Cervical Dystonia

Janet D. Pearl, MD, MSc

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Cervical Dystonia

What is it?

Cervical dystonia is a painful condition of the neck in which the muscles involuntarily contract and cause unwanted movement of the head. It is also known as spasmodic torticollis, and it has no known cause or cure. Several movements are commonly seen with this condition. Tilting the chin to the shoulder is a common one, and slanting the ear toward the shoulder can also occur. In addition, in this condition, the chin can be forced straight upward or straight down, depending on which muscles experience the spasm.

In some cases, the head jerks into the positions, and many patients attempt to fight the movements. This only leads to an increase in jerking movements, and it can result in pain. Often, patients with this condition, exhibit a tremor as spastic muscles are counteracted by opposing muscles. It is often painful and exhausting for many patients who have this uncommon condition. However, with a combination of medication and physical therapy, many patients who have cervical dystonia are able to live full and relatively normal lives.

 Who gets it?

Anyone can potentially get cervical dystonia, but patients with certain histories are more likely at risk. A prior head, neck, or shoulder injury can sometimes lead to this condition, and certain medications can cause it, as well. Some anti-psychotic drugs and anti-nausea medications have side effects of causing unwanted movements, and cervical dystonia is one of the movement disorders that are seen.

Certain patient populations are also at risk for cervical dystonia. Although any age group can have the condition, including children, it is most commonly seen between the ages of 40 to 70. Men are at risk, but women are much more likely to manifest the symptoms of cervical dystonia. Finally, if someone in your family has the condition, you are at higher risk of developing it yourself. In fact, if someone in your family has any dystonia or movement disorder, you may be at higher risk for cervical dystonia.

What kind of pain results?

The pain that arises from cervical dystonia is generally muscular neck pain. You may feel stiffness and soreness in the muscles that are in constant movement, and your natural tendency to attempt to stop the movement can cause them to become strained. The neck pain can radiate down into the shoulders and cause muscular pain there, as well. Many patients experience headaches from the constant movement and tension in the muscles of the neck and shoulders. Muscle relaxants are often helpful in relieving the pain from the muscles spasms, but a vast amount of other medications may be tried, such as anti-Parkinson’s drugs, anti-seizure drugs, and anti-inflammatories.

 Treatment for Cervical Dystonia

Medications are the most common and effective method of treating the symptoms, and a Pain Medicine physician who is skilled in movement disorders is frequently the only specialist you need for your neck pain treatment. They can prescribe analgesics, Parkinson’s medications, and muscle relaxants to ease the symptoms, or perfrom Trigger Point Injections or Botox injections to directly relax the muscles in spasm.

Physical therapy is important in the treatment of cervical dystonia, and the exercises that increase neck muscle strength and flexibility are the most helpful. Occasionally, a neck brace is used to help movement, and physical therapists can help teach stress management techniques. In extreme cases, surgery may be necessary to sever muscles or nerves that are causing the spasm. By disconnecting the muscles that are tense, you should be able to control the movement of your head and neck. Finally, a small device can be implanted in the brain to provide deep brain stimulation, and this is thought to interfere with the signals from the overactive muscles and allow you to move your head normally.

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