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Acute TorticollisAPPROACH

BACK AND NECK · 19 SECTIONS

⚲

515 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Atraumatic Back Pain Sciatica And Radicular Back Pain Back Pain With Neurologic Deficit, Cauda Equina Concern Back Pain With Fever Or Immunosuppression, Spinal Infection Concern Atraumatic Neck Pain Neck Pain After Trauma Neck Pain With Meningismus Concern Acute Torticollis

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx80

Chief concern and context

›Presentation pattern

›Sudden fixed neck rotation or lateral flexion

›Painful neck spasm with limited range of motion

›Painless head tilt

›Recurrent episodes

HPI OPQRST

›Onset

›Time course

›Trauma

›Minor neck movement

›Recent infection

›Recent medication dose

›Provocation and palliation

›Worse with head movement

›Worse with swallowing

›Worse with coughing or sneezing

›Relief with support or immobilization

›Relief with heat

›Quality

›Spasm

›Cramping

›Sharp pain

›Deep ache

›Region and radiation

›Unilateral paraspinal

›Midline cervical

›Shoulder or scapular radiation

02Alarm Features/alarm37

Immediate escalation triggers

›High risk features

›Airway compromise signs

›Stridor

›Drooling

›Muffled voice

›Sepsis physiology

›Hypotension

›Tachycardia with fever

›Central nervous system infection concern

›Fever with neck stiffness

›Altered mental status

›Petechial or purpuric rash

›Spinal cord compression concern

›Progressive weakness

›New gait instability

›Cervical spine injury concern

›Midline cervical tenderness after trauma

›Focal neurologic deficit after trauma

Dangerous historical patterns

›High risk history

›Significant trauma

›Immunocompromise

›IVDU

›Anticoagulation use

›Malignancy history

›Recent head and neck infection with worsening torticollis

03Medications/meds40

Current and recent medications

›Medication review targets

›Antipsychotics

›Antiemetics with dopamine blockade

›SSRIs and SNRIs

›Stimulants

›Benzodiazepine withdrawal

›Recent anesthesia or sedation

Allergies and contraindications

›Contraindications to common therapies

›NSAID contraindications

›Active GI bleed

›Advanced CKD

›Sedation risk

›OSA

›Concurrent opioids

›Anticholinergic risk

›Narrow angle glaucoma

›Urinary retention

ED symptomatic medications

›Analgesics

›Acetaminophen PO 1000 mg once

›Maximum 4000 mg per 24 hours

›Lower maximum with chronic alcohol use

›NSAID example

›Ibuprofen PO 400 mg to 600 mg once

›Naproxen PO 500 mg once

›Muscle relaxant example

04Diet/diet15

Recent intake and hydration

›Intake context

›Reduced oral intake

›Dehydration symptoms

›Vomiting limiting PO meds

Caffeine and stimulants

›Stimulant exposure

›Energy drinks

›Excess caffeine

›Pre workout supplements

Alcohol and substances

›Substance exposure

›Alcohol intoxication

›Alcohol withdrawal risk

›Cannabis

Dietary triggers and patterns

›Trigger patterns

›Fasting

›Poor sleep related intake changes

05Review of Systems/ros21

Head and neck

›Local symptoms

›Sore throat

›Dental pain

›Ear pain

›Neck swelling

›Voice change

Neurologic

›Neuro symptoms

›Headache

›Photophobia

›Dizziness

›Weakness

›Paresthesias

Infectious and inflammatory

›Systemic symptoms

›Fever

›Chills

›Night sweats

›Weight loss

Cardiopulmonary

›Cardiorespiratory symptoms

›Chest pain

›Dyspnea

›Syncope

06Collateral History and Family History/chafh12

Collateral and reliability

›Source considerations

›Witnessed trauma details

›Medication timing confirmation

›Pediatric caregiver reliability

Family history

›Relevant inherited risks

›Connective tissue disorders

›Early stroke history

›Migraine family history

Exposure and household context

›Environment

›Sick contacts

›Daycare exposures

›Recent travel

07Risk Factors/rf20

Trauma and structural risk

›Cervical injury risks

›High energy mechanism

›Older adult fall

›Osteoporosis

›Rheumatoid arthritis

›Prior cervical fusion

Infection risk

›Deep space infection risks

›Diabetes mellitus (E11.9)

›Immunosuppression

›Recent ENT infection

›Recent dental infection

›Recent head and neck surgery

Vascular risk

›Cervical artery dissection risks

›Recent minor trauma

›Neck manipulation

›Connective tissue disorder

Medication adverse effect risk

›Dystonia risks

›Recent dopamine blocking medication

›Young age

›Prior dystonic reaction

08Differential Diagnosis/ddx60

Life threatening

›Cannot miss diagnoses

›Meningitis (G00.9)

›Fever with neck stiffness

›Altered mental status

›Retropharyngeal abscess (J39.0)

›Sore throat with torticollis

›Trismus

›Drooling

›Cervical spine fracture or instability (S12.9)

›Trauma

›Midline tenderness

›Neurologic deficit

›Spinal epidural abscess (G06.1)

›Fever

›Severe pain

›Neurologic deficit

›Cervical artery dissection (I77.71)

›Neck pain with headache

›Horner syndrome

›Posterior circulation symptoms

Common

›Frequent etiologies

›Acute cervical muscle spasm (M62.838)

›Overuse

›Awkward posture

›Normal neurologic exam

›Cervical strain or sprain (S16.1)

09Past Medical History/pmh13

Relevant chronic conditions

›Comorbidities

›Rheumatoid arthritis (M06.9)

›Ankylosing spondylitis (M45)

›Osteoporosis (M81.0)

›Malignancy history

›Immunosuppression

Prior procedures and devices

›Cervical spine history

›Prior cervical surgery

›Prior cervical fracture

›Implanted hardware

Baseline function

›Functional baseline

›Baseline neurologic deficits

›Baseline neck range of motion limits

10Physical Exam/exam34

General and vitals

›Initial status

›Airway and speech quality

›Work of breathing

›Hemodynamic status

›Fever assessment

Head and neck

›Neck examination

›Head position

›Active range of motion

›Passive range of motion

›Midline cervical tenderness

›Paraspinal tenderness

›Oropharynx and ENT

›Tonsillar asymmetry

›Uvular deviation

›Trismus

›Drooling

›Neck mass or swelling

Neurologic

›Neuro screen

›Mental status

›Cranial nerves

›Motor strength

›Sensory exam

›Reflexes

›Gait if safe

11Lab Studies/labs12

Core labs when red flags present

›Infection evaluation

›CBC with differential

›CRP

›ESR

›Blood cultures if febrile or septic physiology

Targeted labs by differential

›Metabolic and medication related

›CMP if dehydration concern

›Pregnancy test when imaging or teratogenic meds possible

›CK if severe prolonged spasm with concern for rhabdomyolysis

Limitations and pitfalls

›Interpretation cautions

›Normal WBC does not exclude deep neck infection

›CRP and ESR can be normal early in infection

12Imaging/img32

Scoring Systems

›Cervical spine trauma decision tools

›Canadian C-Spine Rule

›Validated in alert stable blunt trauma

›Guides imaging selection and can reduce radiography

›NEXUS criteria

›Low risk criteria set for blunt trauma clearance

›High sensitivity in original validation cohort

MRI

›MRI indications

›Suspected spinal epidural abscess

›Suspected cervical myelopathy

›Persistent neurologic deficit

›Suspected ligamentous injury with concerning exam

›MRI cautions

›Unstable patient

›Implanted device incompatibility

›Need for sedation in pediatrics

›CT cervical spine

›Trauma with decision tool positive

›Midline tenderness after trauma

›Focal neurologic deficit after trauma

›Older adult with concerning mechanism

›Imaging guided by ACR Suspected Spine Trauma

›CT neck with IV contrast

›Suspected deep neck space infection

›Trismus with fever and neck swelling

13Special Tests/spec14

Bedside maneuvers

›Cervical spine clearance elements

›Midline tenderness assessment

›Active rotation to 45 degrees each side when appropriate

›Distracting injury assessment

›Radiculopathy maneuvers

›Spurling test

›Shoulder abduction relief sign

Infection and meningismus tests

›Meningeal signs

›Nuchal rigidity

›Kernig sign

›Brudzinski sign

Medication reaction confirmation

›Dystonia response test

›Rapid improvement after IV diphenhydramine

›Recurrence prevention dosing plan

14ECG/ecg12

When ECG is relevant

›Indications

›Chest pain or dyspnea

›Syncope

›Electrolyte concern

›QT prolonging medication exposure

High risk patterns

›ECG red flags

›New ischemic changes

›Significant QTc prolongation

›Wide complex tachycardia

Serial ECG logic

›Repeat ECG triggers

›Ongoing chest pain

›Evolving symptoms

15Assessment/ax24

Working diagnosis framework

›Torticollis category

›Benign muscular spasm likely

›Normal neurologic exam

›No fever

›No trauma red flags

›Trauma related torticollis possible

›Mechanism concerning

›Midline tenderness

›Neurologic symptoms

›Infectious deep neck space concern

›Fever

›Odynophagia

›Trismus

›Medication induced dystonia

›Recent dopamine antagonist exposure

›Oculogyric crisis or jaw dystonia

Severity and risk stratification

›High risk status

›Airway risk

›Sepsis risk

›Neurologic deficit

›Low risk status

›Isolated paraspinal spasm

›Stable vitals

›Improving with analgesia

16Plan/plan40

Differential Management

›!Cervical radiculopathy→›!Cervical spine fracture→›Retropharyngeal abscess→

Approach to the critical patient

›First 5 minutes workflow

›Airway monitoring if drooling or stridor

›Continuous pulse oximetry if respiratory symptoms

›IV access if fever with systemic symptoms

›Early antibiotics if sepsis physiology

›Early ENT consult if airway concern

›Reassessment loop

›Pain and ROM reassessment at 30 minutes

›Neuro reassessment after analgesia

›Airway reassessment if infectious concern

Symptom control for low risk presentation

›Analgesia and spasm relief

›NSAID or acetaminophen

›Heat

›Gentle supported positioning

›Short course muscle relaxant if needed

›Activity modification

›Relative rest 24 to 48 hours

›Avoid heavy lifting and sudden neck movement

Suspected acute dystonic reaction

›Immediate treatment

›Diphenhydramine IV 50 mg once

›Consider benztropine IV 1 mg to 2 mg once

17Disposition/dispo18

ICU or high acuity care

›ICU criteria

›Airway compromise risk

›Sepsis with hypotension

›Rapidly progressive neurologic deficit

Inpatient admission

›Admission indications

›Deep neck space infection

›Suspected spinal epidural abscess

›Cervical spine fracture or instability

›Persistent severe pain requiring parenteral analgesia

Observation pathway

›Observation candidates

›Dystonic reaction requiring recurrence monitoring

›Uncertain diagnosis with improving symptoms but persistent limitation

Discharge criteria

›Safe discharge features

›No red flags

›Normal neurologic exam

›Stable vitals

›Pain controlled with PO meds

›Reliable follow up

18Discharge Instructions/di24

Copy discharge instructions

›Summary

›Your neck spasm is called acute torticollis and often improves over several days

›Your exam today did not show signs of a dangerous cause

›Medications

›Use acetaminophen as directed on the label

›Use an anti inflammatory medicine only if you can take it safely

›If you were given a muscle relaxant, do not drive or drink alcohol

›Activity

›Gentle neck movement as tolerated

›Avoid heavy lifting and sudden twisting for 48 hours

›Heat packs 15 to 20 minutes up to 4 times per day

›Follow up

›Primary care or physiotherapy within 3 to 7 days if not improving

›Earlier follow up within 24 to 48 hours if symptoms worsen

›Return to ED now if

›Fever

›New weakness or numbness

›Trouble walking

›Severe headache

›Confusion

›Trouble breathing

›Drooling

›Worsening throat pain or trouble swallowing

›New neck swelling

19References/r7

Evidence and guidelines

›Key sources

›ACR Appropriateness Criteria Cervical Pain or Cervical Radiculopathy, 2019

›ACR Appropriateness Criteria Acute Spinal Trauma, 2019

›Stiell IG et al Canadian C-Spine Rule derivation, JAMA, 2001

›Hoffman JR et al NEXUS criteria validation, NEJM, 2000

›Stiell IG et al Canadian C-Spine Rule versus NEXUS, NEJM, 2003

›Lewis K et al Dystonic Reactions, StatPearls, 2023

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Acute TorticollisAPPROACH

BACK AND NECK · 19 SECTIONS

⚲

515 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx80

Chief concern and context

›Presentation pattern

›Sudden fixed neck rotation or lateral flexion

›Painful neck spasm with limited range of motion

›Painless head tilt

›Recurrent episodes

HPI OPQRST

›Onset

›Time course

›Trauma

›Minor neck movement

›Recent infection

›Recent medication dose

›Provocation and palliation

›Worse with head movement

›Worse with swallowing

›Worse with coughing or sneezing

›Relief with support or immobilization

›Relief with heat

›Quality

›Spasm

›Cramping

›Sharp pain

›Deep ache

›Region and radiation

›Unilateral paraspinal

›Midline cervical

›Shoulder or scapular radiation

02Alarm Features/alarm37

Immediate escalation triggers

›High risk features

›Airway compromise signs

›Stridor

›Drooling

›Muffled voice

›Sepsis physiology

›Hypotension

›Tachycardia with fever

›Central nervous system infection concern

›Fever with neck stiffness

›Altered mental status

›Petechial or purpuric rash

›Spinal cord compression concern

›Progressive weakness

›New gait instability

›Cervical spine injury concern

›Midline cervical tenderness after trauma

›Focal neurologic deficit after trauma

Dangerous historical patterns

›High risk history

›Significant trauma

›Immunocompromise

›IVDU

›Anticoagulation use

›Malignancy history

›Recent head and neck infection with worsening torticollis

03Medications/meds40

Current and recent medications

›Medication review targets

›Antipsychotics

›Antiemetics with dopamine blockade

›SSRIs and SNRIs

›Stimulants

›Benzodiazepine withdrawal

›Recent anesthesia or sedation

Allergies and contraindications

›Contraindications to common therapies

›NSAID contraindications

›Active GI bleed

›Advanced CKD

›Sedation risk

›OSA

›Concurrent opioids

›Anticholinergic risk

›Narrow angle glaucoma

›Urinary retention

ED symptomatic medications

›Analgesics

›Acetaminophen PO 1000 mg once

›Maximum 4000 mg per 24 hours

›Lower maximum with chronic alcohol use

›NSAID example

›Ibuprofen PO 400 mg to 600 mg once

›Naproxen PO 500 mg once

›Muscle relaxant example

04Diet/diet15

Recent intake and hydration

›Intake context

›Reduced oral intake

›Dehydration symptoms

›Vomiting limiting PO meds

Caffeine and stimulants

›Stimulant exposure

›Energy drinks

›Excess caffeine

›Pre workout supplements

Alcohol and substances

›Substance exposure

›Alcohol intoxication

›Alcohol withdrawal risk

›Cannabis

Dietary triggers and patterns

›Trigger patterns

›Fasting

›Poor sleep related intake changes

05Review of Systems/ros21

Head and neck

›Local symptoms

›Sore throat

›Dental pain

›Ear pain

›Neck swelling

›Voice change

Neurologic

›Neuro symptoms

›Headache

›Photophobia

›Dizziness

›Weakness

›Paresthesias

Infectious and inflammatory

›Systemic symptoms

›Fever

›Chills

›Night sweats

›Weight loss

Cardiopulmonary

›Cardiorespiratory symptoms

›Chest pain

›Dyspnea

›Syncope

06Collateral History and Family History/chafh12

Collateral and reliability

›Source considerations

›Witnessed trauma details

›Medication timing confirmation

›Pediatric caregiver reliability

Family history

›Relevant inherited risks

›Connective tissue disorders

›Early stroke history

›Migraine family history

Exposure and household context

›Environment

›Sick contacts

›Daycare exposures

›Recent travel

07Risk Factors/rf20

Trauma and structural risk

›Cervical injury risks

›High energy mechanism

›Older adult fall

›Osteoporosis

›Rheumatoid arthritis

›Prior cervical fusion

Infection risk

›Deep space infection risks

›Diabetes mellitus (E11.9)

›Immunosuppression

›Recent ENT infection

›Recent dental infection

›Recent head and neck surgery

Vascular risk

›Cervical artery dissection risks

›Recent minor trauma

›Neck manipulation

›Connective tissue disorder

Medication adverse effect risk

›Dystonia risks

›Recent dopamine blocking medication

›Young age

›Prior dystonic reaction

08Differential Diagnosis/ddx60

Life threatening

›Cannot miss diagnoses

›Meningitis (G00.9)

›Fever with neck stiffness

›Altered mental status

›Retropharyngeal abscess (J39.0)

›Sore throat with torticollis

›Trismus

›Drooling

›Cervical spine fracture or instability (S12.9)

›Trauma

›Midline tenderness

›Neurologic deficit

›Spinal epidural abscess (G06.1)

›Fever

›Severe pain

›Neurologic deficit

›Cervical artery dissection (I77.71)

›Neck pain with headache

›Horner syndrome

›Posterior circulation symptoms

Common

›Frequent etiologies

›Acute cervical muscle spasm (M62.838)

›Overuse

›Awkward posture

›Normal neurologic exam

›Cervical strain or sprain (S16.1)

09Past Medical History/pmh13

Relevant chronic conditions

›Comorbidities

›Rheumatoid arthritis (M06.9)

›Ankylosing spondylitis (M45)

›Osteoporosis (M81.0)

›Malignancy history

›Immunosuppression

Prior procedures and devices

›Cervical spine history

›Prior cervical surgery

›Prior cervical fracture

›Implanted hardware

Baseline function

›Functional baseline

›Baseline neurologic deficits

›Baseline neck range of motion limits

10Physical Exam/exam34

General and vitals

›Initial status

›Airway and speech quality

›Work of breathing

›Hemodynamic status

›Fever assessment

Head and neck

›Neck examination

›Head position

›Active range of motion

›Passive range of motion

›Midline cervical tenderness

›Paraspinal tenderness

›Oropharynx and ENT

›Tonsillar asymmetry

›Uvular deviation

›Trismus

›Drooling

›Neck mass or swelling

Neurologic

›Neuro screen

›Mental status

›Cranial nerves

›Motor strength

›Sensory exam

›Reflexes

›Gait if safe

11Lab Studies/labs12

Core labs when red flags present

›Infection evaluation

›CBC with differential

›CRP

›ESR

›Blood cultures if febrile or septic physiology

Targeted labs by differential

›Metabolic and medication related

›CMP if dehydration concern

›Pregnancy test when imaging or teratogenic meds possible

›CK if severe prolonged spasm with concern for rhabdomyolysis

Limitations and pitfalls

›Interpretation cautions

›Normal WBC does not exclude deep neck infection

›CRP and ESR can be normal early in infection

12Imaging/img32

Scoring Systems

›Cervical spine trauma decision tools

›Canadian C-Spine Rule

›Validated in alert stable blunt trauma

›Guides imaging selection and can reduce radiography

›NEXUS criteria

›Low risk criteria set for blunt trauma clearance

›High sensitivity in original validation cohort

MRI

›MRI indications

›Suspected spinal epidural abscess

›Suspected cervical myelopathy

›Persistent neurologic deficit

›Suspected ligamentous injury with concerning exam

›MRI cautions

›Unstable patient

›Implanted device incompatibility

›Need for sedation in pediatrics

›CT cervical spine

›Trauma with decision tool positive

›Midline tenderness after trauma

›Focal neurologic deficit after trauma

›Older adult with concerning mechanism

›Imaging guided by ACR Suspected Spine Trauma

›CT neck with IV contrast

›Suspected deep neck space infection

›Trismus with fever and neck swelling

13Special Tests/spec14

Bedside maneuvers

›Cervical spine clearance elements

›Midline tenderness assessment

›Active rotation to 45 degrees each side when appropriate

›Distracting injury assessment

›Radiculopathy maneuvers

›Spurling test

›Shoulder abduction relief sign

Infection and meningismus tests

›Meningeal signs

›Nuchal rigidity

›Kernig sign

›Brudzinski sign

Medication reaction confirmation

›Dystonia response test

›Rapid improvement after IV diphenhydramine

›Recurrence prevention dosing plan

14ECG/ecg12

When ECG is relevant

›Indications

›Chest pain or dyspnea

›Syncope

›Electrolyte concern

›QT prolonging medication exposure

High risk patterns

›ECG red flags

›New ischemic changes

›Significant QTc prolongation

›Wide complex tachycardia

Serial ECG logic

›Repeat ECG triggers

›Ongoing chest pain

›Evolving symptoms

15Assessment/ax24

Working diagnosis framework

›Torticollis category

›Benign muscular spasm likely

›Normal neurologic exam

›No fever

›No trauma red flags

›Trauma related torticollis possible

›Mechanism concerning

›Midline tenderness

›Neurologic symptoms

›Infectious deep neck space concern

›Fever

›Odynophagia

›Trismus

›Medication induced dystonia

›Recent dopamine antagonist exposure

›Oculogyric crisis or jaw dystonia

Severity and risk stratification

›High risk status

›Airway risk

›Sepsis risk

›Neurologic deficit

›Low risk status

›Isolated paraspinal spasm

›Stable vitals

›Improving with analgesia

16Plan/plan40

Differential Management

›!Cervical radiculopathy→›!Cervical spine fracture→›Retropharyngeal abscess→

Approach to the critical patient

›First 5 minutes workflow

›Airway monitoring if drooling or stridor

›Continuous pulse oximetry if respiratory symptoms

›IV access if fever with systemic symptoms

›Early antibiotics if sepsis physiology

›Early ENT consult if airway concern

›Reassessment loop

›Pain and ROM reassessment at 30 minutes

›Neuro reassessment after analgesia

›Airway reassessment if infectious concern

Symptom control for low risk presentation

›Analgesia and spasm relief

›NSAID or acetaminophen

›Heat

›Gentle supported positioning

›Short course muscle relaxant if needed

›Activity modification

›Relative rest 24 to 48 hours

›Avoid heavy lifting and sudden neck movement

Suspected acute dystonic reaction

›Immediate treatment

›Diphenhydramine IV 50 mg once

›Consider benztropine IV 1 mg to 2 mg once

17Disposition/dispo18

ICU or high acuity care

›ICU criteria

›Airway compromise risk

›Sepsis with hypotension

›Rapidly progressive neurologic deficit

Inpatient admission

›Admission indications

›Deep neck space infection

›Suspected spinal epidural abscess

›Cervical spine fracture or instability

›Persistent severe pain requiring parenteral analgesia

Observation pathway

›Observation candidates

›Dystonic reaction requiring recurrence monitoring

›Uncertain diagnosis with improving symptoms but persistent limitation

Discharge criteria

›Safe discharge features

›No red flags

›Normal neurologic exam

›Stable vitals

›Pain controlled with PO meds

›Reliable follow up

18Discharge Instructions/di24

Copy discharge instructions

›Summary

›Your neck spasm is called acute torticollis and often improves over several days

›Your exam today did not show signs of a dangerous cause

›Medications

›Use acetaminophen as directed on the label

›Use an anti inflammatory medicine only if you can take it safely

›If you were given a muscle relaxant, do not drive or drink alcohol

›Activity

›Gentle neck movement as tolerated

›Avoid heavy lifting and sudden twisting for 48 hours

›Heat packs 15 to 20 minutes up to 4 times per day

›Follow up

›Primary care or physiotherapy within 3 to 7 days if not improving

›Earlier follow up within 24 to 48 hours if symptoms worsen

›Return to ED now if

›Fever

›New weakness or numbness

›Trouble walking

›Severe headache

›Confusion

›Trouble breathing

›Drooling

›Worsening throat pain or trouble swallowing

›New neck swelling

19References/r7

Evidence and guidelines

›Key sources

›ACR Appropriateness Criteria Cervical Pain or Cervical Radiculopathy, 2019

›ACR Appropriateness Criteria Acute Spinal Trauma, 2019

›Stiell IG et al Canadian C-Spine Rule derivation, JAMA, 2001

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›Lewis K et al Dystonic Reactions, StatPearls, 2023

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

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