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Acquired torticollis

Last reviewed: 9 Apr 2025
Last updated: 17 Nov 2022

Summary

Definition

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
Full details

Other diagnostic factors

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

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
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests 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
Full details

Treatment algorithm

ACUTE

without pain or functional impairment

with functional impairment or pain or diminished quality of life

ONGOING

refractory to therapy with botulinum toxin

Contributors

Authors

David B. Sommer, MD, MPH
David B. Sommer

Neurologist and Movement Disorder Specialist

Reliant Medical Group

Worcester

MA

Disclosures

DBS declares that he has no competing interests.

Acknowledgements

Dr David B. Sommer would like to gratefully acknowledge Dr Mark A. Stacy, a previous contributor to this topic.

Disclosures

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

NC

Disclosures

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

Robert Werner, MD

Professor

Chief of PM&R

Ann Arbor VA Medical Center

Ann Arbor

MI

Disclosures

RW declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Stacy M. Epidemiology, clinical presentation, and diagnosis of cervical dystonia. Neurol Clin. 2008 May;26(suppl 1):23-42. Abstract

Singer C, Velickovic M. Cervical dystonia: etiology and pathophysiology. Neurol Clin. 2008 May;26(suppl 1):9-22. Abstract

Colosimo C, Suppa A, Fabbrini G, et al. Craniocervical dystonia: clinical and pathophysiological features. Eur J Neurol. 2010 Jul;17(suppl 1):15-21. Abstract

Rodrigues FB, Duarte GS, Marques RE, et al. Botulinum toxin type A therapy for cervical dystonia. Cochrane Database Syst Rev. 2020 Nov 12;11:CD003633.Full text  Abstract

Dashtipour K, Lew M. Cervical dystonia. In: Stacy MA, ed. Handbook of dystonia. New York, NY: Informa Healthcare; 2007:137-53.

Jankovic J, Leder S, Warner D, et al. Cervical dystonia: clinical findings and associated movement disorders. Neurology. 1991 Jul;41(7):1088-91. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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