Tics in adults: causes, tests and treatment in the UK

The NHS describes tics as fast, repetitive muscle movements that result in sudden and difficult to control body jolts or sounds. Motor tics affect movement, while vocal or phonic tics produce a sound. Tics can be simple, such as blinking, or more complex, such as repeating a sound or phrase.

Many adults who notice tics have had them before. Because tics are most common in childhood, the usual NHS description is of a condition that improves over time, with many people finding them settle or stop completely. Tics that appear for the first time in adult life are described as very occasional, and this is why a careful assessment is worthwhile.

Examples listed by the NHS include blinking, wrinkling the nose or grimacing, jerking or banging the head, clicking the fingers, touching other people or things, coughing, grunting or sniffing, and repeating a sound or phrase. In a small number of cases the repeated phrase may be something obscene or offensive. The NHS Tourette syndrome page adds that swearing is rare.

Tics happen randomly and may be associated with stress, anxiety, tiredness, excitement or happiness. They often begin with an unpleasant sensation, known as an urge, that builds up until relieved by the tic, and they can sometimes be partly suppressed. Tics tend to get worse if they are talked about or focused on, which is why the NHS suggests care when filming them for a GP.

The NHS says it is not clear what causes tics. They are thought to be due to changes in the parts of the brain that control movement, they can run in families and there is likely to be a genetic cause in many cases. They also often happen alongside attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD).

In adults it is particularly important to ask about other contributors. The NHS notes that tics can sometimes be triggered by illegal drugs such as cocaine or amphetamines and are occasionally caused by more serious health conditions such as cerebral palsy or Huntington's disease. A doctor will usually ask about medicines and drug use as part of the assessment.

The NHS uses the term Tourette syndrome when tics have lasted for more than a year. A GP may think of Tourette syndrome if tics started before the age of 18, have been happening for 1 year or more and involve both sounds and movements. Lots of children have tics at some point without having Tourette syndrome.

Because of those age criteria, adults who first notice tics later in life may be assessed differently, and referral to a specialist such as a neurologist is common when the picture is unclear. The specialist may use tests such as an EEG, MRI scan or blood test to check whether symptoms are caused by Tourette syndrome or another condition.

Mild tics that cause no problems do not always need medical attention, and they can disappear as quickly as they appear. The NHS advises seeing a GP if you are concerned, need support or advice, or the tics:

• occur very regularly, or become more frequent or severe;

• cause emotional or social problems, such as embarrassment or social isolation;

• cause pain or discomfort, including accidental self-injury;

• interfere with daily activities or work;

• are accompanied by anger, depression or self harm.

Treatment is not always needed. The NHS says self-help tips such as avoiding stress or tiredness are often very helpful for the majority of people. Its Tourette syndrome advice also suggests a consistent daily routine with plenty of physical activity and a calm, regular bedtime routine.

If tics are more severe and affect everyday activities, therapies that reduce how often tics occur may be recommended. These are habit reversal therapy, which teaches intentional movements that compete with the tic; comprehensive behavioural intervention for tics (CBiT), a set of behavioural techniques; and exposure with response prevention (ERP), which helps people get used to the unpleasant sensation before a tic so the tic does not occur.

Medicines can also reduce tics. They may be used alongside psychological therapies or after therapies have been tried without success. The NHS Tourette syndrome page notes that the medicine offered also depends on whether ADHD or OCD is present and that side effects should be discussed. It adds that there is little evidence that herbs, supplements and other complementary treatments help.

In most cases tics improve over time or stop completely. They can last a few months, or come and go over several years. The NHS notes they are normally most severe from around 8 years of age until teenage years and usually start to improve after puberty, which is mainly relevant to those whose tics began in childhood.

Support groups can help. Tourettes Action is listed by the NHS as a source of information and support, including online and face-to-face groups and support with employment and education. Telling a manager or teacher what to expect can reduce the stress that makes tics worse.

Assessment normally starts with a GP, who can refer to a neurologist or other specialist if needed. Behavioural therapy for tics is delivered by trained therapists, and availability varies by area. Private assessment is possible, but it is worth asking whether the clinician has experience of tic disorders and which therapy approach they use.