Tourette's Syndrome

How to Treat Tic Disorders

Most tic disorders fade with time. However, patients who experience significant distress due to their tics do find that therapy, medication, and simple lifestyle changes can make a big difference, especially with symptoms of Tourette Syndrome.

portrait funny expression of ADHD two years old blonde happy smiling child sticking out tongue at garden
portrait funny expression of ADHD two years old blonde happy smiling child sticking out tongue at garden

Though tic disorders were once considered extremely rare, recent studies show they affect as many as 20 percent of children and 1 percent of adults. Despite this, no clear medical guidelines exist for the best course of treatment, and every doctor has his or her preferred course of action for treating a patient’s tic disorder.

Most doctors, however, start with a “wait and see” approach. Tics often operate in a cycle, waxing and waning on a two-week basis. The majority of tics go away on their own after a few cycles, meaning no treatment is needed. Even if the tic doesn’t go away by itself, some patients still choose not to pursue treatment. If the tics are not severe, or don’t cause intense embarrassment, most patients become used to them and see treatment as unnecessary.

If treatment is deemed necessary, by both the patient and the doctor, these options exist:

Treating Tic Disorders with Medication

Medication is used to treat some tic disorders, but it’s not the first line of treatment; generally, it’s only prescribed when tics interfere with functioning and when all non-medical interventions have been exhausted. Tic disorders, like other conditions, should only be treated with medication while a patient is under the supervision of a medical doctor.

Several medication options exist, and it’s difficult to predict how a patient will respond to one specific mediation versus another. The first drug of choice is usually haloperidol, a typical antipsychotic. Other options include risperidone, an atypical antipsychotic, and non-stimulant medications often used to treat ADHD — including Strattera and guanfacine. Some patients also experience positive results with antidepressants, including SSRIs and tricyclics.

These medications should be started at the lowest possible dose to reduce the risk of side effects. Side effects vary for each medication, but generally include things like weight gain, dizziness, problems sleeping, gastrointestinal distress, and headaches. In some rare cases, the side effects can be more troubling than the tic disorder itself — in those cases, the patient is advised to focus on other forms of treatment.

Treating Tic Disorders with Therapy

The therapy of choice for tic disorders is called habit-reversal therapy, or HRT. In HRT, the individual learns to recognize the “trigger” feeling preceding the tic — in most cases, it is a feeling of “tension” or “pressure” that can only be relieved by carrying out the tic. Once a patient successfully identifies her trigger, she can learn to respond to this feeling by engaging in an alternative behavior — reducing the tension without resorting to the tic.

An example given by the authors of a study published in the Archives of General Psychiatry is a patient whose tic is shoulder twitching. “The competing response might involve isometric tensing of arm muscles while pushing the elbow against the torso,” the study’s authors write. “Thus, the competing response encourages the patient to respond to the urge to tic in a new way.”

HRT also teaches patients to identify stressors that can aggravate their tics, and offers them coping mechanisms or strategies to avoid the stressors entirely. HRT is highly effective, in both children and adults — multiple studies have shown a 17 to 50 percent reduction in tics after 6 weeks of such therapy.

It’s a common misconception that a patients who acknowledges and actively attempts to suppress her tic will experience stronger or more varied tics, but countless studies have shown the opposite to be true. In fact, a study on vocal and motor tics showed that, even when treatment focused solely on vocal tics, motor tics still decreased by 26 percent as a result.

Treating Tic Disorders with Dietary Changes

Research exploring the link between diet and tic disorders is very preliminary and limited. Most doctors do not advise their patients to rely solely on diet to treat tic disorders. However, eating certain foods — and avoiding others — may have a positive effect on the condition, with generally few side effects.

Omega-3 Fatty Acids: In small samples, children and adults with tic disorders have experienced positive results while taking omega-3 fatty acids. One 2012 study published in Pediatrics found that, while omega-3s did not significantly improve tic scores, they did help with “tic-related impairment” — meaning the psychological distress or additional symptoms associated with the tic disorder. In addition, up to 50 percent of children with tic disorders also have ADHD, which also responds positively to omega-3s.

Magnesium and Vitamin B6: In a small 2008 study published in the journal Medicina Clinica, children with Tourette Syndrome experienced positive results while taking supplemental magnesium and vitamin B6. The results of the study are questionable — due to its small sample size and lack of control group — but introducing more food-sourced magnesium and B6 will not likely introduce any negative side effects, and could result in positive changes for children or adults with tic disorders. Foods high in these vitamins include green leafy vegetables, legumes, whole grains, fruits, fish, and nuts. Talk to your doctor before introducing any supplements to your or your child’s diet.

Avoiding Caffeine, Sugar, and Soda: Another small preliminary study looked at the influence of certain foods on symptoms of tic disorders. Researchers found a correlation between higher incidence of tics and increased consumption of cola drinks, coffee, black tea, preservatives, refined sugar, and artificial sweeteners — possibly due to their effects on dopamine levels in the brain.

These results didn’t come entirely as a surprise, since most doctors already recommend that patients being treated for tic disorders avoid caffeine as much as possible. However, this study was the first to link preservatives, sugar, and other sweeteners to aggravated tics, suggesting that further research may be needed to examine the relationship between these substances and tic disorders.

A special diet will not likely eliminate tics, but reducing stress — including gastrointestinal stress — can have an overall positive effect on the severity of the condition. If you suspect you are sensitive to certain foods (like gluten, dairy, or food dyes), trying an elimination diet may help you uncover the exact cause and avoid it.

Treating Tic Disorders with Lifestyle Changes

In mild cases, tic disorders can be treated with informal relaxation exercises that help children and adults reduce the stress that can exacerbate tics. Examples of these techniques include deep breathing, visual imagery, and guided muscle relaxation. While these techniques are seldom as effective as formal behavioral therapy, they can help patients improve their outlook on the condition and feel more in control of symptoms.

Exercise can also be used to relieve stress, provide an outlet for excess energy and help you feel in control of your body and mind — without negative side effects.

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