Hemifacial Spasm: Understanding and Treating a Complex Neuromuscular Disorder
Michelle Gellis, AP, Dipl. Ac.
WHAT YOU NEED TO KNOW
In TCM, hemifacial spasm reflects underlying imbalances in the body, often involving liver qi stagnation, liver wind, liver blood deficiency, and kidney qi and yin deficiency.
While Western medical treatments such as oral medications, Botox injections and surgery can provide some relief, they often come with limitations.
Through techniques like scalp acupuncture, motor-point therapy and cupping, practitioners can improve circulation, reduce spasms and restore facial symmetry, enhancing the patient’s quality of life.
Hemifacial spasm (HFS) is a neuromuscular condition characterized by involuntary muscle spasms on one side of the face, most commonly the left. Unlike facial or eyelid tics, which can occur on either side and typically cease during sleep, HFS spasms can persist throughout the day and continue during rest. This condition affects approximately 11 in 100,000 people, with a higher prevalence in middle-aged women and individuals of Asian descent. (Figure 1)
Muscles of facial expression innervated by facial nerve: eyelid, protractors, frontalis, orbicularis oris, platysma, mentalis
Triggers
Stress, excessive, caffeine intake, reading, watching TV, driving, certain eye or head postures, light exposure
Certain head postures, anxiety, fatigue, stress, chewing, light exposure, sleep deprivation
Occurs during sleep
No
Yes
HFS often begins subtly with twitching in the eyelid muscles. These spasms can escalate in severity, causing tears and forcing the eye to close completely. Over time, the spasms may spread to involve muscles across the cheek, mouth and chin, leading to visible asymmetry in the face. (Figure 2)
FIG 2 Clinical presentation of HFS.
In severe cases, spasms in muscles such as the risorius and depressor anguli oris can create a permanent frowning appearance. Other symptoms may include clicking sounds in the ear, hearing loss and changes in auditory perception, further complicating the condition’s impact on quality of life.
Etiology of HFS
In traditional Chinese medicine (TCM), hemifacial spasm reflects underlying imbalances in the body, often involving:
Liver qi stagnation: Disrupted energy flow contributes to tension and spasms.
Liver wind: Erratic, involuntary movements associated with internal wind.
Kidney qi and yin deficiency: Impaired nervous system stability exacerbates symptoms.
FIG 3 Facial nerve involvement in HFS.
Western medicine attributes primary HFS to vascular compression of the facial nerve (cranial nerve VII) as it exits the brainstem. (Figure 3) This compression, often caused by a hardened or displaced blood vessel, irritates the nerve, misdirecting its signals and triggering spasms across the same side of the face. Secondary HFS may result from facial nerve damage caused by tumors, infections, trauma, or demyelinating disorders.
Treatment Approaches
While Western medical treatments such as oral medications, Botox injections and surgery can provide some relief, they often come with limitations, including side effects, temporary effectiveness and risks associated with invasive procedures. As a result, many patients turn to alternative therapies like acupuncture for a more holistic approach.
In TCM, treatment focuses on addressing underlying deficiencies while managing presenting symptoms. Key acupuncture-based techniques include:
Scalp acupuncture: Targeting motor areas to regulate nerve function and reduce spasms.
Motor Points and Submuscular Needling: Releasing muscle tension, improving circulation and restoring function.
Facial cupping: Enhancing local circulation and alleviating tightness in facial muscles.
Auricular acupuncture: Utilizing points like Ear Shen Men to calm the nervous system and reduce stress-induced exacerbations.
Lifestyle factors, including stress, caffeine, screen time, and light exposure, can act as triggers for HFS, making patient education an essential component of treatment. By addressing these contributors and promoting relaxation techniques, practitioners can help reduce symptom severity.
A Multidisciplinary Approach
Hemifacial spasm is a challenging condition that benefits from a combined approach of conventional and alternative therapies. Acupuncture offers a natural, effective alternative that targets both the root causes and symptoms of HFS. Through techniques like scalp acupuncture, motor-point therapy and cupping, practitioners can improve circulation, reduce spasms and restore facial symmetry, enhancing the patient’s quality of life.
With comprehensive care and a focus on underlying imbalances, acupuncture serves as an invaluable tool for managing HFS and supporting long-term wellness.
Editor’s Note: This article is excerpted from Michelle’s book, Treating the Face: A Comprehensive Guide for Acupuncturists and Health Professionals. It has been edited lightly to conform with Acupuncture Today’s style guide.
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