Tics

Page last reviewed: 13/07/2011

Tics are rapid, repeated, involuntary contractions of a group of muscles that either result in a movement (a motor tic) or a sound (a vocal tic). Most tics are mild, infrequent and hardly noticeable, but some can be frequent and severe.

Motor tics can affect any part of the body, but often involve the muscles of the face, eyes, head and neck, producing movements such as:

  • facial twitching,
  • grimacing,
  • blinking, and
  • shrugging of the shoulders.

Common vocal tics include:

  • coughing,
  • grunting, or
  • clearing the throat.

Sometimes tics may appear to be similar to normal movements. However, tics are not voluntary and most people are unable to consciously control them. Some people are able to suppress tics for a short time, although this is said to be like holding back a sneeze. The person feels increasing tension until the tic is finally released.

Types of tic

Tics can be classified into three categories according to the type of tic and how long the person has had it for. The three categories of tics are described below.

Transient tic disorders

Transient tic disorders occur when a person has a motor tic, a vocal tic or both almost every day for at least four weeks, but not for more than a year.

Transient motor tics, such as blinking or snapping the fingers, usually only affect one muscle group.

Transient tics are very common, with about one in 10 children developing one or more tics during their school years. Transient tics are not harmful. They do not usually require treatment and usually disappear as the child gets older.

Chronic tic disorders

Chronic tic disorders occur when a person has had either a motor tic or a vocal tic (but not both), regularly or intermittently for more than one year. During this time, they will not have had a tic-free period for more than three months.

Although chronic tics do not usually require treatment, they can cause problems. For example, a child with a chronic tic may be ridiculed or bullied by other children.

Tourette's syndrome

Tourette's syndrome (TS) is a condition that includes behavioural problems, such as attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD).

People with TS also usually have chronic tic disorders, involving severe, multiple tics that include at least one vocal tic and several motor tics.

A person with TS will experience both motor tics and vocal tics on a regular basis or intermittently for more than one year. During this time, they will not have had a tic-free period for more than three months.

See Useful links for more information about Tourette's syndrome.

How common are tics?

Tics are more common in boys than in girls.

Transient tic disorders are very common. Many children develop them while they are at school, usually from seven to nine years of age.

Compared with transient tic disorders, chronic tic disorders and Tourette's syndrome are rare and often continue into adulthood.

Glossary

Sneeze
Sneezing is an involuntary expulsion of air and bacteria from the nose and mouth.
Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.

Page last reviewed: 13/07/2011

Motor tics can be either simple or complex.

Simple motor tics

Simple motor tics only involve one muscle group. They include:

  • eye blinking or eye jerking,
  • wrinkling the nose,
  • tongue movements, including sticking out the tongue,
  • head twitches or head jerks,
  • squatting and hopping,
  • snapping the fingers, and
  • shrugging the shoulders.

Complex motor tics

Complex motor tics either involve more than one muscle group or are made up of a series of simple motor tics.

Complex motor tics are usually slower than simple motor tics. It often appears as if the person is doing the movement intentionally. They can significantly interfere with daily life and may be physically harmful to the person with the tic.

Complex motor tics include:

  • facial grimacing,
  • bending over to touch the floor,
  • smoothing clothing,
  • lip-biting,
  • head-banging,
  • touching other people or things, and
  • obscene gestures or movements.

Simple vocal tics

As with motor tics, vocal tics can also be simple or complex.

Simple vocal tics involve sounds that are made by moving air through the nose or mouth. They include:

  • coughing,
  • grunting,
  • barking,
  • hissing,
  • sniffing,
  • snorting, and
  • throat clearing.

Complex vocal tics

Complex vocal tics involve saying words, phrases or sentences. They may include:

  • using obscene, offensive or socially unacceptable words and phrases (coprolalia), or
  • repeating a sound, word or phrase (echolalia).

Complex vocal tics may interrupt the flow of normal speech or they can sometimes occur at the beginning of a sentence in a similar way to a stutter or stammer.

When tics happen

People with tics often describe the feeling as being like a 'tension' that builds up inside them. The tension eventually causes them to move, make the sound or say the words, phrase or sentence that is associated with their tic.

The sensation increases if they try to prevent the tic. Once they have made the movement or sound, they describe feeling a sense of relief until the need to tic begins again.

Tics usually stop during sleep. They tend to be less frequent when someone is deeply absorbed in an activity.

Tics are often made worse by stress or heat. They can also be worse when a person is tired or excited or when they become self-conscious about their tic being noticed.

Page last reviewed: 13/07/2011

The exact cause of tics is unknown. Tics often run in families, with several family members being affected. Tics are thought to be an inherited disorder, possibly with a genetic cause.

Defective gene

It is possible that a defective gene is responsible for causing a person to develop a tic. Research is trying to establish whether this is the case.

Stimulant medication

Some types of stimulant medication that are used to treat certain conditions, such as attention deficit hyperactivity disorder (ADHD), can cause tics. Such tics usually stop when the stimulant is no longer taken.

Tourette's syndrome

As with other types of tics, the cause of Tourette's syndrome is not fully understood.

What is known is that Tourette's syndrome stems from the way that the brain and spinal cord develop and involves neurotransmitters (the chemicals that carry signals within the brain).

One possible theory is that some parts of the central nervous system develop unevenly, causing the symptoms of Tourette's syndrome.

Head injury

On very rare occasions, tics may be caused by a head injury.

Glossary

Hyperactivity
Hyperactivity is a higher than normal level of activity and restlessness.
Genetic
Genetic is a term that refers to genes - the characteristics inherited from a family member.
Gene
Genes contain information that you inherit from your parents, such as eye or hair colour. They are carried by chromosomes.

Page last reviewed: 13/07/2011

Tics are diagnosed from a description of the symptoms and by observing them. Special tests are not usually required in order to diagnose tics.

Occasionally, an electroencephalogram (EEG) may be recommended in order to rule out seizures (fits) as the cause of tic movements. An EEG is a painless procedure that records the electrical messages from your brain.

Glossary

Electroencephalogram
EEG stands for electroencephalogram. It is a painless test that records the electrical messages from the brain.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.

Page last reviewed: 13/07/2011

The treatment of tics depends on their severity, the distress that they cause and the effects that they have on school or work and everyday activities.

Most transient tic disorders do not require treatment because they are mild, infrequent and do not usually interfere with school, work or everyday life.

Medicines

If you decide to have medicinal treatment for your tics, the choice of medicine will initially depend on several factors including:

  • the type of symptoms that are most problematic,
  • the severity of the symptoms,
  • the degree of importance that you place on treatment, and
  • the risk of possible side effects.

In clinical studies, a number of different types of medicine have been shown to be effective in treating tics, although they can have unpleasant side effects. Some types of medicines that are used to treat tics include:

  • dopamine receptor agonists,
  • alpha2-adrenergic agonists,
  • benzodiazepines, and
  • selective serotonin reuptake inhibitors (SSRIs).

Dopamine receptor agonists

Dopamine receptor agonists are often used to treat tics. They mimic the effects of dopamine, which is a naturally occurring chemical in the brain that helps to control and co-ordinate your body's movements.

Neuroleptics are a type of dopamine agonist that are sometimes used to treat psychosis (a mental condition in which someone is unable to distinguish between reality and their imagination). In much lower doses, neuroleptics have also been shown to be very effective at treating tics.

There are several different neuroleptics, but haloperidol and pimozide are particularly effective in suppressing tics. Neuroleptics can have side effects, which means the initial dose you will be given is likely to be low so as to minimise any adverse reactions to the medication.

Common side effects of neuroleptics include:

  • sedation,
  • depression,
  • weight gain, and
  • lethargy (feeling tired and lacking in energy).

Neurological side effects of neuroleptics can include:

  • tremor (shaking),
  • restlessness and involuntary movements (akathisia), and
  • symptoms of parkinsonism, such as slowness of movement and muscle stiffness (rigidity).

As well as haloperidol and pimozide, clinical trials have shown that other types of neuroleptics, including risperidone, ziprasidone and olanzepine can also be effective in treating tics.

Alpha2-adrenergic agonists

Alpha2-adrenergic agonists, such as clonidine, have been shown to be effective in suppressing tics, and for treating the symptoms of attention deficit hyperactivity disorder (ADHD).

Alpha2-adrenergic agonists are less effective than neuroleptics in treating tics, but they have less adverse side effects and have been shown to benefit some people. Sedation is the most common side effect of alpha2-adrenergic agonists.

Benzodiazepines

Benzodiazepines, such as clonazepam, have been shown to reduce the severity of tics in some people. Benzodiazepines are not as effective as neuroleptics in suppressing tics and they may have side effects. Clonazepam is usually better tolerated than haloperidol and so it is sometimes recommended as an alternative to it.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, are often used to treat people who are depressed or have obsessive compulsive disorder (OCD).

SSRIs have been shown to improve tics in some people, but make them worse in others, or have no effect at all.

Psychological treatment

Psychological treatment, such as counselling or learning relaxation techniques, may be recommended for people who have particularly frequent or severe tics that affect their emotional wellbeing.

Cognitive behavioural therapy (CBT), a form of therapy that aims to change a person's behaviour by changing the way that they think about a situation, may be useful for some people with tics by helping them to control their condition.

The involuntary, uncontrollable nature of tics means that psychological treatments are usually only effective at treating any 'knock-on' effects of the condition, such as emotional distress.

See Useful links, above, for more information about counselling and CBT.

Diet and exercise

There are no specific foods that are known to have an adverse effect on tics. A healthy, balanced diet is recommended, containing foods from all five food groups - fruit and vegetables, carbohydrates, proteins, dairy, and fats and sugars.

There are no types of physical activity that should be avoided by people with tics. Recommended guidelines state that you should exercise for a minimum of 30 minutes a day, five times a week. If you have not exercised for some time, see your GP for a health check-up before starting a new programme of activity.

See the Useful links, above, for more information and advice about diet and exercise.

Glossary

Psychotherapy
Psychotherapy is the treatment of mental and emotional health conditions, using talking and listening.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

Browse Health A-Z