Cervical Dystonia

What is cervical dystonia?

Cervical dystonia is a neurological condition (affecting your brain and nerves) that causes involuntary muscle contractions in your neck. When your muscles contract, they tighten and can’t relax. This condition affects your posture. Your head and neck may make abnormal movements that look similar to a spasm or jerk. This condition can cause pain and discomfort, which can affect your day-to-day activities.

Cervical dystonia is a type of focal dystonia. This is a group of conditions that cause muscle spasms in one part of your body.

You may hear your healthcare provider refer to cervical dystonia as spasmodic torticollis.

What are the types of cervical dystonia?

There are two types of cervical dystonia. You can tell them apart by the cause:

• Primary: The cause is unknown.
• Secondary: The cause is known.

How common is cervical dystonia?

Cervical dystonia is the most common form of focal dystonia. It affects an estimated 60,000 people in the United States.

What are the symptoms of cervical dystonia?

Cervical dystonia causes involuntary movements like:

• Spasms: Your muscles tighten, feel hard and can’t relax. Your muscles may twitch or make a jerking movement suddenly.
• Tremors: Certain parts of your body, like your arms, shake uncontrollably.

Involuntary movements can affect your posture. Your posture is the position that you hold your body in when you’re standing or sitting. Posture changes with cervical dystonia may include:

• Rotating (turning) your head.
• Tilting (slightly moving at an angle) your head forward, backward or side to side.
• Bending (curving) your neck and head forward, backward or side to side.

These movements can cause pain (a burning sensation) in your shoulders and neck. You may also experience headaches with cervical dystonia.

What causes cervical dystonia?

Healthcare providers don’t know the exact cause of all cases of cervical dystonia. Research suggests your basal ganglia, or the part of your brain that regulates muscle movements, isn’t working as it should.

Secondary dystonia may be the result of:

• Complications of psychiatric medication use.
• Traumatic brain injury.
• Parkinson’s disease.
• Genetic change (mutation) of GNAL, THAP1, CIZ1 or ANO3 genes.

What are the risk factors for cervical dystonia?

You may be more at risk of developing cervical dystonia if you:

• Have biological family members who have the condition.
• Take dopamine antagonists or antipsychotics.
• Experienced a brain injury.

While the condition can affect anyone at any age, it’s most common among:

• Women and people assigned female at birth.
• People between the ages of 30 and 60.

What are the complications of cervical dystonia?

Symptoms of cervical dystonia can affect your daily routine and how well you’re able to perform certain activities. Pain, tremors or spasms can make it difficult to move your neck, jaw, arms and trunk. You may have trouble with speech, swallowing and physical coordination. Severe cases may limit your ability to work or complete tasks that you used to be able to do, like combing your hair or brushing your teeth.

If cervical dystonia is left untreated, you may experience pain and dystonia or muscle spasms in other parts of your body beyond your neck.

How is cervical dystonia diagnosed?

A healthcare provider will diagnose cervical dystonia after a physical exam to review your symptoms. They’ll also ask you about your medical history and your family’s medical history to see if you’re aware of the condition in your biological family.

Testing, like an MRI or electromyography, isn’t necessary unless your healthcare provider suspects spinal cord compression or nerve damage or irritation.

How is cervical dystonia treated?

Treatment for cervical dystonia may include:

• Botulinum toxin injections.
• Oral medications.
• Physical therapy.
• Deep brain stimulation surgery.

Some people might notice that their symptoms resolve after touching their chin or wearing a neck brace (cervical collar).

Treatment varies for each person diagnosed with the condition. What works for you might not work for someone else. You may need to try different types of treatment until you find the right one or few that work for you.

How does botulinum toxin treat cervical dystonia?

Many people know about a common brand of botulinum toxin called Botox®. This is a type of botulinum toxin serotype A that can treat cervical dystonia in addition to botulinum toxin type B. Botulinum toxin works by weakening the dystonic neck muscle, in turn, keeping it from contracting.

Your healthcare provider will inject this medication into the muscles in your neck. You may notice the effects of the medication about a week after the injection. It lasts between two to three months. When the effects wear off, your symptoms will reappear. You’ll need repeat injections to manage your symptoms.

Side effects of botulinum toxin include:

• Difficulty swallowing.
• Injection site pain.
• Neck weakness.

What medications treat cervical dystonia?

Some of the most common medications to treat cervical dystonia include:

• Dopaminergic agents (levodopa).
• Anticholinergic agents (benztropine, trihexyphenidyl).
• Baclofen.
• Clonazepam.

Side effects may include memory problems and fatigue.

Can cervical dystonia be prevented?

There’s no known way to prevent cervical dystonia.

What’s the outlook for cervical dystonia?

Cervical dystonia is a lifelong condition, but it doesn’t affect your life expectancy. The condition may progressively worsen over time or your symptoms may plateau (reach a point where they don’t change).

With treatment, you and your healthcare provider can manage your symptoms so you can get back to the activities you enjoy without discomfort.

Does Botox cure cervical dystonia?

No. There’s no cure for cervical dystonia. Botox, a brand of botulinum toxin, can temporarily treat the symptoms of cervical dystonia, but it isn’t a cure.

When should I see a healthcare provider?

Visit a healthcare provider if:

• You notice muscle spasms or tightness in your neck.
• You have a dystonia diagnosis and experience treatment side effects or worsening symptoms.

What questions should I ask my healthcare provider?

• Am I at risk of cervical dystonia if someone in my biological family had it?
• What type of treatment do you recommend?
• Are there side effects of treatment?
• Will I need surgery?

A note from Cleveland Clinic

Cervical dystonia is an uncomfortable condition. The muscles in your neck have trouble relaxing, which makes your head move when you don’t want it to. It can prevent you from participating in certain activities you once enjoyed or completing your daily routine. Your healthcare provider can help you find a treatment that works best to address your symptoms so you can feel better.