treatment. Neurologists use instrumental examinations for hemifacial spasms. First, doctors use MRI in a special mode to treat a hemifacial spasm. This is necessary to rule out vascular and neural conflict in the brain’s structures.

When vascular conflict is detected, doctors use surgical treatment. Medication and botulinum therapy may be helpful. In most cases, doctors use it when they have not confirmed the cause of nerve-vessel contact.

In this article, we will discuss the hemifacial spasm diagnosis and treatment. So read below for more information.

What triggers hemifacial spasm?

There are several causes of hemifacial spasms. One of them can be Parkinson’s disease or dystonia. Hemispasm is usually caused by vascular compression of the facial nerve root. Most often, it is the anterior inferior cerebellar artery. But compression of the posterior inferior cerebellar artery can affect:

  • the root by the posterior inferior cerebellar artery;
  • the superior cerebellar artery;
  • vertebral artery;
  • the labyrinthine artery;
  • main artery;
  • branches of the anterior inferior cerebellar artery. 

Less frequently, compression by vascular malformations or veins is possible. Doctors can recognize these symptoms of hemifacial spasm with MRI.

The cause of hemifacial spasm can sometimes also be:

  • benign tumors or cysts in the cerebellopontine angle;
  • foci of demyelination in multiple sclerosis;
  • adhesions;
  • bone deformities;
  • tumors of the 4th ventricle, brainstem, and cerebellum. 

Neurological diseases cause hemifacial spasms. These may also include hereditary and genetic diseases. 

Hemifacial Spasm Diagnostic

Usually, the universal hemifacial spasm diagnosis sequence is:

  • Neurological examination and interview of the patient;
  • MR angiography;
  • CT (computed tomography);
  • ENMG (electroneuromyography).

Early cases of hemifacial spasm are sometimes difficult to distinguish from:

  • facial myokymia;
  • tics or myoclonus. 

After all, they can cause pathological processes in the cerebral cortex or the brain stem. In such cases, the most valuable diagnostic method is neurophysiological testing.

There are several criteria for hemifacial spasm diagnosis with corresponding clinical manifestations:

  • broad and variable synkinesis in the blink test;
  • high-frequency discharges on electromyography (EMG).

Stimulation of one branch of the facial nerve can extend to the entire face. It can also cause a response in a muscle innervated by another branch. Synkinesia is absent in essentially blepharospasm, dystonia, or epilepsy. Needle myography shows irregular, short, high-frequency bursts of potentials of motor units. They correlate with the observed facial movements.

Magnetic resonance imaging is the diagnostic method of choice. MRI  is appropriate when physicians need to rule out compression in a hemifacial spasm. Cerebral angiography is usually ineffective in diagnosing hemifacial spasms. Ectasized blood vessels are rarely detected. And these vascular findings can be difficult to correlate with nerve exposure. Neurologists perform angiography and magnetic resonance. But angiography is usually used for surgical, vascular decompression.

Hemifacial Spasm Treatment Methods

Hemifacial Spasm Treatment Methods

This condition can be frustrating and embarrassing for those who experience it. As it can cause difficulty with facial expressions, eye problems, and social discomfort. Fortunately, several treatment options are available for hemifacial spasms. So can help manage symptoms and improve quality of life.

The most common medical treatments for hemifacial spasms include:

  • botulinum toxin injections;
  • medical treatment;
  • surgical interventions, such as microvascular decompression or facial nerve resection. 

These hemifacial spasm treatments aim to relieve pressure on the affected facial nerve. In doing so, they reduce muscle contractions and improve facial muscle function. Although medical treatments are effective, they may not be suitable for everyone. And some people may prefer alternative or complementary therapies to relieve their symptoms.

Besides medical treatment, alternative therapies may also be great for treating hemifacial spasms. These may include methods such as: 

  • acupuncture;
  • chiropractic care;
  • massage therapy;
  • mind-body techniques.

The effectiveness of these treatments may vary from person to person. So, discussing alternative therapies with a doctor before trying them is important. Read more about the most effective hemifacial spasm treatment options.

Botulinum toxin injections

Botulinum toxin injection under electromyography (EMG) monitoring is the best method. Usually, it is a choice for most patients with hemifacial spasms. Chemodenervation is safe and has a good therapeutic effect on most patients. It is especially good for those with persistent contractions. Spasms disappear 3-5 days after injection and last about six months.

Medication hemifacial spasm treatment

Treatment of hemifacial spasms most often begins with medication therapy. Usually, doctors use drugs from different pharmacological groups: 

  • baclofen;
  • carbamazepine;
  • gabapentin;
  • clonazepam. 

But, it is necessary to consider their side effects, which can affect patients’ lives. Because hemifacial spasm requires regular intake of the above drugs. Scientists have studied the effects of drugs on these pharmacological groups. They conducted studies on small groups of patients without placebo control. Doctors use botulinum toxin type A quite extensively to treat HPS. Therapists inject it subcutaneously or intramuscularly into the affected muscles. These can include:

  • facial muscle palsy;
  • ptosis;
  • keratitis;
  • drooling;
  • strabismus.

Hemifacial spasm surgery methods

The best treatment for hemifacial spasms is vascular decompression. Doctors perform this operation only for a reasons. It is needed when the patient is socially disadvantaged and informed about the possible results of treatment. It may not occur immediately but takes about 6-8 months. So it is not customary to revise immediately after surgery. Complete regression after surgery – about 86%. In general, hemifacial spasm surgery is beneficial for treating the disease.

Alternative therapies

There is no conclusive evidence to support alternative therapies for hemifacial spasm treatment. Some people have found them helpful in managing their symptoms: 

  • Acupuncture involves the insertion of thin needles into specific points on the body to stimulate energy flow. Some studies have suggested that acupuncture may help reduce muscle spasms. So it improves facial muscle function in people with hemifacial spasms.
  • Chiropractors use spinal adjustments and manual techniques to align the body. 
  • Mind-body techniques like meditation, yoga, and tai chi can help reduce stress and promote relaxation.

How can you stop facial spasms? 

Besides medical and surgical interventions, certain lifestyle changes can also be beneficial. So people can use them instead of more serious methods, such as hemifacial spasm surgery. These may include stress-reducing techniques such as:

  1. meditation or yoga;
  2. getting enough sleep;
  3. avoiding caffeine and alcohol;
  4. maintaining a healthy diet;
  5. exercise routine. 

It is important to note that while triggers may exacerbate hemifacial spasm symptoms, they are not the underlying cause. Thus, while managing triggers can help manage symptoms, working with a medical professional is important. They can determine the appropriate treatment plan based on found causes.

If you or a loved one is experiencing symptoms, contact our clinic. Lone Star Neurology has a wide range of services to treat these conditions. Our professional team of neurologists and doctors of the highest calibre will ensure a comfortable treatment and hemifacial spasm diagnosis. Contact our clinic without hesitation, and we will help you!


  • What is the first line treatment for hemifacial spasm?

The first-line treatment for hemifacial spasms is botulinum toxin injections. Botulinum toxin is a neurotoxin that temporarily paralyzes the muscles responsible for the spasms, relieving the symptoms. The injections are typically administered every 3-6 months. It depends on the individual’s response and the severity of the condition.

  • How long does it take to treat hemifacial spasms?

Typically, botulinum toxin injections, the first-line treatment, relieve symptoms for about 3-6 months and must be repeated regularly for ongoing management. The duration of treatment will be determined on a case-by-case basis by a healthcare professional.

  • Can facial massage help in hemifacial spasms?

Yes, some people have reported relief from their symptoms after receiving regular massages. But massage therapy has not been extensively studied for hemifacial spasms.

  • How do I stop facial spasms?

Still, the most effective method to relieve facial muscle hypertonicity today is botulinum therapy, which can only be performed by a competent beautician after consultation.

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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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