What is the treatment for muscle spasms and tension in a headache (cephalalgia) with a tic disorder?

From the Guidelines

Treatment of muscle spasms and tension in head tics should prioritize a combination of medication and non-pharmacological approaches, with a focus on physical therapy and stress management techniques, as suggested by the most recent guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense 1.

Medication Approaches

• Muscle relaxants such as baclofen (10-25 mg three times daily) or tizanidine (2-4 mg three times daily) can help reduce muscle tension.
• Botulinum toxin injections administered by a neurologist directly into the affected muscles every 3-4 months are particularly effective for focal tics involving the head and neck.
• Benzodiazepines like clonazepam (0.5-2 mg daily) might be prescribed for short-term use to address anxiety-related tension that may worsen tics.

Non-Medication Approaches

• Physical therapy focusing on stretching and strengthening exercises for neck and shoulder muscles can reduce tension that contributes to head tics, as suggested by the guideline 1.
• Stress management techniques such as progressive muscle relaxation, deep breathing exercises, and mindfulness meditation practiced for 10-15 minutes daily can help reduce muscle spasms and tics.
• Comprehensive behavioral intervention for tics (CBIT) has shown effectiveness when practiced consistently over 8-10 weekly sessions.
• Heat application to tense muscles for 15-20 minutes several times daily and ensuring adequate sleep (7-9 hours nightly) can also help reduce the frequency and intensity of muscle spasms and tics. Key considerations in managing head tics include:
• Individualized treatment plans based on the frequency and severity of attacks, presence of temporary disability, and profile of associated symptoms.
• Limiting acute therapy to no more than two times per week to guard against medication-overuse headache.
• Considering preventive migraine therapy in patients with suspected medication overuse or those at risk for medication overuse.

From the FDA Drug Label

Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions Improvement is manifested by relief of muscle spasm and its associated signs and symptoms, namely, pain, tenderness, limitation of motion, and restriction in activities of daily living Cyclobenzaprine hydrochloride tablets have not been found effective in the treatment of spasticity associated with cerebral or spinal cord disease, or in children with cerebral palsy.

The treatment of muscle spasms and tension in head tic is not directly addressed in the provided drug labels. However, based on the information provided, cyclobenzaprine may be used to relieve muscle spasm associated with acute, painful musculoskeletal conditions.

• Key points:
  • Cyclobenzaprine is indicated for relief of muscle spasm associated with acute, painful musculoskeletal conditions.
  • Cyclobenzaprine has not been found effective in the treatment of spasticity associated with cerebral or spinal cord disease.
  • The use of cyclobenzaprine for head tic is not directly addressed in the provided drug labels. 2

From the Research

Treatment of Muscle Spasms and Tension in Head Tic

• The treatment of muscle spasms and tension in head tic can be managed through various pharmacological and non-pharmacological approaches 3, 4, 5.
• Botulinum toxin injections have been shown to be an effective and well-tolerated treatment for adults with tics, including head tics 3.
• Pharmacological treatment options for tic disorders and Tourette Syndrome include risperidone, tiapride, aripiprazole, and pimozide, among others 4.
• Alpha-2 agonists and dopamine-modulating agents have also shown promise in the treatment of tic disorders 5.
• Cognitive-behavioral therapy and deep brain stimulation surgery may also be considered for patients with refractory tic disorders 5.

Role of Muscle Relaxants in Head Tic Treatment

• Muscle relaxants such as baclofen, tizanidine, and botulinum toxin A have been studied as potential preventative treatments for migraine and tension-type headaches, which may be related to head tics 6.
• These agents may have a role in reducing muscle spasm and tone, although further clinical trials are needed to determine their efficacy and optimal administration schedules 6.
• Other drugs such as carbamazepine, phenytoin, and sodium valproate have been used to treat trigeminal neuralgia, a condition characterized by severe facial pain, which may be related to head tics 7.