Cervical dystonia

Gary Volkell DO (

Dr. Volkell of Albany Medical Center has no relevant financial relationships to disclose.

Eric Steven Molho MD (

Dr. Molho of Albany Medical College has received honoraria as a speaker for Neurocrine Biosciences; fees as a consultant for Lundbeck and CNS Ratings; educational grants from Merz North America, AbbVie inc. and Allergan; research grant support from Amneal Pharmaceuticals, Biogen, Biohaven Pharmaceuticals, Enterin Inc. and Cerevel Therapeutics. Dr. Molho is supported by the Riley Family Chair in Parkinson’s Disease.

Robert Fekete MD, editor. (

Dr. Fekete of New York Medical College received consultation fees from Acadia, Acorda, Adamas, Amneal/Impax, Kyowa Kirin, Lundbeck, Neurocrine, and Teva.

Originally released September 6, 1993; last updated January 24, 2021; expires January 24, 2024


Cervical dystonia is the most common focal dystonia, consisting of involuntary head and neck movements, which result in abnormal postures, tremor, and associated pain. The etiology remains unclear but appears heterogeneous, and this article discusses possible roles played by genetics and trauma. Botulinum toxin injections have been a breakthrough in the treatment of this condition for the last three decades. Deep brain stimulation has been an alternative option for intractable cases.

Key points


• Cervical dystonia is the most common form of focal dystonia.


• Diagnosis is clinical and is based on history and examination.


• An underlying cause is usually not identified, although secondary causes, especially drug-induced, should be excluded.


• Treatment of choice is botulinum toxin injections and consideration of deep brain stimulation for severe cases not adequately responsive to injections.

Historical note and terminology

The features of cervical dystonia, consisting of abnormal head and neck posture with sustained or intermittent movements, have long been well known. Before the 18th century, several descriptions, sculptures, and paintings depict a possible abnormal position of the neck. Previously known as "spasmodic torticollis," cervical dystonia was defined as "an involuntary hyperkinesis involving the muscles of the neck primarily on one side" (Foltz et al 1959). In 1888, Charcot presented a case of a stockbroker who developed a clonic spasm in the sternocleidomastoid and trapezium after a catastrophic financial loss, which raised the suspicion for psychogenic etiology (Newby et al 2017). It was only in the 20th century that dystonia was separated as an organic etiology.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.

Find out how you can join MedLink Neurology