What does it mean when your face is twitching

Table of Contents Show

• Causes and Symptoms of Face Twitching
• Diagnosing and Treating Facial Twitching
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• What is hemifacial spasm?
• How common is it?
• What causes it?
• Is it inherited?
• What are the symptoms of hemifacial spasm?
• How do doctors diagnose it?
• What treatments are available for hemifacial spasm?
• Is there anything I can do to help myself?
• What is the outlook (prognosis)?
• What causes a twitch in the face?
• Is face twitching normal?

Facial twitching, medically known as a hemifacial spasm, is categorized by an involuntary twitching or contraction of the facial muscles on one side of a person’s face. Your facial muscles are controlled by the facial nerve, which begins at the brainstem and exits the skull below the ear. It is a motor nerve that controls your eyebrows, mouth and lips, but if it becomes damaged or compressed, it can cause muscle spasms that lead to facial twitching. Below, we take a closer look at facial twitching, and we explain how to treat it.

Causes and Symptoms of Face Twitching

As we noted above, facial twitching is usually caused by acute injury or compression of the facial nerve, but it can also be brought on by a condition known as Bell’s palsy. The most common point for compression of the facial nerve is right near its origin in the brainstem, and the compression is often caused by the anterior inferior cerebellar artery. When the nerve is compressed, it begins to misfire, which results in facial muscle contraction.

Since facial twitching is a symptom in and of itself, there are not a lot of other symptoms that appear when the facial nerve is compressed, although some people do report mild to moderate pain. In the vast majority of cases, the spasms start close to the eye and progress down the face as time goes on. In about eight percent of cases, the facial twitching begins near the chin and progresses up towards the eye. The average age of a person who deals with this condition is 44 years old, and is more likely to be female.

Diagnosing and Treating Facial Twitching

If you’re experiencing acute or chronic facial twitching, or if the spasms are becoming more frequent, give Dr. Chang or a specialist in your area a call. He’ll begin the diagnostic process by reviewing your medical history and asking you about your symptoms. From there, he’ll conduct a physical exam that may include some manipulation exercises to see if compression triggers the spasm.

Once he has an idea of what might be causing your facial twitches, he’ll confirm his suspicions with an imaging test like an MRI, which can also rule out issues like a brain tumor or aneurysm. An electromyogram may also be conducted to study the nerve and muscle activity in your face.

If you’ve been diagnosed with a hemifacial spasm, you have a variety of treatment options available to you based on the underlying cause of the condition. Here’s a look at some treatment options:

• Medication – Muscle relaxers can help to control mild cases of hemifacial spasm, but they can cause other side effects, so patients who fit the criteria for medications are carefully monitored.

• Botox – Botox injections help to block nerve impulses that trigger muscle movement. Botox is a pretty successful treatment option, but the effects usually only last about three months, so it isn’t a great long-term option.

• Surgery – A minor surgical procedure called a microvascular decompression can relieve facial nerve compression. More than 90 percent of patients are back to their regular lifestyle within two months post-op, while about seven percent suffer a recurrence of symptoms after surgery.

If you or someone you know is dealing with uncontrollable facial twitching, don’t just power through the condition. Have it examined by a specialist like Dr. Chang, and you’ll be amazed at how easily the issue can be treated. Reach out to his clinic for more information.

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Hemifacial spasm is a condition that affects half of your face. It usually starts with a twitching around one eye. It may gradually involve your mouth also. There are different types of treatment. Although the condition is not dangerous, it can affect quality of life.

What is hemifacial spasm?

A spasm is a sudden, involuntary contraction of a muscle or a group of muscles. Hemifacial means half of the face.

The muscles of the face are all controlled by the facial nerve. There is a facial nerve for each side of the face. It starts deep inside your brain and makes its way past many structures to reach the face. The facial nerve carries signals from the brain to make your facial muscles contract or relax. For example, the facial nerve makes you blink, twitch your nose and pout your lips.

If something presses on the nerve somewhere along its course, it can affect how the signals are carried to the face. This may cause muscles to twitch (or contract), or to go into spasm, when you don't want them to.

More temporary twitches of the muscles of the face are NOT hemifacial spasm. For example, facial tics and twitches, and muscle spasms around the eyes (blepharospasm) are different conditions. In these other conditions often both sides of the face can be affected, although not necessarily at the same time.

How common is it?

Hemifacial spasm is a rare condition. In the UK there are thought to be about 4,000 people with hemifacial spasm. It affects men and women, although women tend to be affected slightly more often than men. Symptoms usually start in middle age.

What causes it?

The cause of hemifacial spasm is not fully understood. At the moment, doctors believe the main cause is pressure on the facial nerve from a structure or abnormality within the brain. The most common finding is a blood vessel at the base of the brain, pressing on the nerve. There are other, rare causes too such as infections or strokes. Sometimes there is no obvious cause and doctors may then call it idiopathic hemifacial spasm. Idiopathic means 'of unknown cause'.

Is it inherited?

Because the causes of hemifacial spasm are not inherited, it is unlikely that you will pass the condition on to your children.

What are the symptoms of hemifacial spasm?

Twitching usually begins around the eye. At first the twitching spasms may come and go. Gradually the spasms become worse and the spasm may become permanent. The left side is more often affected than the right. The twitches may spread to involve other muscles on the same side of the face. The mouth and jaw are often involved. The corner of the mouth can become pulled up by permanent spasm. Some people also hear a clicking sound on the side that is affected when the spasm comes.

Some people may have quite a mild condition that causes inconvenience and embarrassment. Others find the spasms may affect their vision and their ability to drive. As the other eye is not affected, they are still able to see.

For some people the spasms may become worse when they are tired and stressed. They may also improve when they lie down.

How do doctors diagnose it?

If you are worried about twitching on one side of your face, you should see your GP. They will ask questions about what has happened and how it is affecting you. They may examine you. If they think it might be hemifacial spasm, they will refer you to a consultant who specialises in nerves (a neurologist). Some neurologists specialise in movement disorders such as hemifacial spasm. 

What treatments are available for hemifacial spasm?

Although there is no guaranteed cure currently, various treatments are available.

Medicines

These can occasionally be helpful when the spasms are mild or infrequent. Anti-epileptic medicines such as carbamazepine and topiramate can be helpful in some people with hemifacial spasm. These medicines work by quieting nerve impulses. The response to these medicines can vary and it may take time to get the right dose. They will need to be taken on a long-term basis. The treatments below are usually preferable options.

Injections

Botulinum toxin is produced by the bacterium Clostridium botulinum. It is usually associated with causing food poisoning called botulism. However, when it is used in controlled doses, it is safely used to relax excessive muscle contraction. It is injected into the facial muscles and blocks the signal from the nerve. This helps to stop the spasms. Botulinum toxin is better known as Botox®, and it is used more often in cosmetic surgery. The effects of the injection last for two to three months and it starts to work within a few days. At least 7-8 people out of 10 with hemifacial spasm are helped by botulinum injections. However, repeated injections are needed every 3 to 4 months as the effect wears off.

There can be side-effects of the injection. These are commonly drooping of the eyelid and double vision. The side-effects usually wear off after 1 or 2 weeks.

Surgery

There are several surgical procedures that can be done. Microvascular decompression is one type. It involves moving the blood vessel that may be pressing on the facial nerve. This often cures the condition but may be unsuitable for some patients with hemifacial spasm. It is successful in 9 out of 10 people with hemifacial spasm. There can rarely be some serious side-effects that may occur as a result of surgery, such as hearing damage or permanent paralysis of the face. For this reason, surgery is usually reserved for cases where the spasms are severe and disabling. Surgery is also used when other treatments have failed to work or if you are young and don't want long-term repeated injections.

Is there anything I can do to help myself?

Learning relaxation techniques may benefit some people. Educating yourself about your condition and staying positive can also help. Other complementary therapies such as homeopathy or acupuncture do not seem to help this condition.

What is the outlook (prognosis)?

Hemifacial spasm is usually a long-term condition. It is not dangerous or fatal but may affect your quality of life. It very rarely improves completely without treatment.

What causes a twitch in the face?

Is face twitching normal?