Objective: Describe the clinical spectrum of blepharospasm

Background: Blepharospasm is characterized by stereotyped, bilateral and synchronous spasms of the orbicularis oculi muscles

Method: Case report

Results: Case 1: 58-year-old female presented with photophobia and dry eyes, alongside lifelong history of retro-orbital throbbing headache, characterized as bi-frontal and resembling sinus pressure. She had a tendency to wear sunglasses outdoors, and the headaches typically commenced an hour after waking, intensifying throughout the day. Accompanying symptoms included increased blinking, eye pain, intermittent neck pain, left shoulder cramping, and a habit of tucking her right jaw for relief. Over-the-counter analgesics proved ineffective for the headaches. Upon examination, signs of excessive blinking, clonic activity of the orbicularis, involuntary eyelid closure, and prominent frontalis and procerus muscle activity were observed. She was ultimately diagnosed with blepharospasm.

Case 2: 67-year-old female presented with a history of headache characterized as “sinus” headaches since her teenage, accompanied by jaw and neck pain, photophobia and light sensitivity. Her symptoms included sensations of plugged sinuses without nasal discharge and increased eye irritation during the winter months. Previous interventions including decongestants and sinus surgeries yielded no relief. CT imaging and endoscopy did not reveal any significant findings. 

Case 3: 45-year-old male referred for evaluation of sinus headaches, which he described as bifrontal and accompanied by infra-orbital and peri-nasal pressure, with temporary relief from self-massaging. He experienced nasal congestion without discharge or relief, from decongestants and reported sensitivity to light. Clinical examination revealed excessive blinking and involuntary eyelid closure, along with narrowing of the interpalpebral distance. Notably, there were signs of generalized dystonia, characterized by frequent wrinkling of the forehead and elevation of the eyebrows, with a “figure 11” appearance.

All 3 cases responded well to targeted onabotulinum toxin A injection therapy for blepharospasm.

Conclusion: Blepharospasm should be considered in the differential diagnosis of facial pain and symptoms resembling sinus issues or seasonal allergies, as prompt identification and treatment with botulinum toxin injections can be highly effective and can prevent unnecessary and ineffective treatments.

References: 1. Johnstone SJ, Adler CH. Headache and facial pain responsive to botulinum toxin: an unusual presentation of blepharospasm. Headache. 1998 May;38(5):366-8. doi: 10.1046/j.1526-4610.1998.3805366.x. PMID: 9630789.
2. Charleston L 4th, Strabbing R, Cooper W. Is sinus disease the cause of my headaches? An update on sinus disease and headache. Curr Pain Headache Rep. 2014 Jun;18(6):418. doi: 10.1007/s11916-014-0418-3. PMID: 24760488.
3. Bernichi JV, Rizzo VL, Villa JF, Santos RF, Caparroz FA. Rhinogenic and sinus headache – Literature review. Am J Otolaryngol. 2021 Nov-Dec;42(6):103113. doi: 10.1016/j.amjoto.2021.103113. Epub 2021 Jun 17. PMID: 34175774.
4. Harrison AR, Erickson JP, Anderson JS, Lee MS. Pain relief in patients receiving periocular botulinum toxin A. Ophthalmic Plast Reconstr Surg. 2008 Mar-Apr;24(2):113-6. doi: 10.1097/IOP.0b013e31816386e1. PMID: 18356715.
5. Kilduff CLS, Casswell EJ, Salam T, Hersh D, Ortiz-Perez S, Ezra D. Use of Alleviating Maneuvers for Periocular Facial Dystonias. JAMA Ophthalmol. 2016;134(11):1247–1252. doi:10.1001/jamaophthalmol.2016.3277

« Back to 2025 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/blepharospasm-as-cause-of-facial-pain-and-sinus-headache-a-case-series/