Torticollis

(Spasmodic Torticollis; Cervical Dystonia)

by Cynthia M. Johnson, MA

Definition

Torticollis is when the head turns and tilts to one side and the chin points to the other side. One shoulder may lift. It may be all the time or may come and go.

Causes

The exact cause is not known. It may be from:

An infant's body pose before birth or during birth
Head or neck injury
Problems with genes
Infection in neck muscles or bones
Problems with the nervous system
Ear or eye problems
Misshapen bones or muscles in the neck
Tumors of the head or neck
Arthritis of the neck
Use of certain medicines

Risk Factors

This problem is more common in women, children under 10, and adults who are 30 to 60 years old. The risk is higher in people who have other family members with this problem.

Symptoms

Muscles of the Neck

Problems range from mild to severe. It often worsens slowly for 1 to 5 years. Then it slows and stays the same. It may last for life. It can result in problems moving and affect posture.

Problems may be:

Rotation and tilting of the head to one side
Stiff neck
Painful spasms of the neck and upper back
Poor range of motion in the head and neck
Headache

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done.

Pictures may be needed. This can be done with:

Treatment

Treatment depends on whether the problem has been since birth (congenital) or started later (acquired). Options are:

Congenital Torticollis

Stretching several times a day
Surgery to make the tendon longer

Acquired Torticollis

Physical therapy and Botox to help relax the muscle and ease pain
Surgery to cut the nerve to the muscle that is in spasm
Deep brain stimulation
Certain oral medicines for pain or to relax the muscles
Injections of:
- Botox to weaken or partly paralyze the muscle—This may help with neck posture. It is best if it is done soon after torticollis starts. It wears off after a few months. It must be done again.
- Alcohol or phenol to deaden the nerve that causes the muscle to contract

Prevention

There are no known ways to prevent this problem.

RESOURCES:

Dystonia Medical Research Foundation
http://www.dystonia-foundation.org

National Spasmodic Torticollis Association
http://www.torticollis.org

CANADIAN RESOURCES:

The College of Family Physicians of Canada
http://www.cfpc.ca

Health Canada
https://www.canada.ca

References:

Cervical dystonia. Dystonia Medical Research Foundation website. Available at: https://dystonia-foundation.org/what-is-dystonia/types-dystonia/cervical-dystonia. Accessed October 9, 2020.

Cervical dystonia. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/cervical-dystonia. Accessed October 9, 2020.

Dystonias fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Dystonias-Fact-Sheet. Accessed October 9, 2020.

Marion MH, Humberstone M, Grunewald R, Wimalaratna S. British Neurotoxin Network recommendations for managing cervical dystonia in patients with a poor response to Botulinum toxin. Pract Neurol. 2016;0:1-8. Available at:
...(Click grey area to select URL)
Accessed October 9, 2020.

Tomczak KK, Rosman NP. Torticollis. J Child Neurol. 2013 Mar;28(3):365-378.

Last reviewed September 2020 by EBSCO Medical Review Board Laura Lei-Rivera, PT, DPT, GCS
Last Updated: 5/14/2021

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