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Post-Traumatic Cervical Dystonia: What It Is and How to Treat It

Doctor looking at female patient's x-ray explaining post-traumatic cervical dystonia to her

Post-traumatic cervical dystonia is a serious form of movement disorder that can occur after TBI.

While there is no cure for cervical dystonia, there are ways to reduce and manage the symptoms, which you will find at the end of this article.

What is Post-Traumatic Cervical Dystonia?

Cervical dystonia is a condition that causes the muscles in your neck to contract involuntarily.

The contractions can make your head twist in several directions, such as:

  • Chin toward the shoulder (torticollis)
  • Chin straight up (retrocollis)
  • Ear toward the shoulder (laterocollis)  
  • Chin straight down (anterocollis)

The most common posture associated with cervical dystonia is the twisting of the chin toward the shoulder so that the head is rotated sideways.

Cervical dystonia is also known as spasmodic torticollis.

Causes of Cervical Dystonia

While the exact cause of cervical dystonia is unknown, scientists believe that it is a result of improper signaling between the brain and the muscles. These bad signals confuse the muscles and cause them to contract.

Cervical dystonia can either be classified as isolated or acquired.

In isolated dystonia, there is no identifiable cause for the symptoms. With acquired dystonia, the symptoms are triggered by damage to certain areas of the brain.

The most common cause of acquired cervical dystonia is a traumatic brain injury.  

Symptoms of Post-Traumatic Cervical Dystonia

man rubbing neck suffering from symptoms of post-traumatic cervical dystonia

©iStock/twinsterphoto

Symptoms of cervical dystonia do not appear right away. Rather, they will typically begin gradually, then worsen until they reach a plateau.

Symptoms are usually worsened by standing, walking, or stress.  

Some common, early symptoms of post-traumatic cervical dystonia include:

  • Neck pain that radiates to shoulders
  • Raised shoulder
  • Headache
  • Head tremor
  • Enlargement of neck muscle

Sometimes cervical dystonia will cause the neck to freeze in one position, and sometimes it causes people to experience abrupt, jerky neck movements.

These movements can be easily confused with tremors after brain injury. Many people with cervical dystonia also experience hand tremors, which can make diagnosis even more complicated.

The worst symptom of cervical dystonia is severe muscle pain. Therefore, before you can begin treatment, it is crucial to get that pain under control.

How to Relieve Pain from Cervical Dystonia

There are several methods that doctors use to treat the pain from cervical dystonia. You may need to try a combination of methods before you find the treatment that works for you.

Botox

botox for post-traumatic cervical dystonia

The most common treatment for pain relief is Botox injections in the neck muscles every three months.

The botulinum toxin in Botox immobilizes the nerves in the neck, which relaxes the muscle and relieves pain.

Botox is an effective treatment for painful muscle spasms, and 90% of people with cervical dystonia report an improvement in their symptoms after an injection.

Still, it does not always work for everyone. If you do not see any results from Botox, you might find relief through other methods.

Medication

Several oral medications can help relieve pain and other symptoms associated with post-traumatic cervical dystonia. According to the Dystonia Foundation, some effective meds include:

  • Anticholinergics. These block the neurotransmitter acetylcholine, which causes muscles to contract.
  • Dopaminergics. These meds increase dopamine-related activity in the brain, which can reduce pain.
  • Baclofen. This drug acts as a muscle relaxer and helps reduce spasms.

In addition, some anti-convulsants that are typically taken to treat epilepsy have been successfully used on cervical dystonia patients.

While these drugs can help fight the pain associated with cervical dystonia, TBI patients should use them cautiously.

Some drugs, such as Valium, which is sometimes recommended, can have a negative effect on the brain and will slow down recovery.

Therefore, be sure to always consult with your doctor before starting any medications.

Acupuncture

woman trying acupuncture for post-traumatic cervical dystonia

Acupuncture can be an effective complementary medicine to help relieve the symptoms of post-traumatic cervical dystonia.

When used in combination with Botox injections, many people report significant improvements in their symptoms than when using Botox alone.

While not everyone sees improvements from acupuncture, it might be worth trying, especially if traditional treatments are not having an effect.

Treating Post-Traumatic Cervical Dystonia

The methods above can help relieve the pain of cervical dystonia and may reduce its severity. While this is important, it is still only a temporary fix.

The only way to fully treat post-traumatic cervical dystonia is to address the root cause, which is poor communication between the brain and the neck muscles.

The following treatments can help improve that connection.

Physical Therapy

woman doing physical therapy for post-traumatic cervical dystonia

Physical therapy may help relieve cervical dystonia by activating the brain’s neuroplasticity.

Neuroplasticity refers to your brain’s ability to repair itself and create new neural pathways. These new pathways are formed through repetitive, therapeutic exercise.

When these new pathways are established, communication between the brain and the rest of the body will be restored, which will improve function.

Therefore, one of the best ways to treat dystonia after brain injury is to exercise and stretch your neck muscles. Most therapists recommend doing exercises that move in the opposite direction of the person’s twist.

Of course, this can be difficult to do, especially when the dystonia causes abnormal movements. As a result, you might need medication to get the dystonia under control first.

Once the dystonia goes down, you can work on exercising your neck muscle to engage neuroplasticity.

Deep Brain Stimulation

Deep brain stimulation is a surgical treatment for dystonia that uses implanted electrodes to send high-frequency signals to structures in the brain that control involuntary movements.

These signals suppress some of the abnormal signals that the brain is sending to the muscles, which reduces muscle spasms in the neck.

Deep brain stimulation is a relatively new treatment for cervical dystonia, and some of the evidence for it is still inconclusive. But if your symptoms are severe, it might be something worth considering with your doctor.  

Outlook for Patients with Post-Traumatic Cervical Dystonia

Cervical dystonia is a painful condition that can arise after a head injury.

There is currently no cure, however, combining physical therapy with anti-spasmodic medication seems to be the most effective treatment approach. Other therapies such as acupuncture and deep brain stimulation may also reduce symptoms.

We hope this article helps you find the treatment for cervical dystonia that best fits your needs.

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