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Acquired torticollis

Last reviewed: 8 Nov 2023
Last updated: 17 Nov 2022



History and exam

Key diagnostic factors

  • involuntary twisting or deviation of the neck
  • neck pain
  • presence of sensory trick
  • abnormal head posture
  • otherwise normal neurologic exam
More key diagnostic factors

Other diagnostic factors

  • head tremor
  • insidious onset
  • headache
  • asymmetrical hypertrophy of neck muscles
  • normal range of motion (ROM) of neck (early in course)
Other diagnostic factors

Risk factors

  • female sex
  • middle age (40 to 59 years)
  • white ancestry
  • family history of acquired torticollis
  • exposure to dopamine-blocking drugs
  • history of trauma
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • cervical x-rays
  • CT or MRI of the brain
  • CT or MRI of the neck
  • DYT-1 gene
  • serum ceruloplasmin, urinary copper excretion
  • electromyography
More investigations to consider

Treatment algorithm


without pain or functional impairment

with functional impairment or pain or diminished quality of life


refractory to therapy with botulinum toxin



David B. Sommer, MD, MPH
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 topic.


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 topic. Duke University has received funding from Allergan for a continuing medical education program.

Peer reviewers

Allison Brashear, MD

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 topic.

Robert Werner, MD


Chief of PM&R

Ann Arbor VA Medical Center

Ann Arbor



RW declares that he has no competing interests.

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