From the Guidelines
Torticollis is a condition characterized by recurrent episodes of abnormal, painless head postures, often presenting as benign paroxysmal torticollis (BPT) with alternating head positions from side to side, lasting from minutes to several days, typically onset before 3 months of age 1.
Definition and Characteristics
Torticollis, specifically BPT, is marked by its episodic nature, with the head assuming unusual postures without pain. These episodes can vary significantly in duration, from a few minutes to several days. The condition often manifests early in life, typically before the age of 3 months, and has been associated with migraines that may appear later in childhood, suggesting a link to age-dependent migraine disorders 1.
Clinical Presentation and Management
The clinical presentation of BPT includes recurrent episodes of torticollis, which may be accompanied by symptoms such as irritability, discomfort, or vomiting. However, treatment is generally not necessary unless these symptoms necessitate symptomatic management, indicating a relatively benign course for many patients 1. The approach to managing torticollis, particularly BPT, focuses on alleviating discomfort and supporting the patient through episodes, rather than correcting the torticollis itself, unless complications or significant distress arise.
Key Considerations
- Early onset: Typically before 3 months of age.
- Episodic nature: Episodes can last from minutes to days.
- Painless: Despite the abnormal head postures, pain is not a characteristic feature.
- Association with migraines: Later development of migraines suggests a potential link to migraine disorders.
- Conservative management: Treatment is often not required unless symptoms cause significant distress.
From the Research
Definition of Torticolis
- Torticollis refers to a twisting of the head and neck caused by a shortened sternocleidomastoid muscle, tipping the head toward the shortened muscle, while rotating the chin in the opposite direction 2.
- It is a movement disorder of the nuchal muscles, characterized by tremor or by tonic posturing of the head in a rotated, twisted, or abnormally flexed or extended position or some combination of these positions 3.
- Spasmodic torticollis is a type of torticollis that affects adults, causing limited muscle control and impacting daily activities and quality of life 4.
- Congenital muscular torticollis is an idiopathic postural deformity evident shortly after birth, typically characterized by lateral flexion of the head to one side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle 5.
Types of Torticolis
- Nonparoxysmal (nondynamic) torticollis, which can be caused by congenital muscular, osseous, central nervous system/peripheral nervous system, ocular, and nonmuscular, soft tissue factors 2.
- Paroxysmal (dynamic) torticollis, which can be caused by benign paroxysmal, spasmodic (cervical dystonia), Sandifer syndrome, drugs, increased intracranial pressure, and conversion disorder 2.
- Spasmodic torticollis, which is a focal dystonia that affects adults 4.
- Congenital muscular torticollis, which is an idiopathic postural deformity evident shortly after birth 5.