What are the treatments for cervical muscle spasms?

Treatment of Cervical Muscle Spasms

For cervical muscle spasms, first-line treatment includes nerve-stabilizing agents such as pregabalin, gabapentin, and duloxetine, with botulinum toxin type A injections recommended for cases that don't respond to oral medications. 1

Pharmacological Management

First-Line Medications

• Nerve-stabilizing agents:
  • Pregabalin
  • Gabapentin
  • Duloxetine
  • These medications help control both pain and muscle spasms 2

Muscle Relaxants

• Cyclobenzaprine: 5mg three times daily for up to 2-3 weeks 3, 4
  • More effective than placebo for acute muscle spasms
  • Lower dose (5mg) is as effective as higher dose (10mg) with fewer side effects
  • Common side effects: fatigue, somnolence, dizziness, sedation, and nausea 5
  • Only indicated for short-term use (up to 2-3 weeks) 3

For Refractory Cases

• Botulinum toxin type A injections 2, 1, 6:
  • Recommended dose: 135 units of OnabotulinumtoxinA (Botox)
  • Frequency: Every 84 days, not exceeding 400 units
  • Alternative formulations with similar efficacy:
    • AbobotulinumtoxinA (Dysport)
    • IncobotulinumtoxinA (Xeomin)
    • RimabotulinumtoxinB (Myobloc)
  • Particularly effective for cervical dystonia (characterized by painful dystonic spasms of cervical muscles)
  • Potential side effects: dysphagia, excessive weakness, pain at injection site

Non-Pharmacological Management

Physical Therapy and Rehabilitation

• Referral to rehabilitation specialist is strongly recommended for comprehensive neuromusculoskeletal management 2, 1
• Manual treatments:
  • Mobilization and manipulation of cervical and thoracic spine
  • Stretching exercises
  • Range of motion exercises
• Vestibular rehabilitation if vestibular symptoms are present 1

Special Considerations

For Post-Radiation Cervical Muscle Spasms

• Patients who have undergone radiotherapy for head and neck cancer may develop painful cervical muscle spasms
• Botulinum toxin A injections to affected sternocleidomastoid muscles have shown benefit in this specific population 6

For Cervical Dystonia

• Characterized by painful dystonic spasms of cervical muscles
• Can be caused by neck dissection, radiation, or both
• Requires comprehensive management with both medications and rehabilitation 2

Follow-Up and Monitoring

• Reassess within 1 month after initial treatment to evaluate:
  • Symptom resolution
  • Side effects
  • Need for dose adjustment 1
• For botulinum toxin treatment, monitor for dysphagia, excessive weakness, and pain at injection site

Cautions and Contraindications

• Cyclobenzaprine should only be used short-term (up to 2-3 weeks) 3
• Botulinum toxin contraindications include allergy to the toxin and caution in pregnancy and with anticoagulant use 1
• Muscle relaxants may cause sedation and should be used with caution when driving or operating machinery 4

By following this treatment approach, most patients with cervical muscle spasms can achieve significant relief of symptoms and improved quality of life.