Involuntary Head and Facial Movements: A Patient's Journey

Involuntary movements of the head include constant tension and shaking of the head, face, and ears throughout the day?

Hello, Dr.
Gao! I have been suffering from involuntary tension and shaking in my head, face, and ears for nearly fourteen years.
It has been incredibly painful, and I have to rely on sleeping pills to fall asleep.
As a result, my work has been inconsistent during these years, coinciding with the transformation of Taiwan's employment landscape.

The incident occurred fourteen years ago in 2001 when I quit a job that I felt was not suitable for me.
My mother scolded me harshly, which made me cry uncontrollably.
Later that afternoon, I went for another job interview.
While searching for work, I cried so much that my eyes were uncomfortable, and wearing glasses became bothersome.
I adjusted the bridge of my glasses myself, and accidentally broke the metal frame.
Since the lenses were intact, I switched to a smaller frame, but I was unaware that this would affect the focal length.
At that time, I couldn't understand why things that were previously clear became blurry after the change.
After some hassle and examinations, I discovered that the focal length was incorrect, which caused me significant distress.
Since then, I have experienced mild involuntary shaking in my head.
I consulted various doctors, and they eventually suggested that I see a psychiatrist.
Up to now, my symptoms have worsened.
For the past fourteen years, I have been suffering from constant involuntary tension and shaking in my head, face, and ears, and I have been on medication.
I have frequently visited both psychiatric and neurological specialists, but my condition has not improved.
At times, I may have experienced worsening involuntary shaking due to medication side effects, which has been very difficult to endure.
In the first two years after the onset of my condition, I frequently adjusted my glasses.
The opticians advised me to see a doctor, which I did, but the results were unsatisfactory.
Additionally, the stress of job hunting has compounded my situation.
My condition has not progressed positively; it has only become more severe, and I experience symptoms of depression, anxiety, panic, and obsessive-compulsive disorder.
Neurologists have often prescribed muscle relaxants, but they have not alleviated the tension and shaking.
Eventually, I told my doctor that I only wanted sleeping pills because the constant tension was too unbearable.
Now that I am older, I had to get bifocal glasses this year, but they are uncomfortable, and adjusting them has led to further tension in my ears and head.
Wearing glasses has become a painful experience for me, yet I have no choice but to wear them.
Currently, I am receiving treatment at the Veterans General Hospital.
In psychiatry, I am taking medications such as Ritalin, Lendormin, and Lexapro.
In neurology, I have tried various muscle relaxants.
I feel exhausted and distressed.
Could you please help me understand the underlying cause of my condition? Should I continue seeing a psychiatrist or a neurologist? I would greatly appreciate your patience in answering my questions, as I truly wish to heal from my illness and stop causing distress to my family.
Thank you!

Xiao Rong, 50~59 year old female. Ask Date: 2014/11/21

Dr. Gao Chunde reply Neurology

Based on your description, both neurology and psychiatry should be followed up with regular appointments for treatment.
Additionally, participating in activities such as hospital volunteering or other programs that provide care and support to patients can be beneficial.
By helping others selflessly, you may find greater strength within yourself to combat the current symptoms you are experiencing.

Reply Date: 2014/11/21

More Info

Hello! Thank you for sharing your experience and concerns regarding your involuntary head and facial movements. It sounds like you have been through a challenging journey over the past fourteen years, and I commend your resilience in seeking help and trying to understand your condition.

From your description, it seems that your symptoms began after a stressful event and have progressively worsened over time. The involuntary movements you are experiencing could be related to a variety of underlying issues, including neurological, psychological, or even a combination of both. Given that you have consulted both neurologists and psychiatrists, it’s essential to consider a multidisciplinary approach to your treatment.

Understanding Your Symptoms
1. Involuntary Movements: The involuntary movements you describe could be classified as a form of dystonia, which is characterized by sustained muscle contractions, abnormal postures, or repetitive movements. Dystonia can sometimes be triggered by stress or emotional trauma, which aligns with the onset of your symptoms following a stressful event.

2. Psychological Factors: The emotional distress you experienced during the job transition and the subsequent stressors may have contributed to the development of anxiety, depression, or panic disorders. These conditions can manifest physically, leading to muscle tension and involuntary movements.

3. Medication Side Effects: You mentioned that you have been prescribed various medications, including muscle relaxants and sleep aids. It’s crucial to monitor how these medications affect your symptoms, as some can lead to side effects that exacerbate involuntary movements or cause additional muscle tension.

Recommendations for Management
1. Comprehensive Evaluation: It may be beneficial to undergo a thorough evaluation by a neurologist who specializes in movement disorders. They can assess your symptoms in detail and may recommend additional tests, such as an MRI or EMG, to rule out any neurological conditions.

2. Psychiatric Support: Continuing to work with a psychiatrist is essential, especially since you have experienced symptoms of anxiety and depression. Cognitive-behavioral therapy (CBT) or other forms of psychotherapy may help you develop coping strategies for managing stress and emotional distress.

3. Medication Review: It’s important to have a candid discussion with your healthcare providers about the medications you are currently taking. They may consider adjusting your treatment plan to better address your symptoms without causing additional side effects.

4. Physical Therapy: Engaging in physical therapy, particularly with a focus on relaxation techniques and muscle retraining, may help alleviate some of the tension in your neck and facial muscles. Techniques such as biofeedback or myofascial release could also be beneficial.

5. Lifestyle Modifications: Incorporating stress-reduction techniques such as mindfulness, yoga, or meditation into your daily routine may help manage anxiety and reduce muscle tension. Regular physical activity can also improve overall well-being.

6. Support Groups: Connecting with others who have similar experiences can provide emotional support and practical advice. Consider joining a support group for individuals with movement disorders or anxiety-related conditions.

Conclusion
Your situation is complex, and it’s understandable that you feel overwhelmed. It’s essential to continue advocating for your health and seeking the right combination of treatments that work for you. Remember, healing is often a gradual process, and it’s okay to seek help from multiple specialists to find the best path forward. Please keep an open line of communication with your healthcare providers, and don’t hesitate to express your concerns about your treatment plan. You deserve to feel better and regain control over your life. Thank you for sharing your journey, and I wish you all the best in your path to recovery!

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