What are the treatments for hemifacial spasm?

Hemifacial spams can be treated with oral medication such as carbamazepine, baclofen and gabapentin which all work by decreasing the nerve hyperactivity which causes hemifacial spasm.  Unfortunately, oral medications are only partially effective in treating the symptoms and can be limited by side effects of dizziness and sedation. 

Botulinum toxin (Botox) is the treatment of choice.  In the office, the neurologist will inject the affected muscle with Botox and within 7-10 days, most patients experience marked relief.  Side effects include facial muscle weakness and double vision and can be minimized when performed by an experienced neurologist.  Injections must be repeated every three months.

In patients who have symptoms which do not respond to oral medications or Botox, surgical options (surgical nerve decompression) are available which relieve the pressure on the affected nerve. 

Surgical treatment in the form of microvascular decompression, which relieves pressure on the facial nerve, will relieve hemifacial spasm in many cases. Other treatments include injections of botulinum toxin into the affected areas and drug therapy with medications such as clonazepam, diazepam, and levodopa, which help relax the muscles.

This answer is based on source information from National Institute of Neurological Disorders and Stroke.