ConditionBones, joints & muscles
Torticollis (Wry Neck)
Torticollis, or wry neck, is a condition in which the neck is twisted so the head tilts to one side and the chin turns to the other. In adults, the most common form is acute wry neck: sudden neck pain and stiffness, often on waking, that usually clears within a week. In babies, congenital muscular torticollis from a tight neck muscle responds well to stretching. A long-lasting, involuntary twisting in adults is cervical dystonia, a neurological condition treated with botulinum toxin injections.
Also called: Wry neck, stiff neck, acute torticollis, congenital muscular torticollis, cervical dystonia (spasmodic torticollis)
At a glance
- What it is
- A twisted neck with the head tilted to one side and the chin rotated to the other.
- Types
- Acute wry neck (adults and children), congenital muscular torticollis (babies), cervical dystonia (adults), secondary torticollis.
- Common causes
- Awkward sleeping position, muscle spasm, a tight neck muscle at birth, and in children infections or minor injuries.
- Red flags
- Fever, trouble swallowing, injury, weakness or numbness, or torticollis after a new medicine.
- Treatment
- Heat, gentle movement and pain relief for acute cases; stretching for babies; botulinum toxin for cervical dystonia.
When to get help
Call 911 or go to the ER
- Neck pain or a twisted neck after a fall, car crash or diving injury, especially with numbness, tingling or weakness in the arms or legs: keep still and call 911 or your local emergency number
- Neck stiffness with fever, severe headache, confusion or a rash (possible meningitis)
- A child with a stiff, tilted neck, fever, drooling or trouble swallowing or breathing (possible throat abscess)
See a doctor within a day or two
- Sudden twisting of the neck, eyes rolling up or jaw locking after starting an anti-nausea or antipsychotic medicine (acute dystonic reaction)
- A child with new torticollis after a sore throat or ear infection
- Torticollis with double vision, unsteadiness or vomiting
Book a routine appointment
- A baby who always turns the head one way, has a lump in the neck muscle, or a flattened area of the head
- Wry neck that has not improved after 1 to 2 weeks
- Repeated involuntary neck turning, pulling or jerking in an adult
Usually safe to manage at home
- Neck pain and stiffness on waking, without injury, fever or arm symptoms
Types of torticollis
| Type | Who | Typical features |
|---|---|---|
| Acute wry neck | Teens and adults, sometimes children | Sudden painful stiffness on waking or after an awkward movement; clears within days to 2 weeks |
| Congenital muscular torticollis | Babies, noticed in the first weeks | Tight or shortened sternocleidomastoid muscle; head tilts to one side and turns to the other; sometimes a soft lump in the muscle |
| Cervical dystonia | Adults, usually 30 to 60 | Involuntary, sustained or jerky muscle contractions turning or tilting the head; often painful |
| Secondary torticollis | Any age | Caused by infection, injury, eye problems, medicines or other conditions |
Acute wry neck
The most common type. You wake up with a painful, stiff neck and cannot turn your head to one side. It is thought to come from a strained muscle, irritated small joints in the neck, or a minor disc problem, often from an awkward sleeping position, cold drafts or sudden movement. Pain usually improves within 24 to 48 hours and settles within a week, occasionally two.
Self-care
- Keep moving gently: turn your head as far as is comfortable several times a day; avoid neck collars, which slow recovery.
- Heat: a warm pack or warm shower relaxes muscles.
- Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose, if safe for you.
- Good sleep posture: one supportive pillow, not too high.
- Gentle massage.
Torticollis in babies
Congenital muscular torticollis is one of the most common muscle conditions in newborns. It is linked to position in the womb or a difficult birth. Signs include:
- the head tilting to one side and the chin turning to the opposite side
- preferring to look or feed in one direction
- a soft lump in the neck muscle in the first weeks
- a flattened area on the back or side of the head (plagiocephaly)
Treatment:
- Stretching exercises taught by a pediatrician or physical therapist, done gently several times a day
- Repositioning: placing toys, light and attention on the side the baby turns away from
- Tummy time while awake and supervised
- Physical therapy: more than 9 in 10 babies improve with early treatment, usually within months
- Surgery to lengthen the muscle is rarely needed if stretching fails after 12 to 18 months
Babies with torticollis are checked for hip dysplasia and for other causes such as eye problems or spine abnormalities.
Torticollis in children
Besides acute wry neck, causes include:
- throat or ear infections, which can inflame tissues and loosen joints in the upper neck (Grisel syndrome)
- retropharyngeal abscess: fever, neck stiffness, drooling and trouble swallowing
- minor injuries
- eye muscle imbalance causing a head tilt to see clearly
- reactions to some medicines
- rarely, spine abnormalities or posterior fossa tumors
Cervical dystonia (spasmodic torticollis)
A neurological movement disorder in which neck muscles contract involuntarily, turning, tilting or pulling the head. It can cause neck pain, tremor and difficulty with daily activities. Symptoms may lessen when touching the chin or cheek (a "sensory trick"). Treatment includes:
- Botulinum toxin injections every 3 months, the main treatment
- oral medicines for some people
- physical therapy
- deep brain stimulation for severe cases not helped by injections
See dystonia.
Diagnosis
Most torticollis is diagnosed by examination. Doctors check neck movement, muscles, nerves and eyes. Imaging (X-ray, CT or MRI) is used after injury, with neurological symptoms, fever, or torticollis that does not improve. Ultrasound may be used for the neck muscle in babies.
Frequently asked questions
How long does a wry neck last?
Most acute wry neck improves within 24 to 48 hours and clears within a week. Some cases take up to two weeks. See a doctor if it lasts longer, keeps coming back, or comes with fever, injury, numbness or weakness.
How do I fix a stiff neck from sleeping wrong?
Keep the neck moving gently within comfort, apply heat, take an over-the-counter pain reliever at the label dose if safe for you, and avoid holding the neck still or wearing a collar. Gentle stretches and a supportive pillow help prevent recurrence.
What causes torticollis in babies?
It is usually caused by tightness or shortening of the sternocleidomastoid muscle on one side of the neck, linked to the baby's position in the womb or birth. Stretching exercises and repositioning work for most babies, especially when started early.
What is the difference between torticollis and cervical dystonia?
Torticollis describes a twisted neck from any cause. Cervical dystonia is a specific, long-lasting neurological condition in which neck muscles contract involuntarily. Acute wry neck usually clears in days, while cervical dystonia is chronic and treated with botulinum toxin injections.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Pediatrics: Congenital muscular torticollis, clinical practice guideline (APTA/AAP)
- American Academy of Orthopaedic Surgeons (OrthoInfo): Torticollis
- National Institute of Neurological Disorders and Stroke: Dystonia
- MedlinePlus: Torticollis
- NHS: Stiff neck