Michael Pourfar, MD
Michael Pourfar, MD, assistant professor of neurosurgery and neurology at NYU Langone Health and codirector of its Center for Neuromodulation.
Bottom Line: Facial tics will keep coming until you get to the heart of the problem
Facial tics—abnormal, brief movements of any part of the face that many people feel compelled to make—can make you want to put a paper bag over your head. And just trying to will yourself to stop your facial tics doesn’t work—it’s similar to holding back a sneeze or putting off using the restroom. Ultimately, you have to let it out. In fact, the suppression of a tic, say during a job interview or date, can result in a flurry of tics later on. But hiding out isn’t your only solution.
There are two types of facial tics—motor tics and vocal tics. Examples of motor tics include eye rolling, eye blinking, nose flaring, mouth twitching and clicking the tongue. Examples of vocal tics include clearing the throat and grunting. You can have either type on its own without any other underlying condition (often referred to as simple tics)…or both together as part of a condition such as Tourette syndrome. Less commonly, they can occur in association with other neurological symptoms requiring further investigation.
Tics are actually quite common in children, more boys than girls, often waning as they reach young adulthood. Tics persist into adulthood in about 25% of children who have them, sometimes with a break. Sometimes childhood tics go away and then come back later in life
Facial tics aren’t caused by anything wrong with your face—they result from a problem in the brain’s circuitry when the cortex and deeper structures of the brain, which typically coordinate with one another to control and suppress movement, are out of balance.
A facial tic is different from a twitch, which can be caused by caffeine, stress, fatigue or an irritated facial nerve among other causes. Unlike tics, twitches can’t be consciously controlled at all—you can’t even delay them. But in most people, twitches occur only occasionally.
In and of themselves, facial tics aren’t harmful and don’t require treatment. But they might harm you socially in certain circumstances…or make you feel self-conscious—so for many people, minimizing them is a goal.
Medications can sometimes be used to treat facial tics—these include alpha-adrenergic agonists, neuroleptic drugs and dopamine blockers. But avoiding medication is preferable, if possible, because drugs all come with unwanted side effects that might include drowsiness, dizziness and weight gain, among others. It’s better to first try these nondrug strategies…
Identify your personal triggers. Although facial tics are physiological in origin, they can be triggered or exacerbated by psychological factors. Do your facial tics worsen when you’re tired or stressed or anxious about a deadline or meeting? If you can pinpoint your triggers, you can try to make lifestyle changes to stop them, such as get more sleep and…
Find more ways to manage stress. Stress can play a role not only in the onset of facial tics but also in their severity. Incorporate breathing exercises into your day or schedule time to meditate or take a short walk. Getting enough sleep so that you feel truly rested is also helpful for managing stress-related facial tics.
Use your new understanding of your tics in social situations. Once you understand your condition, you’ll find it easier to talk to others about it, which will make the tics less of a factor socially. It’s OK to just come out and say, “I have this tic”—in fact, doing so will help alleviate the stress of trying to hide your tic and worrying about how others will react to it.
Try therapy to stop tics. Cognitive behavioral therapy and habit reversal therapy are two forms of talk therapy in which people learn to change their behaviors when they find themselves in circumstances that tend to bring tics on—this kind of therapy sometimes prevents tics or, at least, helpsyou direct the tic urge to some less bothersome movement. It typically involves several sessions and requires ongoing efforts, but it is effective in many cases.
Check out the related article “How to Stop an Annoying Eyelid Twitch.”