Brief Answer:
Anxiety or important neurological disease may cause the cheeks to twitch- some more information is needed

Detailed Answer:
Hello and welcome to "Ask a Doctor" service,

I carefully read your query.

Twitching of the muscles on the face can happen due to common and not serious conditions such as anxiety but they may also indicate a neurological condition.

To better determine the cause of the twitches in your case, it is important for us to know more about them. So, kindly let me know of the following:

- Since how long have you noticed your cheeks twitching?
- Does it happen always when you smile or on certain occasions? How often do you get it?
- Have you noticed anything that makes it worse or helps alleviate them?
- Is there any relation with the consumption of coffee, energy drinks, alcohol or other drugs?
- Is there any relation to stressful situations?
- Do you have other neurological symptoms such as weakness or numbness (tingling) on any of your limbs or on your trunk or face? Any problem with the vision or while swallowing or speaking? Any problem with your balance?
- Do you have twitches in other areas of the body?
- Do you suffer from any chronic condition and do you use any medications regularly (over the counter or prescription medications)?

I hope to hear back from you soon with the above information.
I remain at your disposal for further medical assistance.

Regards,
Dr. Antoneta Zotaj
General and Family Physician

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Brief Answer:
Benign fascicular syndrome is likely but examinations are needed to rule out other important conditions

Detailed Answer:
Hello and welcome back,

Thank you for the reply and the extra information provided.

Twitching of lips and tremors of hands, most of the time is not due to serious conditions. One of them would be benign fasciculation syndrome which consists of twitching of volunteer muscle groups, meaning muscles that we move voluntarily. It may affect muscle groups on the face, hands or legs but may affect muscle groups in any area of our body and is not a worrisome condition.

On the other hand, important neurological diseases may cause twitching as well so it is important to have a thorough examination with your doctor, including a neurological exam, to determine if these twitches are benign or other conditions are the cause.

Your doctor will have to check for weakness and atrophy of the muscles which are important in ALS, a very rare neurological condition that causes twitches as well. MS needs to be ruled out and in this case, if the doctor finds neurological deficits during the examination, he may order an MRI of the brain and spine to rule it out.

Also, some blood tests to rule out problems with the thyroid (TSH and FT4), electrolytes (Ca++, K+, Na+, etc) and basic metabolic profile are routinely done in these cases.

According to the results of these tests and examinations, the doctor will determine the cause of the twitches and which is the best management plan. If all the tests are normal the benign fasciculation syndrome is likely and the doctor may give myorelaxants or medications that work by calming down the neurological system (gabapentin, pregabalin, etc).

I hope this answers your query.
I remain at your disposal for further medical assistance.

Regards,
Dr. Antoneta Zotaj
General and Family Physician

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