Sudden facial weakness on one side. Time-critical — steroids work best started within 72 hours.
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Bell's palsy is sudden weakness of the muscles on one side of the face, caused by inflammation of the facial nerve. It typically comes on over hours to a couple of days, and it is frightening — most people who develop it assume they are having a stroke.
This page carries two urgent messages.
The first is how to tell the difference. In Bell's palsy the forehead is affected too — you cannot raise the eyebrow or wrinkle the forehead on that side. In a stroke the forehead is usually spared, because it receives nerve supply from both sides of the brain. If you can still wrinkle your forehead but the lower face has dropped, treat it as a stroke and call 999.
The second is timing. Steroid treatment substantially improves recovery, but only if started within 72 hours of symptoms beginning. This is one of the few genuinely time-critical things a GP appointment can deliver, and it is a reason to book the same day rather than wait to see whether it settles.
Limb weakness, numbness, confusion or difficulty speaking are not features of Bell's palsy. Any of those makes this a 999 call.
There is no test for Bell's palsy. It is diagnosed by the pattern and by ruling out the causes that need different treatment.
Whether the forehead is involved. In Bell's palsy the whole side of the face is weak, including the forehead — you cannot raise the eyebrow or wrinkle the brow.
In a stroke the forehead is usually spared, because it receives nerve supply from both sides of the brain.
That single distinction is why this assesses well on video, and it is the first thing checked.
Most cases need none. Blood glucose is worth checking, since diabetes is commoner in people who develop it.
Imaging is reserved for atypical cases — gradual onset over weeks, no recovery by three to four months, both sides affected, or other neurological signs.
Facial weakness is one of the conditions video handles well, because the diagnosis is largely visual. The GP will ask you to raise your eyebrows, close your eyes tightly, smile and puff out your cheeks — all of which show clearly on camera.
Call 999 immediately if:
Seek same-day assessment for:
This is the part that causes lasting harm if neglected, and it is easy to get right. If the eye will not close fully, the surface dries out and can ulcerate.
Any eye pain, redness or blurring needs same-day assessment.
Gentle movement is reasonable, and there is no evidence that vigorous exercise speeds recovery.
Specialist facial physiotherapy genuinely helps where recovery is incomplete — that is a referral worth asking for at around three months rather than waiting a year.
Most people recover completely, and improvement usually starts within two to three weeks. Full recovery can take three to six months.
A minority are left with some residual weakness, and starting steroids within 72 hours meaningfully improves the odds — which is why speed matters more than anything else here.
Bell's palsy is time-critical, and that is what makes speed worth paying for. Oral steroids started within 72 hours of symptom onset significantly improve the chance of complete recovery — and the benefit diminishes after that window. A same-day consultation on day one is worth considerably more than a free appointment on day four.
NHS urgent care and 111 can also achieve this quickly and free, and if you can be seen today on the NHS that is equally good. The point is speed, not who provides it.
The critical clinical distinction, and the reason this needs assessing rather than self-diagnosing: Bell's palsy affects the whole side of the face including the forehead. If the forehead still wrinkles and the eyebrow lifts on the affected side, that is not Bell's palsy — it suggests a stroke, and it is an emergency.
Eye care is the part most often under-emphasised and it costs very little. If the eye will not close fully, the cornea can dry and ulcerate. Lubricating drops during the day, ointment at night, and taping the eye closed while sleeping are what protect sight, and are available over the counter.
NHS facial physiotherapy is available for slow or incomplete recovery.
What needs emergency assessment: forehead sparing, weakness elsewhere, slurred speech, severe headache, or a painful vesicular rash in or around the ear — which suggests Ramsay Hunt syndrome and needs antivirals as well.
NICE Clinical Knowledge Summary, Bell's palsy, is the principal reference. It recommends prednisolone started within 72 hours of onset for adults, noting improved rates of complete recovery, and advises that antivirals are not routinely recommended alone.
CKS emphasises eye protection — lubricating drops, ointment at night and taping the eye closed — where eye closure is incomplete, to prevent exposure keratopathy.
CKS sets out the distinction between upper and lower motor neurone facial weakness: forehead sparing indicates an upper motor neurone lesion requiring urgent assessment for stroke, which is the basis for the point above.
NICE NG128, Stroke and transient ischaemic attack, governs the emergency pathway where central causes are suspected.
CKS covers Ramsay Hunt syndrome — facial palsy with a vesicular rash — which requires antiviral treatment alongside steroids and carries a poorer prognosis, warranting urgent ENT referral.
The forehead. In Bell's palsy you cannot wrinkle the forehead or raise the eyebrow on the affected side.
If the forehead still moves but the lower face has dropped, treat it as a stroke and call 999. The same applies to any limb weakness, difficulty speaking, or instantaneous onset.
Within 72 hours. Steroids work considerably better when started early, and the benefit falls away after that window.
Do not wait to see whether it settles.
Most people recover fully. Improvement typically begins within two to three weeks and continues over three to six months.
A minority have some lasting weakness, which is why early treatment and eye protection matter.
Because it cannot close, so it dries out — and a dry cornea can ulcerate and scar.
Drops by day, ointment and taping at night. It is the single most important piece of self-care, and it is frequently under-emphasised.
Shingles affecting the facial nerve, causing facial weakness alongside a painful blistering rash in or around the ear — sometimes in the mouth.
It needs different, higher-dose antiviral treatment and has a poorer outlook if missed, so mention any rash, ear pain or hearing change.
Worth raising if you have had a tick bite, a spreading circular rash, or if both sides of your face are affected.
Bilateral facial weakness is rarely Bell's palsy and warrants a different workup.
Recurrence is uncommon. Where it does recur, or affects the same side twice, that warrants further investigation rather than simply repeating treatment.
There is no good evidence that it does. The most widely accepted explanation is reactivation of a virus affecting the nerve, and in most cases no trigger is ever identified.
August 24, 2026
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