Bell’s palsy: Symptoms and treatments

Bell’s palsy is a temporary medical condition that causes weakness or paralysis of your facial muscles, usually on just one side of your face. Thankfully it isn’t very common or life-threatening. But for those who are affected by it, Bell’s palsy can be quite frightening, especially when you first develop it. That’s because the way it affects your facial muscles might initially make you think you’re having a stroke.

What is Bell's palsy?

Named after the Scottish surgeon Charles Bell who first described the condition in 1821, Bell’s palsy is the result of a problem with the facial nerve (the nerve that controls the muscles in your face). Also known as idiopathic facial paralysis, Bell’s palsy is the most common cause of facial nerve palsy, which is the name for loss of movement of the facial muscles.
 
Other causes of facial nerve palsy include:
 

• Stroke

• Lyme disease

• Ramsay-Hunt syndrome

• Sarcoidosis 

• Tumour of the hearing nerve (acoustic neuroma) or salivary gland

• Surgery to remove a tumour of the hearing nerve or salivary gland

• Head or facial trauma (caused by injury, for example)

While Bell’s palsy is a temporary condition, waiting for your facial muscles to start working again can be frustrating. There are treatments that can give you better odds of recovering fully, but there’s no quick fix or cure.
 

How do you get Bell’s palsy? 

Anyone can develop Bell’s palsy, with men and women affected at the same rate. But nobody knows exactly why some people get it while others don’t. What we do know is that some things give you a higher-than-normal risk of developing Bell’s palsy, including:
 

• Your age (people aged between 15 and 60 years are more likely to develop Bell’s palsy than others)

• Having an existing medical condition such as diabetes, a weakened immune system, obesity, high blood pressure, multiple sclerosis or an upper respiratory condition

• Pregnancy (pregnant women are thought to be three times more likely to develop Bell’s palsy than women who aren’t pregnant (i))

 

Is Bell’s palsy hereditary?

There is some evidence to suggest there may be an inherited predisposition to developing Bell's palsy as one review of 230 consecutive patients with Bell's palsy revealed a 6% incidence of a positive family history of facial paralysis. It is commonly documented that those that have a family history of the condition are more likely to develop the condition more than once.
 

How common is Bell’s palsy?

According to Facial Palsy UK, it’s difficult to know exactly how many people experience Bell’s palsy because not all people with the condition are diagnosed or recorded (ii). However, the charity estimates that between 20 and 30 per 100,0000 people are affected each year, with the average GP seeing a case of Bell’s palsy every two years (ii). Patient UK, meanwhile, suggests around one in 60 people have Bell’s palsy at some stage in their life (iii).
 

Bell's palsy symptoms 

The symptoms of Bell’s palsy usually come on within a few hours to a couple of days, usually peaking at around 72 hours. Some experts suggest some people experience earache or feel tired and run down before the most common symptom – facial weakness/paralysis – starts (this symptom is thought to affect 70 per cent of those with Bell’s palsy (iv)). 
 
Most people with Bell’s palsy experience facial weakness/paralysis on one side of their face, but in around one per cent of cases, both sides are affected (ii). The ways in which facial weakness/paralysis affect you and how severely they affect you depend on how badly your facial nerve is damaged, and may include the following:

• Drooping on one side of the face (typically this involves drooping of the eyebrow and/or bottom eyelid, drooping of one corner of the mouth and the loss of the nasolabial fold – the fold that runs from the side of the nose to the corner of the mouth)

• Problems closing the eye on the affected side of the face (this can cause eye pain and discomfort, dry eye and excessive tear production)

• Paralysed forehead and cheek muscles

• Speech problems – for example, some words may be difficult to form since muscles in both sides of the face are needed to pronounce certain sounds or letters (B and P, for instance)

• A runny nose on the affected side (caused by loss of muscle control around the nose)

Other symptoms can also include:
 

• Pain or a mild ache near the ear on the affected side of the face that lasts for a few days

• Loss of taste on one side of the tongue

• Difficulties with chewing or a dry mouth 

• Dribbling from the affected side of the mouth

• Numbness or tingling of the cheek and/or mouth

• Hearing difficulties, including normal sounds seeming louder than usual, with loud sounds feeling unusually uncomfortable (hyperacusis)

 

Bell’s palsy vs stroke 

The facial weakness/paralysis caused by Bell’s palsy can often be confused with  the facial drooping that accompanies a stroke. Thankfully there are ways to tell them apart:
 

• Facial drooping with Bell’s palsy affects the entire half of the face, but with a stroke, most of the face is affected but not the forehead.

• With a stroke, other parts of the body are affected, such as the hands, arms and legs – but Bell’s palsy only affects the face.

• Symptoms of a stroke usually happen suddenly, whereas Bell’s palsy symptoms tend to develop over a few hours or days (though if you wake up with Bell’s palsy symptoms it may seem as if they’ve started suddenly).

For more information on stroke, including further details on the symptoms to look out for and what you should do if it happens, read our stroke guide.
 

How long does Bell’s palsy last?

Bell’s palsy is a temporary condition, though an estimated five to 10 people in every 100 who have the condition are left with some permanent slight weakness (v). Experts are divided on how long it lasts for those who do recover completely, with the NHS claiming most people get better within nine months (vi) and the National Institute of Clinical Excellence (NICE) claiming complete recovery from Bell’s palsy usually happens within three to four months (vii).
 
Facial Palsy UK, meanwhile, states a large review shows just over 70 per cent of people with Bell’s palsy make a full recovery, and that improvement can happen as early as two to three weeks from onset (though it can take anywhere from three to six months and beyond) (ii).
 
Full recovery also usually happens without treatment – though getting treatment as early as possible (within 72 hours of your symptoms starting) makes full recovery even more likely. Indeed, you should notice your symptoms starting to improve within a few weeks, even without treatment.
 
A small number of people, however, can experience another bout of Bell’s palsy, often within a few years of the initial episode (according to Patient UK, one in 14 people who has Bell’s palsy can have further episodes in the future, particularly if the condition runs in their close family (iii)). When recurrence happens, Bell’s palsy can affect either side of the face (that is, not necessarily the same side as before).
 

Are there any complications associated with Bell’s palsy?

Most people who develop Bell’s palsy don’t get any complications if they recover fully. Some people who had a severe case, however, may experience one or more of the following:
 

• Permanent damage to the facial nerve

• Permanent vision damage or persistent dry eye

• Synkinesis – a condition where part of your face moves involuntarily when you move another (the eye on the side of the face that was affected may close when you smile, for instance) 

• Mental health issues such as stress, anxiety, depression or low self-esteem

The good news, however, is that Bell’s palsy doesn’t affect any other part of your body, including your brain.
 

What causes Bell’s palsy?

The facial weakness/paralysis associated with Bell’s palsy is thought to be caused by inflammation compressing the facial nerve. Also called the seventh cranial nerve, the facial nerve is found on each side of your face (for more information, read our guide to facial nerve disorders. Each branch of the nerve passes through a narrow corridor of bone called the temporal bone, and this is where the nerve becomes inflamed and compressed, causing Bell’s palsy symptoms.
 
Exactly why the nerve becomes inflamed and compressed, however, isn’t clear. Experts think the most probable cause in most cases is a viral infection – the most likely culprits being the herpes simplex virus, which causes cold sores, and the varicella-zoster virus, which causes chickenpox and shingles (though the viruses that cause HIV, glandular fever, flu, mumps and rubella – or German measles – may be triggers too).
 
The idea is that these viruses can lay dormant in the body and are somehow reactivated. The facial nerve reacts to the virus by becoming inflamed as it passes through the temporal bone, which reduces the flow of oxygen and blood to the nerve cells, damaging them and triggering the symptoms of Bell’s palsy.
 
Other theories suggest non-viral causes for the nerve inflammation of Bell’s palsy include autoimmunity and a depleted immune system or simply feeling tired and run down (after a recent bout of illness, for example). Sleep problems, physical trauma and stress  have been named as possible triggers for Bell’s palsy too.
 
According to the National Organization for Rare Disorders (NORD), there may also be an inherited tendency towards developing Bell’s palsy (viii).

 

Should you see your GP?

While the symptoms of Bell’s palsy get better on their own without medication, it’s still a good idea to see your GP if you experience any of them. Try to see a doctor quickly, as the medication used to treat Bell’s palsy is most effective if you start taking it within 72 hours of first developing symptoms.
 
Your GP may also want to do some tests to rule out other, more serious, conditions such as stroke, or if the diagnosis isn’t clear-cut. Tests may include blood tests to check for conditions such as Lyme disease and sarcoidosis, or scans to rule out other causes of nerve damage and stroke.
 
If you do start treatment within the optimum timeframe for Bell’s palsy, you should notice an improvement in your symptoms fairly soon, usually with a few weeks or so. If your symptoms haven’t improved after three weeks of treatment, however, the NHS advises that you go back to your GP as you may need a different treatment plan.
 

Treatment for bells palsy 

Most cases of Bell’s palsy don’t need any treatment as there’s a good chance of full recovery without it. But getting the right treatment can improve your chances of recovering fully, so it’s usually advisable. You may also need help with protecting your eye if one of your symptoms is that your eye doesn’t close properly.
 
The main treatments for Bell’s palsy include steroid medication, antiviral medication and eye-related treatments:
 

Steroid tablets  

 
Most people treated for Bell’s palsy are prescribed a 10-day course of steroid tablets, the most common being prednisolone tablets - a common type of corticosteroid.  These are prescribed with the aim of reducing inflammation. According to Patient UK studies show you have a 17 in 20 chance of full recovery of the nerve if you take steroid tablets, compared with a 15 in 20 chance if you don’t (iii).
 
However, if you don’t start taking steroid tablets within 72 hours of your symptoms showing up, it’s likely they won’t have much effect.
 

Antiviral medicines  

 
These may sometimes be prescribed if your GP suspects you’re experiencing Bell’s palsy symptoms as a result of having a virus. However, experts aren’t really sure how beneficial antivirals are (if at all). Combining antivirals with steroid tablets may be a little more effective than taking steroid tablets on their own.
 

Eye treatments  

 
Not being able to blink or close one of your eyelids fully can cause problems for the front of your eye and make your eye very dry. If you experience this symptom, the treatments you may be offered include lubricating eye drops and ointments, eye pads, wrap-around sunglasses or goggles to protect your eye when you’re outdoors and surgical tape to help keep your eye closed while you sleep.
 
Eye surgery is also sometimes recommended in cases where someone’s eye is at risk because of Bell’s palsy. This includes procedures that stitch your eyelids together, or to raise a drooping lower lid.
 

Physical therapy

 
Depending on your symptoms, you may be referred for physiotherapy, speech and language therapy. Muscles that are paralysed can contract and shorten, which may be irreversible. With the help of a physical therapist your facial muscles can be massaged and worked to help stop this from happening.
 

Facial nerve rehabilitation

 
Depending on what services are available in your area you may also be offered facial rehabilitation therapy, particularly if you haven’t fully recovered within three months or thereabouts. This can include help and advice such as how to take care of your eyes and how to tape your eye closed, how to manage a dry mouth, how to make eating and drinking easier and ways to make your speech clearer.
 
Your therapist may also recommend things you can do at home, including daily exercises that aim to help your muscles learn how to work properly again and stretches to relieve facial muscles that have become too tight. It is, however, important to get professional advice on how to stretch and exercise your facial muscles, as you may do more harm than good if you attempt to do them yourself without help.
 

Bells Palsy exercises

 
Massaging your face to keep your muscles healthy is another thing your therapist may recommend. Massaging your forehead or cheeks, for instance may help the muscles regain some of their strength – again, your therapist can show you what to do.
 

Botox for Bell’s palsy

 
Other therapies offered to the small number of people who experience permanent facial weakness after a bout of Bell’s palsy include Botox injections (for those who have facial muscle spasms) and surgeries that can help with their cosmetic appearance.
 

Psychological therapies

 
If your mental well-being has been affected due to  Bell’s palsy, you may be recommended to attend psychological therapy or support group.
 

Living with Bell’s Palsy 

If you develop Bell’s palsy it’s important to get plenty of rest – this includes taking time off work/school if necessary.
 
There are also a few more things you can do yourself at home to ease some of your symptoms:
 

Keep it warm  

 
Using a warm cloth or a heated wheat bag – even a hot water bottle – can help relieve pain if you place it on the affected area (take care to make sure whatever you use is warm, not hot).
 

Drink through a straw 

 
If your mouth is affected you may find it difficult to drink from a glass. The easy way to remedy this is to drink using a straw. Also, try eating soft foods rather than anything you have to chew if you’re struggling with eating.
 

Relax as much as you can  

 
Stress may trigger Bell’s palsy but having Bell’s palsy can be stressful too. This is why it’s important to rest and relax as much as possible. Use whatever relaxation techniques work for you, whether it’s meditating, doing deep breathing exercises or just having a long soak in a warm bath.
 

Talk about it  

 
Having Bell’s palsy can make you withdrawn, especially if you’re embarrassed about your facial appearance. Try not to isolate yourself while you’re recovering, as talking about how you feel with someone you trust could make you feel better and supported.
 

Avoid irritants  

 
It may not always be possible, but whenever you can try to avoid environments that may cause eye irritation (dusty environments, for instance).
 

Focus on the future 

 
Remember your symptoms are unlikely to last forever, as most people with Bell’s palsy make a full recovery. Telling yourself that your condition is just temporary may help make you feel more secure and reassured.

 

Diet and Bell’s palsy 

Eating a nutritious balanced diet is always a good idea, and if you have Bell’s palsy there may be an argument for focusing on foods that reduce inflammation and avoiding those that may make inflammation worse. For more information about an anti-inflammatory diet, read our guide entitled What is inflammation?
 
Certain supplements may be beneficial too, including formulations that have been found to reduce inflammation. You may, for instance, want to try one or more of the following:
 

L-carnitine  

 
An amino acid often used in supplement form by people who take part in sports and exercise, l-carnitine (or just carnitine) is found in foods such as beef, fish, chicken, milk and cheese. An older study suggests carnitine may be useful for Bell’s palsy symptoms if taken alongside steroid tablets as it may help the nerve recover more quickly than by taking steroid tablets alone (ix).
 

Vitamin B12 

 
An important B vitamin that some people may lack in their diets, B12 may also help the facial nerve recover more quickly in cases of Bell’s palsy. Another older study found taking B12 alongside steroid tablets or on its own helped reduce the recovery time significantly when compared to taking steroid tablets without B12 (x). Vitamin B12 is found in foods such as meat, fish, cheese, eggs and milk, as well as in some fortified breakfast cereals.
 

Ginkgo biloba  

 
Several studies suggest this herbal remedy may help protect the nerves, though unfortunately, these tend to be animal and lab-based trials, which are less robust than human trials. There may be a case for trying ginkgo because of its anti-inflammatory properties – though again the studies we have are mostly in vitro or animal studies.
 

Magnesium 

 
This important mineral is needed for a range of functions within the body, including healthy muscle functioning. Some research also suggests it may help regenerate damaged nerves, so there may be some benefit in taking a magnesium supplement if you have Bell’s palsy (xi). You can also try adding more magnesium-rich foods to your diet, such as spinach, nuts, wholemeal bread, beans, legumes, dark chocolate, avocados, milk and yoghurt.
 

Vitamin C  

 
Results of trials looking at whether vitamin C may have a role in preventing or relieving the symptoms of Bell’s palsy are mixed, but experts presenting a case study in the open-access journal Cureus suggest vitamin C levels in people with Bell’s palsy may be very low, and that it’s advisable to check levels of the vitamin in all cases of the condition (xii). They also suggest that people at risk of developing Bell’s palsy should be encouraged to increase their intake of vitamin C-rich foods, including berries, peppers, citrus fruit, kiwi, tomatoes, broccoli and cauliflower.
 

Turmeric  

 
Turmeric’s active ingredient – curcumin – is widely thought to deliver several health benefits, including helping with reducing inflammation. One published review, for instance, states that, at the molecular level, curcumin suppresses a number of cell signalling pathways involved in inflammation, which suggests it has anti-inflammatory properties (xiii). Numerous other studies have also shown that curcumin helps reduce inflammation in several different medical conditions (though no studies have been carried out into the specific role of curcumin in Bell’s palsy) (xiv).
 

More support for Bell’s Palsy 

Charities and organisations that offer further information and support for people with Bell’s palsy include:
 
Facial palsy: This charity aims to offer access to the best information, treatment and support available to people affected by facial palsy.
 
The Brain Charity : Supporting people with Bell’s palsy as well as those living with other neurological conditions, this charity also has a helpline (call 0151 298 2999).
 
Bell’s Palsy UK:  One of the services offered by Bell’s Palsy UK is an online forum, where you can communicate with other people who have been affected by Bell’s palsy.
 
Meanwhile, you can find out lots more about a wide variety of health conditions in our pharmacy health library.
 

References:

1. Available online: https://www.facialpalsy.org.uk/causesanddiagnoses/bells-palsy/

2. Available online: https://patient.info/brain-nerves/bells-palsy

3. Available online: https://cpdonline.co.uk/knowledge-base/care/bells-palsy/

4. Available online: https://www.nbt.nhs.uk/our-services/a-z-services/emergency-zone/ed-miu-patient-information/bells-palsy

5. Available online: https://www.nhs.uk/conditions/bells-palsy/

6. Available online: https://cks.nice.org.uk/topics/bells-palsy/background-information/prognosis/

7. Available online: https://rarediseases.org/rare-diseases/bells-palsy/

8. Mezzina C., et al. Idiopathic facial paralysis: new therapeutic prospects with acetyl-L-carnitine. Int J Clin Pharmacol Res. 1992;12(5-6):299-304. Available online: https://www.semanticscholar.org/paper/Idiopathic-facial-paralysis:-new-therapeutic-with-Mezzina-Grandis/9745c8287c8888dc56646fbd51f6b3143525e501

9. Jalaludin MA. Methylcobalamin treatment of Bell's palsy. Methods Find Exp Clin Pharmacol. 1995 Oct;17(8):539-44. Available online: https://europepmc.org/article/MED/8749227

10. Zhang J et al. Magnesium Promotes the Regeneration of the Peripheral Nerve. Front Cell Dev Biol. 2021 Aug 11;9:717854. Available online: https://www.frontiersin.org/articles/10.3389/fcell.2021.717854/full

11. Swarnakar R, Yadav SL, Vitamin C Deficiency as a Risk Factor for Bell's Palsy: A New Association. Cureus. 2022 Jan 12;14(1):e21143. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8831488/

12. Numakkara AB et al., Curcumin, the golden nutraceutical: multitargeting for multiple chronic diseases. Br J of Pharm. 2017;174:1325-1348. Available online: http://accurateclinic.com/wp-content/uploads/2020/10/Curcumin-the-golden-nutraceutical-multitargeting-for-multiple-chronic-diseases-2017.pdf

13. Pivari F et al., Curcumin and Type 2 Diabetes Mellitus: Prevention and Treatment. Nutrients. 2019 Aug 8;11(8):1837. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723242/

14. Panahi Y et al., Molecular mechanisms of curcumins suppressing effects on tumorigenesis, angiogenesis and metastasis, focusing on NF-κB pathway. Cytokine Growth Factor Rev. 2016 Apr;28:21-9. Available online: https://www.sciencedirect.com/science/article/abs/pii/S1359610115300125?via%3Dihub

15. Panahi Y, Hosseini MS, Akbari A, et al. Mitigation of Systemic Oxidative Stress by Curcuminoids in Osteoarthritis: Results of a Randomized Controlled Trial. J Diet Suppl. 2016;13(2):209-20. Available online: https://www.tandfonline.com/doi/full/10.3109/19390211.2015.1008611

16. Panahi Y., Hosseini MS., Khalili N., et al. Antioxidant and anti-inflammatory effects of curcuminoid-piperine combination in subjects with metabolic syndrome: A randomized controlled trial and an updated meta-analysis. Clin Nutr. 2015 Dec;34(6):1101-8. Available online: https://www.clinicalnutritionjournal.com/article/S0261-5614(15)00002-3/fulltext

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