Torticollis (wry neck): causes, symptoms, treatment and how long it lasts

Torticollis simply describes a neck that is twisted or held to one side. NICE Clinical Knowledge Summaries use the terms torticollis and wry neck interchangeably. Three situations account for most of what people mean, and they have different causes, courses and treatments.

A stiff neck that appeared overnight and is easing is very different from a head that is gradually pulled to one side over months.

NICE describes typical features of acute torticollis as a sudden onset of severe unilateral (one-sided) pain, with restricted and painful neck movements, and diffuse tenderness on the involved side with palpable spasm.

The NHS neck pain page adds that the neck becoming locked in an awkward position while sleeping is among the most common causes of neck pain, alongside bad posture, a pinched nerve and injury such as whiplash.

For a sudden wry neck, NICE says management should include reassurance that symptoms usually resolve within 24 to 48 hours. The NHS says most neck pain only lasts a few weeks, and to see a GP if neck pain or stiffness does not go away after a few weeks.

Cervical dystonia is different. The NHS says dystonia is usually a lifelong problem, but treatment can help relieve the symptoms, and that severity can vary from one day to another.

For acute torticollis, NICE says the cause is often unclear but may be due to posture. Examples are poor positioning at a computer screen, inappropriate seating, sleeping without adequate neck support or carrying heavy unbalanced loads. Doctors also rule out other causes of muscle spasm such as acute disc prolapse, tonsillitis, swollen neck lymph glands, cervical spine injury and neurological disorders leading to dystonia.

The NHS says dystonia is caused by a problem with the part of the brain that controls movement. Often it is not known why this happens, but it can be due to an inherited genetic problem, a side effect of certain medicines (such as antipsychotic and anti-sickness medicines), Parkinson's disease, a stroke, cerebral palsy or multiple sclerosis.

For acute wry neck, NICE suggests oral painkillers such as paracetamol or ibuprofen (with or without codeine), referral to physiotherapy, intermittent heat or cold packs, sleeping on a low firm pillow, good posture and neck flexibility exercises. It advises against routine use of a soft cervical collar and against driving, as it is not possible to rotate the head to view traffic.

The NHS says not to wear a neck collar, because it is better to keep the neck moving unless a doctor tells you otherwise, and not to do anything dangerous because you cannot move your neck, such as driving or cycling. For heat or cold, it suggests a pack of frozen peas wrapped in a tea towel for 5 minutes 3 times a day, or a hot water bottle wrapped in a tea towel for 20 minutes 2 to 3 times a day.

The NHS describes dystonia as uncontrolled and sometimes painful muscle movements, with parts of the body twisting into unusual positions, such as the neck being twisted to the side. Symptoms may be continuous or come and go, and can be triggered by tiredness, stress, alcohol or caffeine, talking, eating or chewing, and activities like writing. NHS inform says neck dystonia is the most common type of focal dystonia and usually causes the head to be pulled in one direction, which can affect movement and cause pain.

If a GP thinks you could have dystonia, they refer you to a neurologist for tests. The NHS lists botulinum toxin injections into the affected muscles, repeated about every 3 months, medicine to relax muscles, and deep brain stimulation surgery, which may be offered on the NHS if other treatments do not help. Physiotherapy and occupational therapy may also help. NHS inform says the effect of botulinum toxin lasts around 3 to 6 months.

The NHS flat head syndrome page lists tight neck muscles (torticollis) as one thing that can cause a flat head. It makes a baby always rest their head on the same side, and they may not be able to turn their head. The page says a baby may be referred for physiotherapy if they have tight neck muscles, and that the physiotherapist will show parents gentle exercises that may help.

The NHS adds that simple things such as varying the position of the baby's head when carrying or feeding may help head shape. Speak to a health visitor or GP if your baby always tilts their head or cannot turn it.

The NHS says to see a GP if neck pain or stiffness does not go away after a few weeks, painkillers like paracetamol or ibuprofen have not worked, you are worried about the pain, or you have other symptoms such as pins and needles or a cold arm, which could be something more serious.

NICE lists features that may indicate serious underlying pathology and need assessment: neurological symptoms and signs, malaise, fever, unexplained weight loss, unremitting pain affecting sleep, a history of violent trauma or neck surgery, and risk factors for osteoporosis. Get urgent advice from NHS 111, or call 999 if you are very unwell.

In many areas you can refer yourself to NHS community musculoskeletal (MSK) services for physiotherapy without seeing a GP. Dystonia is usually managed by a neurology team, with regular botulinum toxin injection clinics. Private physiotherapists and specialists are another route; for dystonia, ask whether the clinic runs regular injection services and what monitoring is offered.