What is a facial tic disorder?

Facial tics are uncontrollable spasms in the face, such as rapid eye blinking or nose scrunching. They may also be called mimic spasms. Although facial tics are usually involuntary, they may be suppressed temporarily.

A number of different disorders can cause facial tics. They occur most often in children, but they can affect adults as well. Tics are much more common in boys than in girls.

Facial tics usually don’t indicate a serious medical condition, and most children outgrow them within a few months.

Facial tics are a symptom of several different disorders. The severity and frequency of the tics can help determine which disorder is causing them.

Transient tic disorder

Transient tic disorder is diagnosed when facial tics last for a short period of time. They may occur nearly every day for more than a month but less than a year. They generally resolve without any treatment. This disorder is most common in children and is believed to be a mild form of Tourette syndrome.

People with transient tic disorder tend to experience an overwhelming urge to make a certain movement or sound. Tics may include:

Transient tic disorder doesn’t usually require any treatment.

Chronic motor tic disorder

Chronic motor tic disorder is less common than transient tic disorder, but more common than Tourette syndrome. To be diagnosed with chronic motor tic disorder, you must experience tics for more than a year and for more than 3 months at a time.

Excessive blinking, grimacing, and twitching are common tics associated with chronic motor tic disorder. Unlike transient tic disorder, these tics may occur during sleep.

Children who are diagnosed with chronic motor tic disorder between the ages of 6 and 8 don’t typically require treatment. At that point, the symptoms may be manageable and can even subside on their own.

People who are diagnosed with the disorder later in life may need treatment. The specific treatment will depend on the severity of the tics.

Tourette syndrome

Tourette syndrome, also known as Tourette disorder, typically begins in childhood. On average, it appears at age 7. Children with this disorder may experience spasms in the face, head, and arms.

The tics can intensify and spread to other areas of the body as the disorder progresses. However, the tics usually become less severe in adulthood.

Tics associated with Tourette syndrome include:

  • flapping arms
  • sticking the tongue out
  • shrugging shoulders
  • inappropriate touching
  • vocalizing of curse words
  • obscene gestures

To be diagnosed with Tourette syndrome, you must experience vocal tics in addition to physical tics. Vocal tics include excessive hiccupping, throat clearing, and yelling. Some people may also frequently use expletives or repeat words and phrases.

Tourette syndrome can usually be managed with behavioral treatment. Some cases may also require medication.

Other conditions may result in facial spasms that mimic facial tics. They include:

  • hemifacial spasms, which are twitches that affect only one side of the face
  • blepharospasms, which affect the eyelids
  • facial dystonia, a disorder that leads to involuntary movement of facial muscles

If facial tics start in adulthood, your doctor may suspect hemifacial spasms.

Several factors contribute to facial tic disorders. These factors tend to increase the frequency and severity of tics.

Contributing factors include:

Your doctor can usually diagnose a facial tic disorder by discussing the symptoms with you. They may also refer you to a mental health professional who can assess your psychological status.

It’s important to rule out physical causes of facial tics. Your doctor may ask about other symptoms to decide whether you need further testing.

They may order an electroencephalogram (EEG) to measure the electrical activity in your brain. This test can help determine whether a seizure disorder is causing your symptoms.

Your doctor might also want to perform an electromyography (EMG), a test that evaluates muscle or nerve problems. This is to check for conditions that cause muscle twitching.

Most facial tic disorders don’t require treatment. If your child develops facial tics, avoid drawing attention to them or scolding them for making involuntary movements or sounds. Help your child understand what tics are so they can explain them to their friends and classmates.

Treatment may be needed if the tics interfere with social interactions, schoolwork, or job performance. Treatment options often don’t completely eliminate tics but help reduce tics. Treatment options can include:

  • stress reduction programs
  • psychotherapy
  • behavioral therapy, comprehensive behavioral intervention for tics (CBIT)
  • dopamine blocker medications
  • antipsychotic medications like haloperidol (Haldol), risperidone (Risperdal), aripiprazole (Abilify)
  • anticonvulsant topiramate (Topamax)
  • alpha-agonists like clonidine and guanfacine
  • medications to treat underlying conditions, such as ADHD and OCD
  • botulinum toxin (Botox) injections to temporarily paralyze facial muscles

Recent studies have shown that deep brain stimulation may help treat Tourette syndrome. Deep brain stimulation is a surgical procedure that places electrodes in the brain. The electrodes send electrical impulses through the brain to restore the brain circuitry to more normal patterns.

This type of treatment can help relieve symptoms of Tourette syndrome. However, more research is needed to determine the best area of the brain to stimulate for improvement of Tourette syndrome symptoms.

Cannabis-based medications might also be effective in helping reduce tics. However, the evidence to support this is limited. Cannabis-based medications should not be prescribed to children and adolescents, or to pregnant or nursing women.

While facial tics usually aren’t the result of a serious condition, you may need treatment if they interfere with your everyday life. If you’re concerned you may have a facial tic disorder, talk to your doctor about treatment options.