Cervical dystonia, also called spasmodic torticollis, is a painful condition in which your neck muscles contract involuntarily, causing your head to twist to one side. Cervical dystonia can also cause your head to uncontrollably tilt forward or back.
A rare disorder that can occur at any age, even infancy, cervical dystonia most often occurs in middle-aged women. Symptoms generally begin gradually and then reach a point where they don't get any worse.
There is no cure for cervical dystonia, but the disorder sometimes resolves on its own. Injecting botulinum toxin into the affected muscles often reduces the signs and symptoms of cervical dystonia. Rarely, surgery may be necessary.
The muscle contractions involved in cervical dystonia can cause your head to twist in a variety of directions, including:
- Chin toward shoulder
- Ear toward shoulder
- Chin straight up
- Chin straight down
The most common type of twisting associated with cervical dystonia is when your chin is pulled toward your shoulder. Some people experience a combination of abnormal head postures. A jerking motion of the head also may occur.
At least two-thirds of the people who have cervical dystonia also experience neck pain that can radiate into the shoulders. The disorder also can cause severe headaches. In some people, the pain from cervical dystonia can be exhausting and disabling.
- Tremor. Cervical dystonia may also cause tremors in your arm or hand.
- Shoulder elevation. The disorder may also cause the shoulder on your affected side to pull up toward your ear.
Researchers believe that the signs and symptoms of cervical dystonia result from a defect in the brain's ability to process chemical messages that allow brain cells to communicate with each other.
In most cases of cervical dystonia, doctors don't know why some people develop the disorder and others don't. Some cases, however, appear to be linked to:
Head, neck or shoulder injuries
Tumors in the brain or spinal cord
Drugs, including some antipsychotic, anti-nausea and antidepressant agents
Toxins, such as heavy metals and carbon monoxide
Risk factors for cervical dystonia include:
- Age. While the disorder can occur in people of any age, even infants, it most commonly begins between the ages of 40 and 60.
- Sex. Compared with men, women are nearly twice as likely to develop cervical dystonia.
- Family history. If a close family member has cervical dystonia or another movement disorder, you are at higher risk of developing the disorder.
Cervical dystonia can lead to:
- Nerve damage. The sustained muscle contractions associated with cervical dystonia can cause permanent damage to compressed nerves. Symptoms include pain, numbness and tingling.
- Involvement of other body parts. Some people who start out with cervical dystonia eventually develop similar symptoms in the face, jaw, arm or trunk.
- Depression. The disability and pain that can be caused by cervical dystonia may result in depression.
Preparing for your appointment
While you might first discuss your symptoms with your family doctor, he or she may refer you to a neurologist - a doctor who specializes in disorders of the brain and nervous system - for further evaluation.
What you can do
Because appointments can be brief, plan ahead and write a list that includes:
- Detailed descriptions of your symptoms, including when they started and if anything makes them better or worse
- Information about medical problems you've had in the past, such as strokes or head injuries
- Information about the medical problems of your parents or siblings
- All the medications and dietary supplements you take
- Questions you want to ask the doctor
What to expect from your doctor
In addition to conducting a physical exam, your doctor may also check your neurological health by testing your:
- Muscle strength
- Muscle tone
- Senses of touch and sight
Your doctor may ask you to rapidly open and close your fists several times, because this activity sometimes triggers the muscle contractions commonly seen in cervical dystonia.
Tests and diagnosis
While the physical examination alone can often confirm a diagnosis of cervical dystonia, it's important to determine if there are underlying conditions causing your signs and symptoms. Tests may include:
- Blood or urine tests. These may reveal the presence of toxins.
- Magnetic resonance imaging (MRI). This type of imaging test may be used to identify and visualize tumors or evidence of stroke.
- Electromyography (EMG). This test measures the electrical activity of muscles. EMG helps evaluate and diagnose muscle and nerve disorders and can help confirm whether you have cervical dystonia or another condition.