DRHOOK- Head-turner: Cervical dystonia a pain in the neck

the handsome doctor John Hong

Pain in the neck? A human resource specialist told me that 95 percent of his work is dealing with the 5 percent of employees who are a pain in the neck. 

Albert Einstein said something like five minutes with a bore seems like an hour, yet one hour in the company of a beautiful woman seems like only five minutes. It's all relative! So pain-in-the-neck people can really wear a girl down.

Are you a pain in the neck— or do you have one?

If you do, maybe it's from dystonia, a movement disorder that makes muscles tighten up. These involuntary muscle contractions can cause twisting, repetitive movements, and abnormal postures– like Jim Carrey in Ace Ventura.

Cervical dystonia is not a pap smear gone wrong. "Cervical" in this case means neck, and for some people, the muscles in the neck and shoulders can cause the head to turn to the side, like they're looking over their shoulder (but no one is following them). This twisting of the neck is called torticollis, and it can be quit debilitating. 

Can you imagine driving if your head is twisted? 

Cervical dystonia can also bend the head forward so the sufferer's chin is forced down to the chest, or backward to cause the head to look up at the ceiling. Others can have the head tilt to the side, like touching your ear to your shoulder. Some people just think a person has poor posture because the head is not straight up. 

The reality is cervical dystonia. In fact, the muscle spasms can cause a little head tremor that can be confused with Katherine Hepburn's "essential tremor disorder."

Though not everyone with cervical dystonia has pain, the majority do have headaches. Tight neck muscles are the biggest cause of tension headaches— because they make the muscles tense from the base of the neck to the temples. 

The dystonia can also affect the jaw and face muscles. Cat got your tongue? If the tongue has dystonia, swallowing, as well as speech, can be difficult. 

Dystonia of the laryngeal muscles can turn Britain's Got Talent's Susan Boyle into a raspy, quivery Stevie Nicks. (As much as I love Stevie Nicks, did any of you hear her sing "Silent Night"? Oh, dear!)

Remember in The Pink Panther Strikes Again how Chief Inspector Dreyfus hated Inspector Clouseau? Dreyfus' eye would twitch wildly whenever he got upset. That's blepharospasm. 

In fact, in dystonia, the abnormal muscle contractions are usually intermittent and often precipitated by stress— whether physical or emotional like with Inspector Dreyfus. A person with upper-limb dystonia might have relaxed hands but then get writer's cramp because of that activity, or even from typing. 

There are many different causes of dystonia, and some are early onset (younger than 26 years of age) or late onset (26 or older). Genetics, medication, and acquired disease can cause many different presentations of dystonia. Seeing a neurologist is a good idea.

Treatment of dystonia usually addresses only the symptoms, because there's no cure. As with everything, if it isn't one thing it's another– and medicines are usually pretty sedating. Botox isn't just for Joan Rivers. It can really be effective in some patients– though it won't make you look younger unless used in the face. 

So remember, dystonia is not Estonia, one of those five gazillion countries that have popped up on the map in the last 20 years. You don't realize how many countries now exist until you watch the opening ceremony of the Olympics. It can be a real pain in the neck to try to remember them all!


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.