Last reviewed: September 2018
Last updated: January  2018



History and exam

Key diagnostic factors

  • involuntary twisting or deviation of the neck
  • neck pain
  • presence of sensory trick
  • abnormal head posture
  • otherwise normal neurological examination

Other diagnostic factors

  • head tremor
  • insidious onset
  • headache
  • asymmetrical hypertrophy of neck muscles
  • normal ROM of neck (early in course)

Risk factors

  • female sex
  • middle age (40s and 50s)
  • white ancestry
  • FHx of acquired torticollis
  • exposure to dopamine-blocking drugs
  • hx of trauma

Diagnostic investigations

Investigations to consider

  • cervical x-rays
  • CT or MRI brain
  • CT or MRI neck
  • DYT-1 gene
  • serum ceruloplasmin, urinary copper excretion
  • EMG
Full details

Treatment algorithm


Authors VIEW ALL

David B. Sommer

Neurologist and Movement Disorder Specialist

Reliant Medical Group




DBS declares that he has no competing interests.

Dr David B. Sommer would like to gratefully acknowledge Dr Mark A. Stacy, a previous contributor to this monograph. MAS has received speaking honoraria and consulting fees from Allergan, the manufacturer of Botox; he has received research grant support from Ipsen, manufacturer of Dysport, and Merz, manufacturer of Xeomin; he is an author of a reference cited in this monograph. Duke University has received funding from Allergan for a continuing medical education program.

Peer reviewers VIEW ALL

Professor and Chair

Department of Neurology

Wake Forest University Baptist Medical Center

Winston Salem



AB declares interests in Allergan; she is an author of a reference cited in this monograph.


Chief of PM&R

Ann Arbor VA Medical Center

Ann Arbor



RW declares that he has no competing interests.

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