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Bell’s palsy is a mysterious condition. Symptoms can arise suddenly but spontaneously remit in a few weeks for most people. Some symptoms include the face going limp including not being able to open your eyes or raising an eyebrow without great effort. When symptoms or complications persist, physical therapy and surgery might help.
What is Bell's palsy?
Bell’s palsy—also called acute peripheral facial palsy—is paralysis or weakness in one half of the face due to swelling and compression (squeezing) of the seventh cranial nerve. This nerve branches out to the nerves that control the facial muscles, saliva glands, tear glands, and the nerve that transmits taste sensations.
Bell’s palsy is an uncommon condition, but anyone can get it. About 30- to 40,000 people experience a bout with Bell’s palsy each year. Symptoms come on quickly—within hours or days—and peak in about three days. The vast majority of patients fully recover without treatment in less than three weeks.
Researchers are baffled on what causes Bell’s palsy, so they classify the condition as “idiopathic facial paralysis.” One theory holds that the condition is triggered by a viral infection. Culprits include the cold sore virus (herpes simplex virus), chickenpox, shingles (or herpes zoster) virus (varicella-zoster virus), the mononucleosis virus (Epstein-Barr), and a litany of other viral suspects. Most people who get Bell’s palsy, however, have no evidence of a viral infection, so some researchers believe it might be due to an immune response or autoimmune disorder.
No matter what the cause, swelling damages the cranial nerve. In most cases (70%), cranial nerve damage is superficial and limited to the protective sheath around the cranial nerve. The body repairs the damage quickly, and complete recovery is achieved within two to five weeks. If there is more extensive damage to the nerve—the “wires” themselves are cut—the body needs to repair the damage by regrowing new nerves to the facial muscles. Not only is recovery slow, but the process is imperfect and may result in long-term or permanent complications such as
- Permanent facial muscle weakness
- Shortening (contracture) of the facial muscles on the affected side
- Tightness or rigidity of the facial muscles on the affected side
- Pulling sensations in the face
- Synkinesis, that is, moving one part of the face provokes an involuntary movement in another part of the face. For instance, a person may try to smile, but the eyelid closes instead
How is Bell's palsy diagnosed?
Bell’s palsy is diagnosed primarily from the symptoms. Imaging and blood tests are unnecessary unless a healthcare provider suspects another condition might be responsible for the paralysis.
Some people are more at risk for Bell’s than others. Age (40-49), pregnancy, diabetes, preeclampsia, obesity, and high blood pressure are all risk factors.
In a physical examination, a healthcare provider will be looking for specific Bell’s palsy symptoms:
- Rapid onset of symptoms
- Weakness or paralysis of all the muscles on one side of the face
- Weakness or paralysis of the forehead on the affected side of the face
- Drooping eyebrow
- Inability to fully close the eyelid on the affected side
- Decreased tear or saliva production
- Drooling
- Loss of taste
- Pain behind the ear or around the jaw
Because one eyelid may not close, eye irritation and dry eye are also common symptoms of Bell’s palsy. Even though tear production goes down, the drooping of the lower eyelid may result in a steady flow of tears, called crocodile tears.
There is a high chance that adults and especially children with Bell’s palsy actually have another—often more serious— condition such as Lyme disease, ear infection (otitis media), Ramsay Hunt syndrome, sarcoidosis, Guillain-Barre syndrome, cancer, stroke, or multiple sclerosis. Both the physical and the medical history will help a physician determine if some other illness is at work.
If there are no signs of another possible condition, a physician can make a diagnosis based only on the history and symptoms.
If the paralysis is severe, the physician may order nerve conduction studies or an electromyography (EMG) to determine how well facial nerves are working. Magnetic resonance imaging (MRI) or a CT scan will be ordered if the physician suspects the symptoms are caused by another condition.
Bell's palsy treatment options
70% of patients with Bell’s palsy experience total remission without treatment in less than three weeks. Half of the remaining patients experience near-total remission by three months. Treatment, then, is conservative and usually involves a few days of oral corticosteroids. Persistent symptoms or complications can be managed with surgery or physical therapy.
Medications
Bell’s palsy is nearly always treated with oral corticosteroids alone or in combination with antiviral agents. Corticosteroids reduce swelling, alleviate symptoms, speed recovery, and reduce the risk of complications. It’s uncertain that adding antiviral treatment does any good, but it may slightly reduce the risk of complications.
Surgery
Occasionally, doctors performed surgical decompression, removing some of the swollen tissue around the irritated nerve, on patients with severe and persistent Bell’s palsy symptoms, but it is only employed in rare cases.
For patients with persistent symptoms, eyelid surgery may be required to prevent injury to the eye. If the eyelid doesn’t close, dry eye can then cause tears and ulcers. Surgery may involve implanting eyelid weights or sewing the corners of the eyelids together to narrow the opening (tarsorrhaphy).
Synkinesis or muscle tightness can be treated with botulinum toxin injections. Botulinum toxin temporarily paralyzes the nerves causing the involuntary facial movements, restoring normal facial function for a few months.
Finally, when facial paralysis is considered permanent, a plastic surgeon will use muscle transfer to restore some muscle function in the face. This involves cutting a part of a working muscle in the face and connecting that part to an area of the face that’s paralyzed.
Physical therapy
For patients with persistent complications due to Bell’s palsy—such as synkinesis—facial neuromuscular retraining uses a series of exercises to teach patients how to re-coordinate facial movements. Most of the exercises can be done at home.
Bell's palsy medications
Bell’s palsy has a high rate of spontaneous recovery, so healthcare providers use drugs conservatively. Nearly all patients will be given a few days of corticosteroids, but more severe cases will include antiviral agents. Pain and headache can be alleviated with over-the-counter pain relievers.
Corticosteroids
Steroids reduce swelling and thus take the pressure off the compressed cranial nerve. Research has shown that no matter how severe the paralysis, corticosteroids speed recovery, alleviate symptoms, and reduce other consequences such as synkinesis. Oral prednisone or prednisolone is given over ten days in a tapering dose.
Antivirals
Bell’s palsy may or may not be related to a viral infection, so severe cases will involve early treatment with antiviral medications and corticosteroids to reduce the risk of complications. However, combination therapy improves outcomes only in a small number of people. Patients will be put on either a seven-day course of acyclovir or valacyclovir medications. These drugs slow down the growth of herpes and varicella-zoster viruses.
Pain relievers
For patients experiencing pain or headache due to Bell’s palsy, over-the-counter pain relievers are enough to manage the pain. NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen, naproxen, or aspirin, not only alleviate pain but help to reduce swelling. Acetaminophen, an over-the-counter pain reliever, can be used by people who are unable to tolerate NSAIDs.
What is the best medication for Bell's palsy?
Healthcare professionals use medications primarily to speed recovery and reduce the risk of nerve damage and long-term complications. Because each case is different, there is no “best” medication for Bell’s palsy.
| Best medications for Bell’s palsy | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Prednisone | Corticosteroid | Oral | 60-80 mg per day in a tapering dose for 10 days | Behavior and mood changes, fluid retention, trouble sleeping, indigestion |
| Orapred (prednisolone) | Corticosteroid | Oral | Two 30 mg tablets per day in a tapering dose for 10 days | Behavior and mood changes, fluid retention, trouble sleeping |
| Zovirax (acyclovir) | Antiviral | Oral | Two 200 mg capsules every four hours five times a day for seven days | Nausea, malaise, diarrhea |
| Valtrex (valacyclovir) | Antiviral | Oral | One 1 gram caplet taken three times a day for seven days | Headache, nausea, abdominal pain |
| Tylenol (acetaminophen) | Analgesic | Oral | Two 325 mg tablets every four to six hours (Max of 3000mg per day) | Nausea, stomach pain, loss of appetite |
| Advil (ibuprofen) | NSAID | Oral | One 200 mg tablet every four to six hours | Nausea, bleeding, stomach pain |
| Aspirin | NSAID | Oral | One or two 325 mg capsules or tablets with water per day | Upset stomach, heartburn, bleeding |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of Bell's palsy medication?
Bell’s palsy medications have several side effects that can vary based on the type of medication. This is not a complete list of possible side effects, so you should consult with a healthcare professional if you have concerns about possible side effects or drug interactions.
Oral corticosteroids cause side effects in many people. The most common are mood and behavior changes, mood swings, aggressiveness, appetite changes, high blood sugar, and elevated blood pressure. Other side effects include confusion, memory problems, thinning skin, and bruising. The most severe side effects are related to high blood pressure and high blood sugar, such as cataracts and glaucoma.
Acyclovir and valacyclovir are similar medications, so patients may experience side effects such as nausea, vomiting, headache, stomach pain, and diarrhea. Side effects are more commonly experienced by people taking these drugs long-term to control herpes infection outbreaks.
Over-the-counter pain relievers are very safe. NSAIDs reduce the body’s ability to form blood clots and protect the digestive system from stomach acid, so the most common side effects are stomach pain, gastrointestinal bleeding, bruising, and bleeding problems. Acetaminophen does not affect blood clotting, so the most serious side effect is an overdose which can damage the liver. Therefore, doses should be limited to 3000 mg every 24 hours.
What is the best home remedy for Bell's palsy?
Bell’s palsy treatment is largely a waiting game. Fortunately, spontaneous recovery is the norm. Home remedies, however, can help reduce pain and prevent complications.
Protect your eye
If your eyelid is not fully closing, eye care is paramount. Regularly use lubricating eye drops to keep the surface of the eye moist. At nighttime, use an eye ointment right before bedtime. Medical tape can keep the eyelid completely closed when you sleep. An eyepatch or goggles can protect the eye from irritants or injury during the daytime.
Do facial exercises
Facial exercises may help reduce the risk of complications, but they should only be done in the recovering (paresis) phase. These exercises can be done at home in a mirror. You can learn them from a physical therapist, facial retraining therapist, or online.
Use warm compresses
You can manage pain with over-the-counter pain relievers, but applying a warm, moist cloth is safer and may be an equally effective way to reduce the pain.
Gently massage the face
Gentle massage also effectively reduces pain and discomfort and loosens overly tight muscles. It only takes five to seven minutes of massage several times a day.
Do relaxation exercises
If recovery is taking a long time, physical therapists strongly recommend facial muscle relaxation exercises to avoid complications such as muscle contractures and rigidity. Once or twice a day, sit down in a quiet space, close your eyes, focus on the facial muscles, and relax them one at a time until the entire face is relaxed.
Stay calm
During the healing process, your body is in charge. Stress and worry compromise the processes that the body uses to heal damage. To maximize the body’s ability to heal the nerve damage, stay calm, keep rested, and don’t fret. Take care of yourself so that your body can take care of you.
Frequently asked questions about Bell's palsy
Is Bell's palsy curable?
Bell’s palsy has a high rate of full and spontaneous recovery with or without treatment. It usually takes less than three weeks to fully resolve. About 30% of people struck with Bell’s palsy may take a longer time to recover or have long-term complications.
Is Bell's palsy caused by stress?
No one knows what causes Bell’s palsy, but most scientists believe it is related to a viral infection. Stress and injury do weaken the immune system, so stress may be a factor in triggering the condition. However, stress does not cause Bell’s palsy.
Is Bell's palsy a mini-stroke?
Bell’s palsy is a compression of the seventh cranial nerve as it emerges through a narrow tunnel of bone. A stroke is when brain cells die due to bleeding or when they are starved of oxygen.
How long does it take to recover from Bell's palsy?
In most patients, Bell’s palsy goes away in less than three weeks.
What should I eat if I have Bell's palsy?
There is no evidence that diet will help Bell’s palsy or reduce the risk of complications. As always, the best diet for Bell’s palsy, as for any medical condition, is a healthy diet rich in nutrients. Stay away from sugar or high carbohydrate foods. Spikes in blood sugar increase swelling throughout the body. Cranial nerve swelling is the heart of the problem.
What is the fastest way to cure Bell's palsy?
Bell’s palsy, unfortunately, is a waiting game. There is no quick fix. The body must repair the nerve damage in its own time. Most people with Bell’s palsy will experience only superficial damage to the cranial nerve and spontaneous and full recovery occurs in about two to five weeks. Corticosteroids do help speed up recovery. For people with more extensive damage to the cranial nerve, the body has to regrow all the nerves to the face, a process that could take months or years. Early treatment with corticosteroids and antiviral medications will help reduce complications.
What are the signs of recovery from Bell’s palsy?
After the first two or three days of symptoms, people with Bell’s palsy will notice a gradual recovery of muscle function. Some muscles start working before others, so you will notice a gradual return of facial tone and function. Full recovery typically happens in three weeks, but some people continue to have muscle weakness for several months. After complete recovery, facial tone and function will be balanced between both sides of the face.
What happens if Bell's palsy goes untreated?
Most cases of Bell’s palsy spontaneously remit after a few weeks with no treatment. However, for severe facial paralysis, treatment does help reduce the risk of permanent nerve damage.
What vitamin is good for Bell's palsy?
As for any medical condition, eat a healthy diet with sufficient vitamins and other nutrients. Both vitamins B6 and B12 are essential for healthy nerve functioning, so be sure that you are eating foods rich in these vitamins, such as turkey, beans, potatoes, spinach, milk, and fish.
Does ibuprofen help Bell's palsy?
Ibuprofen and other over-the-counter pain medications can help relieve the pain and discomfort caused by Bell’s palsy.
Does chewing gum help Bell's palsy?
Bell’s palsy does not affect the muscles used to chew food. Those muscles are controlled by the trigeminal nerve, whereas Bell’s palsy results from compression of the seventh cranial nerve. Chewing gum is often suggested as a good exercise for Bell’s palsy, but it not only doesn’t help, it increases the risk of developing synkinesis, a serious long-term complication of Bell’s palsy. Synkinesis is the body’s attempt to “rewire” the face to get muscles working again. As a result, trying to move one muscle in the face, such as the mouth, moves another muscle in the face, such as an eyelid.
Can Bell Palsy be a sign of something else?
The symptoms of Bell’s palsy can be caused by several more serious conditions such as Lyme disease, bacterial infections of the ear, Ramsay Hunt syndrome, sarcoidosis, Guillain-Barre syndrome, cancer, stroke, or multiple sclerosis.