What Should You Avoid If You Have Bell’s Palsy?

Updated October 2026: rewritten around the Cochrane reviews on steroids and antivirals, the landmark 2007 trial and the US treatment guideline.

Waking up with one side of your face not moving is frightening. Most people with Bell’s palsy recover, but a few early choices make a real difference.

So what should you avoid if you have Bell’s palsy? Mainly three things: waiting too long, neglecting your eye and mistaking a stroke for Bell’s palsy.

This article explains the research. It can’t diagnose you, so please get medical help quickly.

What should you avoid if you have Bell’s palsy?

Here are the mistakes that matter most, based on the trials and guidelines.

First, rule out a stroke

This is the highest-stakes mistake. Bell’s palsy weakens one side of the face, and so can a stroke.

The NHS says to call 999 if a droopy face comes with trouble lifting both arms or trouble speaking. Don’t wait to see if it passes.

Bell’s palsy usually affects only the face and comes on over a few days. Even so, a doctor should make that call, not a mirror or a search result.

What the research shows

Early steroids clearly help

The strongest evidence is for steroid tablets, such as prednisolone. A Cochrane review pooled 7 trials with 895 people.

Six months or more later, 17% of people given steroids still had some facial weakness. Without steroids, it was 28%.

That means about 1 extra person fully recovers for every 10 people treated. Steroids also reduced synkinesis, where parts of the face move together by mistake.

Side effects were no more common than with a dummy pill. In those trials, they were mild, such as trouble sleeping.

The 2007 trial that changed practice

The best-known trial took place in Scotland and was published in 2007. It enrolled 551 people within 72 hours of their symptoms starting.

They took prednisolone, the antiviral acyclovir, both, or dummy pills, for 10 days. Nobody knew who got what.

Acyclovir alone didn’t help. Adding it to prednisolone didn’t add any benefit either.

There were no serious side effects in any group.

Antivirals: only alongside steroids

Bell’s palsy may be linked to a virus, so antivirals sound logical. A 2019 Cochrane review looked at 14 trials with 2,488 people.

Adding antivirals to steroids may make little or no difference to full recovery. But it did seem to reduce long-term problems, like synkinesis and “crocodile tears”, where the eye waters while eating.

Most of the trials were small and had flaws. That’s why doctors may offer antivirals together with steroids, but never instead of them.

Don’t neglect your eye

If your eyelid can’t close fully, your eye can dry out. A dry surface can get scratched or infected, and that can harm your sight.

The US treatment guideline gives eye protection a strong recommendation. The NHS lists three simple tools:

• Eye drops during the day to keep the eye moist.
• Eye ointment, often at night.
• Surgical tape to keep the eye closed at bedtime, if your doctor shows you how.

Get help fast if your eye becomes painful, red or your vision changes.

Be careful with DIY treatments

Bell’s palsy attracts a lot of home remedies and gadgets. Most have little evidence.

The US guideline made no recommendation on acupuncture or physical therapy, because the evidence was too thin. It also made no recommendation on surgery.

Facial exercises look more promising. A 2024 review pooled 7 trials in facial palsy, including Bell’s palsy.

Physical therapy might reduce the chance of not recovering, but the evidence was low quality.

The safest approach is guided therapy. A specialist physiotherapist can teach gentle, controlled movements, instead of forcing big facial expressions.

Eating and drinking safely

A weak mouth makes eating harder. You may drool, bite your cheek or pocket food on one side.

• Take smaller bites and chew on the stronger side.
• Choose softer food until chewing feels normal.
• Use a straw if drinks spill from the weak side.
• Check your mouth after meals for trapped food, and keep brushing well.

What recovery usually looks like

Many people recover with no treatment at all. A Danish study followed 2,570 people with facial palsy, most of them with Bell’s palsy, without treatment.

In 85%, movement came back within 3 weeks. Overall, 71% regained normal facial movement.

With steroids, the odds are better still. The NHS says symptoms should get better within 6 months, although some people take longer.

What earlier research found

Steroids across seven trials

The Cochrane review on steroids, updated in 2016, found clear benefit. It rated the evidence moderate to high quality.

Antivirals across fourteen trials

The Cochrane review on antivirals from 2019 found antivirals alone had no clear effect on recovery. With steroids, they may reduce long-term problems.

The natural course without treatment

The Copenhagen Facial Nerve Study, published in 2002, followed people for up to a year. It found severe lasting problems in 4%.

The US treatment guideline

The American guideline for Bell’s palsy, from 2013, recommends steroids within 72 hours for people aged 16 and over. It advises against routine blood tests and scans for new Bell’s palsy.

How much should you trust this?

Strong. For early steroids, several high-quality trials point the same way.

What makes it convincing

• Two Cochrane reviews pooled the randomised trials.
• The 2007 trial was large, blinded and placebo-controlled.
• Guidelines in the UK and US give the same advice.

What makes me cautious

• Many antiviral trials were small and had flaws.
• Evidence on exercises, acupuncture and gadgets is weak.
• The US guideline’s steroid advice covers only people aged 16 and over.

What this means for you

• Act fast. See a doctor the same day if you can, and certainly within 72 hours.
• Rule out stroke. Arm weakness or slurred speech means calling emergency services.
• Protect your eye until it closes properly again.
• Finish the steroid course your doctor gives you, usually 10 days.
• Go back if things don’t improve after 3 weeks, or get worse at any point.
• Ask about guided therapy rather than trying aggressive exercises alone.

Living with a changed face can affect your mood too. If it’s getting you down, the NHS says to talk to your doctor.

In this Cleveland Clinic video, a doctor explains how Bell’s palsy is treated:

What we still don’t know

1. Do antivirals help people with severe palsy? The trials were too small to be sure.
2. Which exercises work best? The physical therapy trials were small and varied.
3. What causes Bell’s palsy? A virus is suspected but not proven.
4. What’s best for children? The US guideline’s steroid advice covers people aged 16 and over.

My take: speed beats everything

What I like about this research is how clear the main message is. Early steroids work, and they’re cheap and usually safe.

I’m less convinced by the many gadgets and home routines sold online. The evidence for them is thin, and they shouldn’t delay real treatment.

If your face suddenly droops, don’t wait it out. Get checked the same day, protect your eye, and give recovery time.