Management of Acute Torticollis with Muscle Relaxants

Introduction to Treatment Options

• The American College of Physicians recommends tizanidine as an alternative choice to cyclobenzaprine for acute torticollis, starting at 2-4 mg with upward titration as needed, due to its efficacy and safety profile 1
• Tizanidine requires monitoring for hepatotoxicity, which is generally reversible 1

Combination Therapy for Enhanced Pain Relief

• Adding a muscle relaxant to an NSAID or acetaminophen provides greater short-term pain relief than analgesic monotherapy, according to the Annals of Internal Medicine 2, 1
• This combination increases CNS adverse events but may reduce gastrointestinal adverse events 1

Medications to Avoid in Acute Torticollis Management

• Benzodiazepines, such as diazepam, are not preferred due to abuse potential, despite showing similar efficacy to cyclobenzaprine 1
• Baclofen and dantrolene have sparse evidence for acute musculoskeletal pain despite efficacy in spasticity 1