Motor Tics

Motor tics are sudden, jerky movements of the body—typically affecting the shoulders or head—that are not in a person's control. Motor tics can be part of an underlying health condition but can also occur without a known cause. Sometimes, they are a side effect of medication.

This article discusses motor tics—their symptoms, potential causes, and treatment.

Symptoms of Motor Tics

Motor tics are unpredictable jerking movements, typically of the shoulders, neck, or face. However, they can occur anywhere in the body.

Symptoms of motor tics can include:

• Blinking/eye twitches
• Sticking the tongue out/other tongue movements
• Shrugging the shoulders
• Hopping
• Squatting down
• Head twitches
• Facial expressions
• Sexual gesturing
• Snapping fingers
• Biting the lips
• Touching people or objects
• Head banging

Causes of Motor Tics

Motor tics can occur without a known cause or may be part of an underlying health condition. Less commonly, they can be a side effect of certain medications.

Tic Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5, recognizes three types of tic disorders, as follows:

• Tourette's syndrome: Criteria for this disorder include two or more motor tics and a verbal tic for more than one year, with onset before age 18.
• Persistent (chronic) motor or verbal tic disorder: A person with this disorder has either motor or vocal tics; symptoms last more than one year, and onset is before age 18.
• Provisional tic disorder: Symptoms of this disorder—motor or vocal tics—have been present less than one year and begin before age 18.

Other Health Conditions

Motor tics can occur with other health conditions, such as:

• Attention deficit hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)
• Athetoid (dyskinetic) cerebral palsy
• Huntington's disease
• Traumatic brain injury

What Medications Can Cause Motor Tics?

Motor tics in the face can develop as a side effect of medications. This condition—called tardive dyskinesia—can occur from antipsychotic drugs. Unfortunately, tics can be permanent for some, even after discontinuing the medication.

Tardive dyskinesia can also occur from other types of drugs, including medications that treat:

• Nausea
• Acid reflux
• Seizures
• Allergies
• Cold and flu
• Malaria
• Parkinson's disease
• Anxiety
• Mood disorders
• Chronic obstructive pulmonary disorder (COPD)
• Obsessive-compulsive disorder

How to Treat Motor Tics

Motor tics do not always require treatment, especially if they are mild or infrequent. However, motor tics can be embarrassing and significantly impact a person's life. Treatment can include medications or comprehensive behavioral intervention for tics (CBIT).

Medications

Medications do not cure tics, but they can help reduce the frequency and severity of these symptoms.

Examples include:

• Catapres, Kapvay (clonidine)
• Tenex, Intuniv (guanfacine)
• Orap (pimozide)
• Prolixin (fluphenazine HCL)
• Haldol (haloperidol)
• Abilify (aripiprazole)
• Risperdal (risperidone)
• Geodon (ziprasidone HCL)
• Zyprexa (olanzapine)

Haldol, Orap, and Abilify are approved by the Food and Drug Administration (FDA) for treatment of tics. Other medications, such as guanfacine and clonidine, are blood pressure drugs that are used off-label (used to treat something other than what the FDA approves it for) to treat tics.

Comprehensive Behavioral Intervention for Tics (CBIT)

Comprehensive behavioral intervention for tics (CBIT) is a specific type of therapy designed to help reduce frequency of tics.

CBIT helps an individual:

• Recognize their tics and their urges to tic
• Choose a substitute behavior to replace a tic
• Identify triggers and learn how to manage them
• Develop coping strategies and stress management techniques

Are There Tests to Diagnose the Cause of Motor Tics?

There are no specific tests used to diagnose motor tics. A healthcare provider typically identifies them based on a review of your symptoms and review of medications. However, the severity of tics can be rated using assessment tools such as the Yale Global Tic Severity Scale or the Hopkins Motor/Vocal Tic Scale.

Underlying tic disorders and mental health conditions are diagnosed with a psychological assessment and applying the criteria found in the DSM-5.

When to See a Healthcare Provider

Motor tics are not usually harmful, but they can sometimes cause pain if another object is hit during a tic. They can also cause significant emotional distress. If tics are interfering with your or your child's quality of life, see a healthcare provider to discuss potential treatments to reduce their negative impact.

If you observe other behavioral challenges—difficulty paying attention, hyperactivity, impulsivity—see a healthcare provider to rule out other conditions, such as attention-deficit/hyperactivity disorder, that can occur with tics.

Summary

Motor tics are involuntary, jerky movements that can occur without a specific cause or as part of an underlying health condition. Tics can also occur as a side effect of certain medications. Motor tics are not usually harmful, but can cause pain. They can also significantly impact a person's quality of life. Treatment can include medications and comprehensive behavioral intervention for tics (CBIT).