Causes of Cheek Twitching and Facial Muscle Spasms

Waking up one day and finding that half your face is attempting to form a revolution can be unnerving and frustrating, especially if you didn’t know why.

Facial twitching usually doesn’t affect the entire face, but instead only half of it. That is why it is known as a hemifacial spasm. Hemi means “one side” and facial obviously refers to the face.

Having spasms on both sides of the face or having both cheeks twitching is a rare condition.

Hemifacial spasm

Muscles on your face are controlled by the 7th cranial nerve which is the facial nerve. It begins at the brainstem and goes all the way to the skull below the ear. Here, it splits into 5 different branches.

The facial nerve is a motor nerve. As such, it is responsible for the movement of muscles on the face. These include muscles that move the eyebrows, eyes, nose, cheeks, mouth and lips.

A hemifacial spasm also is known as ‘tic convulsif’ comes about when the facial nerve is irritated. An untreated tumor could also be the cause, although this is infrequent. Sometimes, however, there is no clear cause.

There are two forms of this disease; typical and atypical

Typical hemifacial spasm

This is where the twitching starts at the lower eyelid. Over time it spreads to the whole eyelid and down to the muscles around the lip and eventually in the cheekbone. This is the most common form of the condition.

Atypical hemifacial spasm

Here, the twitching starts with the muscles around the lips and then to those on the lower face and cheekbone and finally up to the eyelid. This is a rare form of the disease seen on only 2-3% of patients.


Both men and women are affected by the disease. It is more common however in women over 40 and in some Asian populations.

Hemifacial spasm symptoms

Involuntary twitching on one side of your face

Since most people have typical hemifacial spams, the first symptom is usually when muscle contractions start around your eyelid. Although this is not always too disruptive, it can cause tearing of the eyes or closing of the same. Twitching is often more pronounced in situations of anxiety or simply when you are tired.

The twitching spreads

As time passes, the twitching may begin to spread to other parts of your face, although still on the same side. Sometimes, the spasms may spread throughout one side of the face, affecting all the muscles on it. This includes the cheek, mouth, jaw, chin and neck.

Spasms may also occur when you are asleep, although you may not notice them then.

As the spasms spread they may affect other organs

Other symptoms may occur over time causing you pain and discomfort. They include:

  • Pain behind the ear
  • Ringing in the ears
  • Frequents spasms of the entire face
  • Altered hearing

What causes facial twitching?

We would like to think that medicine has all the answers, but sometimes it doesn’t. In some cases, doctors are unable to discover the root cause of the problem. When this happens, it is known as an idiopathic spasm. However, here are some of the known causes of the condition:

Damage to the facial nerve

When a blood vessel pushes on the facial nerve close to where it connects to your brain stem, the never sends out signals in what is known as an ephaptic transmission. This signal causes the muscles to twitch causing spasms.


Ahead or face injury such as a blow can cause spasms. This is because when the injury occurs, it causes a compression of the facial nerve.


Having a tumor be the cause of facial spasms is a rare occurrence, but it does happen at times. An untreated tumor can cause nerve damage as it grows bigger. Because of its location close to the brain, any tumor should be treated immediately lest it becomes cancerous and spreads. The earlier it’s caught, the better for the patient.

Side effects of Bell’s palsy

Bell’s palsy is where a part of your face is temporarily paralyzed. Sometimes after such an episode, a lingering side effect is spasms or twitching.

Hemifacial spasm treatment and home remedies

Under treatments, we are going to look at home remedies, surgery, Botox injection and the use of medications.

Home remedies

The following home remedies can help reduce symptoms of hemifacial spams

Rest. Allow your body enough time to rejuvenate. This also reduces stress and anxiety.

Reduce caffeine consumption. Caffeine makes your twitching increase so go for fresh fruit juice or green tea.

Do deep breathing exercises to relax your muscles. Remember, this is only a quick and temporary solution.

Massage your face with diluted clove oil. This should provide relief from excessive twitching

Eat food with essential nutrients e.g.:

  • Vitamin D, found in milk, eggs and sun.
  • Magnesium can be used to treat the condition. Eat magnesium-rich foods such as; peas, bananas or almonds, green vegetables and seeds.
  • Antioxidants found in blueberries
  • Chamomile which you can take as tea or supplements.
  • Hyoscyamus is an herb that has antispasmodic attributes that can also help reduce twitching


Your doctor is likely to prescribe a muscle relaxer to prevent twitching. This is the usually the first treatment for the condition as it helps relax your face muscles. The most commonly prescribed medications are: carbamazepine, baclofen and clonazepam.

However depending on the seriousness of the condition, your doctor may prescribe the following:

Botox injection

Doctors uses botulinum toxin type A, also known as Botox to treat facial spasms, not just to remove wrinkles. The chemicals are injected into the face close to where the muscles are twitching. It works by blocking electrical impulses of the muscles on the face, preventing them from acting on misfired stimuli.

This is a longer-term solution, working for 3-6 months before you need to get another one.


This is only recommended by doctors when other treatments prove unsuccessful. The surgery is aimed at relieving any pressure on the nerves that may be the result of a blood vessel or a tumor.

The surgery most used is a Microvascular Depression which is a procedure where the doctor creates an opening in the skull behind the ear and places a small piece of Teflon padding between the nerves and the blood vessels blocking it.