Primary hemifacial spasm (HFS) is characterized by irregular and involuntary contraction of the muscles innervated by the ipsilateral facial nerve. Treatment controls symptoms and improves quality of life (QoL). Objective: Evaluate the initial diagnosis and treatment of HFS prior to referral to a tertiary center. Method: We interviewed through a standard questionnaire 66 patients currently followed in our center. Results: Mean age: 64.19±11.6 years, mean age of symptoms onset: 51.9±12.5 years, male/female ratio of 1:3. None of the patients had a correct diagnosis in their primary care evaluation. Medication was prescribed to 56.8%. Mean time from symptom onset to botulinum toxin treatment: 4.34 ±7.1 years, with a 95% satisfaction. Thirty percent presented social embarrassment due to HFS. Conclusion: Despite its relatively straightforward diagnosis, all patients had an incorrect diagnosis and treatment on their first evaluation. HFS brings social impairment and the delay in adequate treatment negatively impacts QoL.722119122Kenney, C., Jankovic, J., Botulinum toxin in the treatment of blepharospasm and hemifacial spasm (2008) J Neural Transm, 115, pp. 585-591Tan, E.K., Chan, L.L., Clinico-radiologic correlation in unilateral and bilateral hemifacial spasm (2004) J Neurol Sci, 222, pp. 59-64Wang, A., Jankovic, J., Hemifacial spasm: Clinical findings and treatment (1998) Muscle Nerve;, 21, pp. 1740-1747Ho, S.L., Cheng, P.W., Wong, W.C., A case-controlled MRI/MRA study of neurovascular contact in hemifacial spasm (1999) Neurology, 53, pp. 2132-2139Rudzinska, M., Wójcik, M., Szczudlik, A., Hemifacial spasm non-motor and motor-related symptoms and their response to botulinum toxin therapy (2010) J Neural Transm, 117, pp. 765-772Colosimo, C., Berardelli, A., An early image of hemifacial spasm: Édouardbrissaud contribution (2010) Mov Disord, 25, pp. 531-533Auger, R.G., Whisnant, J.P., Hemifacial spasm in Rochester and Olmstead County, Minnesota, 1960 to 1984 (1990) Arch Neurol, 47, pp. 1233-1234Tan, N.-C., Chan, L.-L., Tan, E.-K., Hemifacial spasm and involuntary facial movements (2002) Q J Med, 95, pp. 493-500Chan, L.-L., Ng, K.-M., Fook-Chong, S., Lo, Y.-L., Tan, E.-K., Three-dimensional MR volumetric analysis of the posterior fossa CSF space in hemifacial spasm (2009) Neurology, 3, pp. 1054-1057Han, I.-B., Chang, J.H., Chang, J.W., Huh, R., Chung, S.S., Unusual causes and presentations of hemifacial spasm (2009) Neurosurgery, 65, pp. 130-137Tan, E.-K., Fook-Chong, S., Lum, S.-Y., Lim, E., Botulinum toxin improves quality of life in hemifacial spasm: Validation of a questionnaire (HFS-3 0) (2004) J Neurol Sci, 219, pp. 151-155Jankovic, J., Peripherally Induced Movement Disorders (2009) Neurol Clin, 27, pp. 821-832Munhoz, R.P., Teive, H.A.G., Coletta, M.V.D., Frequency of obsessive and compulsive symptoms in patients with blepharospasm and hemifacial spasm (2005) Arq Neuropsiquiatr, 63, pp. 213-216Stamey, W., Jankovic, J., The other Babinski sign in hemifacial spasm (2007) Neurology, 69, pp. 402-404Xie, T., Zhang, X.-B., Li, Q.-P., Zhu, W., Zhou, H., Gu, Y., Hemifacial spasm patient with ipsilateral total absence of common carotid artery, vertebral artery and aneurysm of the contralateral internal carotid artery (2010) Surg Radiol Anat, 32, pp. 707-710Kollewe, K., Mohammadi, B., Dengler, R., Dressler, D., Hemifacial spasm and reinnervationsynkinesias: Long-term treatment with either Botox or Dysport (2010) J Neural Transm, 117, pp. 759-763Valls-Sole, J., Electrodiagnostic studies of the facial nerve in peripheral facial palsy and hemifacial spasm (2007) Muscle Nerve, 36, pp. 14-20Barbosa, E.R., Takada, L.T., Gonçalves, L.R., Costa, R.M.P.N., Silveira-Moriyama, L., Chien, H.F., Botulinum toxin type A in the treatment of hemifacial spasm. An 11-year experience (2010) Arq Neuropsiquiatr, 68, pp. 502-505Tan, N.C., Tan, E.K., Khin, L.W., Diagnosis and misdiagnosis of hemifacialspasm:A clinical and video study (2004) J Clin Neurosc, 11, pp. 142-144