- Torticollis causes neck pain, stiffness, and trouble turning the head due to involuntary muscle contraction.
- Common causes include poor posture, stress, awkward sleeping positions, sudden neck movements, injuries, or spine problems.
- Treatment depends on the cause and may include medication, physical therapy, botulinum toxin injections, or surgery in more severe cases.
Torticollis is an involuntary contraction of the neck muscles that causes neck pain, stiffness, and trouble turning the head. It may also make one shoulder look higher than the other or cause the head and chin to tilt in opposite directions.
Torticollis is often linked to poor posture, stress, sleeping in an awkward position, sudden neck movements, or intense exercise. It can also be caused by injuries, spine problems, neurological conditions, infections, medication side effects, or congenital changes present from birth.
Treatment for torticollis depends on the cause and may include pain relievers, anti-inflammatory medicines, muscle relaxants, physical therapy exercises, or botulinum toxin injections. Medical evaluation is important when torticollis does not improve, keeps coming back, or occurs with fever, headache, trouble walking, loss of balance, or double vision.
Torticollis symptoms
The main symptoms of torticollis are:
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Difficulty moving the head
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Stiffness and swelling of the neck muscles
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One shoulder being higher than the other
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An asymmetric face, with the head tilted to one side and the chin pointing in the opposite direction
Torticollis symptoms often appear in the morning after sleeping in an awkward position or after intense exercise, especially if the exercise was performed incorrectly.
Depending on the cause, other symptoms may also occur, such as fever, headache, sore throat, difficulty walking, loss of balance, or double vision.
Confirming a diagnosis
Torticollis is usually diagnosed by a primary care provider, pediatrician, or orthopedist based on an evaluation of symptoms, health history, and a physical exam.
The doctor may order blood tests or imaging tests, such as an X-ray, CT scan, or MRI, when symptoms are severe, unusual, or do not improve. These tests can help rule out other possible causes, such as spine problems, infections, neurological conditions, medication side effects, or, more rarely, tumors.
Possible causes
The main causes of torticollis are:
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Excessive stress
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Poor posture or sleeping in an awkward position
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Sudden neck movements or vigorous exercise
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Spine conditions, such as a herniated disc or scoliosis
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Neurological conditions, such as Parkinson’s disease or stroke complications
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Scars in the neck area
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Abscesses in the mouth, head, or neck area
Other causes include strabismus, accidents, and certain medications such as metoclopramide, phenytoin, or carbamazepine.
Torticollis can also be caused by congenital problems and may be present in babies from birth. This is called congenital torticollis.
Although torticollis is not always serious, it can have serious causes, such as infections or tumors. Therefore, identifying the cause of torticollis is essential for recommending the most appropriate treatment.
How to treat
Torticollis usually improves within a few days, even without specific treatment. However, medical care should be sought right away if torticollis occurs after an injury or with symptoms such as fever, headache, difficulty walking, loss of balance, or double vision.
Treatment for torticollis depends on the identified cause, but may include:
1. Medication
Anti-inflammatory medicines, muscle relaxants, and pain relievers are usually used to relieve intense muscle contraction and pain.
Depending on the cause of torticollis, other medications may also be prescribed, such as benzodiazepines and anticholinergics.
2. Exercises and stretches
Exercises and stretches guided by a physical therapist can help improve head posture, relieve pain, and strengthen the neck muscles. They may be recommended in some cases of torticollis.
3. Botulinum toxin injection
When torticollis is caused by excessive muscle contraction, especially cervical dystonia, and does not improve with medication or physical therapy, a botulinum toxin injection, such as Botox, may be recommended.
According to the American Academy of Otolaryngology-Head and Neck Surgery, botulinum toxin is considered a safe and effective treatment option for cervical dystonia, also called spasmodic torticollis.
The injection helps relax the contracted muscle, which can improve head position and relieve pain.
4. Surgery
Surgery is usually only recommended when torticollis does not improve despite appropriate treatment. It is done to help correct head position and improve the neck’s range of motion.
Other treatment options
When torticollis is caused by stress, muscle strain, or sudden neck movements, massaging the affected area and gently pressing on the neck muscles can help relieve pain and discomfort.