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Tics & Tourette’s Syndrome

Tics are sudden, repeated movements or sounds that a person cannot fully control. Many children have tics for a while and then outgrow them; Tourette’s syndrome is diagnosed when both movement and sound tics last a year or more. There is no cure, but mild tics often need no treatment, and behavioral therapy (CBIT), medicines, school support and help with ADHD, OCD and anxiety can make daily life easier.

When to get help quickly. Tics are not usually serious and do not damage the brain (NHS), so most are not emergencies. But please get prompt help in these situations:

  • Thoughts of suicide. Call, text or chat 988 (the 988 Suicide & Crisis Lifeline) any time, day or night (988 Lifeline), or call 911 if you are in immediate danger. Suicidal thoughts and attempts are more common in people with Tourette’s (Swedish register study, 2017).
  • Self-injury. Some of the most disabling tics involve movements that cause self-harm, such as punching oneself in the face (NINDS). The NHS says to see a GP (doctor) if tics cause pain or accidental injury, or come with anger, depression or self-harm (NHS).
  • Tics or OCD that appear suddenly and severely in a child, especially with other new changes such as refusing to eat, a drop in school performance, new separation anxiety, mood swings or changes in handwriting. This can be PANS or PANDAS, which NIMH calls rare; it advises talking to a health care provider if your child has symptoms (NIMH). Strep infections can also bring on or worsen tics, and CDC says the best first step is a thorough assessment by a provider familiar with tics (CDC).
  • Sudden tic-like movements or sounds in a teen or young adult with no history of tics. CDC notes these “functional tic-like behaviors” may need different treatment (CDC).
  • Tics that start in adulthood may need extra expertise to diagnose (NINDS), and can occasionally be triggered by drugs such as cocaine or amphetamines or caused by more serious conditions (NHS).

This guide is for education and does not replace a clinician. Nothing here is a reason to delay care.

What are tics?

Tics are sudden, repeated twitches, movements or sounds, and people who have them cannot stop their body from making them (CDC). They are fairly common in childhood and typically first appear around age 5 (NHS).

  • Motor tics involve movement, such as eye blinking, facial grimacing or shoulder shrugging. Vocal tics involve sound, such as throat clearing, sniffing or grunting (NINDS).
  • Simple tics involve a few muscle groups; complex tics are coordinated patterns, such as a grimace combined with a head twist and shoulder shrug, or repeating words or phrases (NINDS).
  • Swearing tics are not typical. CDC says swearing, often shown in the media, is not needed for a diagnosis and most people with Tourette’s do not have it (CDC).

Temporary tics, chronic tics and Tourette’s syndrome

Clinicians sort tic disorders by the type of tic and how long they have lasted (CDC):

  • Provisional (transient) tic disorder: motor tics, vocal tics or both, lasting less than a year.
  • Persistent (chronic) motor or vocal tic disorder: either motor or vocal tics, not both, lasting a year or more.
  • Tourette’s syndrome: both motor and vocal tics lasting at least a year. NINDS adds that tics begin before age 18 and are not caused by medicines, other substances or medical conditions (NINDS).

Lots of children have tics at some point, and that does not always mean Tourette’s (NHS). There is no blood or imaging test for Tourette’s; it is diagnosed from the history, and tests such as an MRI or EEG are used only occasionally to rule out other conditions (NINDS).

How common are tics, and what to expect

Studies that include undiagnosed children estimate that about 1 in 162 children (0.6%) have Tourette’s, and CDC suggests about half of children with it may not be diagnosed. For Tourette’s and persistent tic disorders together, CDC estimates about 1.4 million people in the U.S., including about 1 in 50 children aged 5 to 14. Boys are about three times as likely as girls to be diagnosed (CDC). The cause is unknown; NINDS says most cases involve several gene variations plus environmental factors (NINDS).

Symptoms usually start between ages 5 and 10 and are typically worst in the early teens. Tics generally lessen by the late teens or early 20s, but for some people Tourette’s lasts into adulthood. It is not degenerative and life expectancy is normal (NINDS). The NHS says tics usually improve after puberty, and sometimes last only a few months (NHS).

Below we compare six approaches. Behavioral therapy and, when needed, medicines have the strongest evidence; complementary approaches have far less. Many tics are mild and need no treatment, and often the biggest issues are the conditions that travel with tics, school and social life, and how others treat you.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Education and watchful waiting for mild tics; behavioral therapy (CBIT, habit reversal or exposure and response prevention); medicines by class when tics cause real problems; treatment of ADHD, OCD, anxiety and depression; school supports; deep brain stimulation only for rare severe cases in research and specialist settings. Cost estimate being researched. No cure, but treatments can help. In trials, about half of children (52.5%) and 38% of adults were much improved after 8 sessions of CBIT, and gains lasted months. Medicines can reduce tics but none works for everyone or removes tics completely, and side effects need monitoring.
Chiropractic Spinal or neck adjustment, sometimes marketed for nervous-system or “brain-based” care. It is not a treatment for tics. Without insurance, about $90–$200 for a first visit and $55–$100 for follow-ups. We found little research. One survey found 12 of 100 people with Tourette’s had tried chiropractic, and a single-patient case report described improvement. Neck manipulation carries a rare risk of artery tears and stroke.
Acupuncture Fine needles (body or scalp points), sometimes with herbs, offered mostly in Chinese-medicine settings for children’s tics. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Reviews of mostly Chinese trials report fewer tics than medicine alone, but the studies are low quality, so experts say there isn’t enough to recommend it. Safe when done with sterile needles.
Herbal medicine Chinese herbal formulas, supplements, vitamins and cannabis-based products marketed for tics. Cost estimate being researched. The NHS says there is little evidence herbs and supplements help. A few Chinese herbal formulas did well in better-quality trials, but not enough to recommend. Cannabis shows promise in small adult studies; larger trials are needed.
Massage therapy Relaxation and relief of tight, sore muscles; pediatric massage (tuina) in Chinese medicine. At one national chain, about $125–$160 for a 60-minute massage for non-members and $65–$90 for members; memberships about $70–$90 a month. Chinese reviews suggest benefit for tics, but experts have low confidence in them. Massage is not a tic treatment, though it may ease soreness and stress, and stress can make tics worse.
MBHA Wellness Coach Understanding tics, steady sleep and activity routines, stress management, practicing CBIT skills between sessions, school and family planning, and finding support. MBHA coaching cost estimate being researched. Practical help alongside your care team. Sleep, exercise and mindfulness are studied, with limited but encouraging results; coaching does not treat tics itself.

Approach 1 of 6

Conventional medicine (AMA)

There is no cure for Tourette’s, but treatments can help manage symptoms (NINDS, NHS). CDC says many people have tics that do not interfere with daily life and need no treatment; treatment is considered if tics cause pain or injury, interfere with school, work or social life, or cause stress (CDC). A 2019 U.S. guideline from the American Academy of Neurology lists the options as watchful waiting, the Comprehensive Behavioral Intervention for Tics (CBIT) and medicine, chosen together by the patient, caregiver and clinician (AAN guideline, 2019).

1. Education and watching how things go

The guideline recommends counseling about how tic disorders usually unfold, teaching teachers and peers, checking for other conditions, and periodically re-checking whether treatment is still needed (AAN guideline, 2019). European guidelines also recommend psychoeducation first, whatever the severity (European guidelines, Part II, 2022).

2. Behavioral therapy: CBIT, habit reversal and exposure therapy

CBIT is taught by a trained therapist. It includes habit reversal: awareness training (spotting each tic and the urge before it) and competing response training (doing a different movement that cannot happen at the same time as the tic), plus education about tics and relaxation. The therapist, and parents for a child, also work out triggers and the situations where tics are worst. CDC says CBIT has been shown to reduce tic symptoms in children and adults, but is not a cure (CDC). The NHS lists habit reversal, CBIT and exposure with response prevention (ERP), which helps people get used to the uncomfortable feeling before a tic, as the main therapies (NHS).

  • Children and teens: in an NIH-funded trial of 126 children aged 9 to 17, 8 sessions of CBIT over 10 weeks lowered tic severity more than supportive therapy and education; 52.5% were much or very much improved versus 18.5%, and 87% of responders still showed benefit 6 months later (randomized trial, 2010).
  • Adults: in 122 people aged 16 to 69, 38.1% of those who got CBIT were much or very much improved versus 6.4% with supportive treatment (randomized trial, 2012).
  • Pooled results: a 2026 meta-analysis of 11 studies (942 young people) found behavioral therapy improved tics, with gains lasting through follow-up (meta-analysis, 2026).
  • Online options: because few therapists offer CBIT, online programs have been tested. In a 224-child English trial, therapist-supported online ERP lowered tic scores more than online education (ORBIT trial, 2021). In a 221-child Swedish trial both groups improved, but more children responded to ERP (47.2% versus 28.7%) (Swedish trial, 2022). A 2026 UK review found the evidence limited and cost-effectiveness uncertain (UK review, 2026).

NINDS says biofeedback and supportive therapy have not been shown to reduce tics, though supportive therapy can help with coping (NINDS). The Tourette Association of America (TAA) offers a provider finder and Centers of Excellence (TAA).

3. Medicines (by class)

Medicine is for tics that cause problems, often alongside or after behavioral therapy. We list classes, not doses; your prescriber decides what fits you.

No one medicine helps everyone and none completely eliminates symptoms (NINDS). CDC lists possible side effects including weight gain, stiff muscles, tiredness and restlessness, notes that doctors often start small and increase slowly, and says most medicines prescribed for Tourette’s are not FDA-approved for tics (CDC). TAA advises adults on tic medicines long term to review them with their doctor and keep up checkups for blood sugar, heart and liver function (TAA). Newer medicines, including ecopipam and gemlapodect, are in trials (review of trials, 2025). Our Medication Safety guide has general tips.

4. Deep brain stimulation and other brain stimulation

Deep brain stimulation (DBS) uses a surgically implanted, battery-operated device to deliver electrical stimulation to specific brain areas. NINDS-funded research is testing it in people with Tourette’s who do not respond well to medicines and behavioral therapy (NINDS). The AAN guideline covers assessing for DBS in adults with severe, treatment-refractory tics (AAN guideline, 2019). A 2026 meta-analysis of 22 studies (358 patients in all) found an average 48% drop in tic scores, with results that differed by brain target (meta-analysis, 2026); a Cochrane review is planned but we found only its protocol (Cochrane protocol, 2024). In randomized trials, non-surgical magnetic stimulation (rTMS) did not significantly lower tic scores, and high-quality trials are few (systematic review, 2025). DBS is a rare, last-step option for a specialist team.

5. Treating what comes with tics

Because ADHD, OCD, anxiety and learning problems often cause more trouble than the tics, CDC says doctors should assess every child with Tourette’s for them (CDC). NINDS notes psychotherapy can help with ADHD, depression, anxiety and OCD (NINDS).

What it costs

Cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic treatment often involves spinal manipulation (NCCIH). None of the sources we read lists it as a treatment for tics, and we found very little research on it. A 2009 survey of 100 people with Tourette’s at a movement-disorder clinic found 12 had tried chiropractic; among all users of any alternative treatment, 56% said they noticed some improvement, and 80% had started without telling their doctor (survey, 2009). The only chiropractic report we found was a single-patient case report of a teenager with migraines, learning problems and Tourette’s whose tics improved after spinal manipulation and exercises; a single case cannot show cause and effect (case report, 2013).

A 2025 Chinese trial of 600 patients tested acupuncture combined with a neck (atlantoaxial joint) bone-setting technique against acupuncture alone and against the medicine tiapride. The combined group did best on tic scores, but the difference in overall effectiveness between the combined and acupuncture-only groups was not significant (randomized trial, 2025). A 2026 expert review placed acupuncture combined with this bone-setting therapy among its second-tier (Class II) studies suggesting benefit, but said the overall evidence for complementary approaches is too limited for general recommendations (systematic review, 2026). This is not the same as a chiropractic adjustment, so it does not prove chiropractic works.

Safety: be cautious about neck manipulation. Serious problems such as strokes involving neck arteries have been reported after spinal manipulation but are very rare. A neck-focused technique has been linked to tears in neck artery walls; experts disagree about whether manipulation can cause them (NCCIH). Tics themselves are not a reason for neck manipulation; tell any provider about your tics first.

What it costs

Without insurance, about $90–$200 for a first visit and $55–$100 for follow-ups; a course of several weeks can come to $500–$1,000 (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture for tics has been studied mainly in China. A 2026 systematic review of complementary approaches found most studies were at high risk of bias; systematic reviews of Chinese studies of acupuncture, acupuncture with herbs and massage suggest bigger tic reductions than conventional treatment, but with low confidence because of poor study quality, and the authors say these limits prohibit evidence-based recommendations for general use (systematic review, 2026). The individual reviews tell the same story:

  • Children’s acupuncture, 2025: 32 trials (2,201 children) found acupuncture may improve motor tics more than the comparison medicine, and add to other treatments, but all results rested on low-quality evidence (meta-analysis, 2025).
  • Scalp acupuncture, 2025: 19 trials (1,463 patients) found lower tic scores than controls and stable long-term benefit; the authors cited low-quality trials and possible publication bias (meta-analysis, 2025).
  • Acupuncture plus herbs, 2024: 18 trials (1,400 participants) found better results than Western medicine, and fewer side effects, but with low-quality, possibly biased studies (meta-analysis, 2024).

Most of these trials come from China and involve children. The largest review compared acupuncture with medicine, or acupuncture plus other treatment with that treatment alone, rather than with sham needling, so we do not know how well the results apply to the U.S. The NHS says there is little evidence that complementary treatments help with symptoms (NHS). If you try it, use it alongside your medical care and not instead of behavioral therapy.

Safety and cost

Relatively few complications have been reported, but they have come from non-sterile needles and improper treatment; the FDA requires acupuncture needles to be sterile and single-use, and most states license acupuncturists (NCCIH). Sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare Part B covers acupuncture only for qualifying chronic low-back pain, not tics (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

The NHS says some people use herbs and supplements, but there is little evidence they help (NHS). In the 2009 clinic survey, 21 of 100 people had tried vitamins and 15 dietary supplements (survey, 2009).

Chinese herbal formulas

The 2026 systematic review of 49 clinical studies found that trials in its top (Class I) quality tier showed that 5-Ling granule, Jingxin Zhidong formula and Ningdong granule reduced tic severity. It also found that most studies had high risk of bias and that the evidence is too limited for general recommendations (systematic review, 2026). These formulas were tested in Chinese trials and may not be available in the U.S.

Cannabis and cannabis-based products

Cannabis claims deserve special care, because the research is small and mostly in adults:

NCCIH cautions that adolescents who use cannabis are four to seven times more likely than adults to develop cannabis use disorder, that frequent use is linked to a higher risk of psychosis in people who are predisposed, and that CBD can cause side effects including changes in alertness and mood, liver injury and drug interactions (NCCIH).

Talk to your doctor or pharmacist before trying a supplement. Supplements may interact with medicines, and the FDA can act against an unsafe product only after it is on the market; some products have been found to contain drugs not listed on the label (NCCIH). We don’t list doses here. See our Medication Safety guide.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage does not treat tics. NCCIH says massage may help neck or shoulder pain, though benefits may last only a short time (NCCIH), so it may ease muscle soreness caused by frequent tics or tension. We did not find research testing massage for soreness from tics specifically. NINDS notes that tics can worsen with excitement or anxiety and ease during calm activities (NINDS), so a relaxing session can be a reasonable part of a stress plan. In the 2009 clinic survey, 19 of 100 people with Tourette’s had tried massage (survey, 2009).

Chinese pediatric massage (tuina) has been studied for tics. A 2025 network meta-analysis of 24 trials (1,657 children) judged massage alone and combined with other Chinese medicine therapies to be effective and safe, but graded the evidence for overall response and total tic score as low or very low quality (network meta-analysis, 2025). The 2026 expert review similarly gave low confidence in massage findings (systematic review, 2026).

The risk of harm from massage appears low, but there have been rare reports of serious side effects, some with vigorous deep-tissue massage or in older adults (NCCIH). Tell your therapist about your tics; ask them to expect movement and sound, and choose a quiet room if that helps.

What it costs

At one national chain, franchise price lists show about $125–$160 for a 60-minute massage for non-members and $65–$90 for members, whose memberships run about $70–$90 a month (The Pricer). Tips are extra.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you turn your care team’s advice into habits — always alongside your doctor and therapist, never instead of them. Coaching does not treat tics.

Understand tics and don’t fight them

Tics tend to get worse when they are talked about or focused on (NHS), and people who suppress tics often feel tension build until the tic must come out (NINDS).

Sleep, calm routines and activity

The NHS suggests a consistent daily routine with plenty of physical activity, a calm regular bedtime without phones or other devices, and avoiding stressful situations where possible, since stress can make tics worse (NHS). A 2024 meta-analysis of 33 studies found sleep problems in about 34% of people with tic disorders, more often with ADHD, OCD, anxiety or mood problems (meta-analysis, 2024); see our Sleep Problems guide. TAA says no study shows that a particular exercise reduces tics, but exercise can ease anxiety and stress and can help limit weight gain from some medicines; overdoing it to the point of fatigue can worsen tics, and some people find vigorous exercise increases tics (TAA).

Mindfulness

The 2026 expert review placed mindfulness-based intervention for tics among its second-tier (Class II) studies suggesting benefit (systematic review, 2026). A pilot trial in 28 adults found it reduced OCD symptoms more than a comparison program, with larger trials needed (pilot trial, 2026), and a 12-week mindful-movement program for 135 children with Tourette’s reported fewer motor tics and less anxiety (randomized trial, 2025).

Practice your skills, prepare for life out and about

A coach can help you keep up with homework from a CBIT therapist, track what helps, keep a medicine list and prepare questions for appointments. TAA suggests absorbing activities in public and carrying an “I have Tourette’s” card in case someone misreads your sounds or movements (TAA).

Find support

The NHS suggests online or face-to-face support groups (NHS), and MedlinePlus points to local TAA chapters (MedlinePlus). MBHA coaching cost estimate being researched.

Another approach

Premonitory urges: why tics feel the way they do

Many tics are preceded by an urge or sensation in the affected muscles, called a premonitory urge. People may feel they must complete a tic in a certain way, or a certain number of times, to relieve the urge (NINDS). The NHS describes an unpleasant sensation that builds until relieved by the tic, though tics can sometimes be partly suppressed (NHS).

That is why “just stop” does not work. Some people can suppress tics for a while, but with a substantial buildup of tension until the tic must be expressed (NINDS). CBIT works with the urge: the person learns to notice it and respond with a competing movement (NINDS, CDC).

NINDS notes tics lessen in light sleep and disappear in deep sleep (NINDS).

Another approach

ADHD, OCD, anxiety and other conditions that come with tics

CDC reports that about 83% of children with Tourette’s have at least one other disorder, and that more than a third of people with Tourette’s also have OCD (CDC). NINDS says these neurobehavioral conditions often cause more impairment than the tics themselves, and they may continue into adulthood even when tics fade (NINDS).

Another approach

Sudden-onset tics: tic-like behaviors, PANS and PANDAS

Typical tics start gradually in early childhood. Sudden, severe onset is different and deserves an evaluation.

Functional tic-like behaviors. CDC says some people, often teenagers and more often girls, develop sudden tic-like behaviors without a history of tics; these may need different treatment (CDC). A 2026 review of 39 studies found they mostly affect adolescents and young adults, with a strong female predominance, an abrupt onset and complex movements and sounds, and that medicine and CBT gave some benefit (systematic review, 2026). A follow-up of 30 people whose symptoms were linked to social media found most improved or recovered over about two years, and a third said simply knowing the correct diagnosis helped (follow-up study, 2026). These behaviors are real and distressing, not “faking.” A clinician familiar with tics should assess them.

PANS and PANDAS. NIMH describes PANS as a sudden and severe onset of OCD or restricted eating in children before puberty, often with tics, mood and behavior changes; PANDAS is a subtype linked to strep infection. They are considered rare, there is no lab test to confirm them, and diagnosis requires a thorough evaluation that rules out other causes. If strep is found, antibiotics are usually used to treat it, and children may benefit from cognitive behavioral therapy, an SSRI medicine or both; NIMH says there is not enough evidence to recommend long-term antibiotics (NIMH). NINDS calls the relationship between Tourette’s and autoimmune brain injury after strep infections one of the most controversial areas of Tourette’s science (NINDS). Having strep and having tics does not by itself mean PANDAS (NIMH).

Another approach

School, work and family

NINDS says students with Tourette’s often do well in a regular classroom, but ADHD, learning disabilities, obsessive-compulsive symptoms and frequent tics can interfere with school; after a comprehensive assessment, students should have access to a setting that meets their needs, which may include tutoring, smaller classes, private study areas or exams outside the classroom (NINDS).

  • Formal plans. CDC says a child may need an Individualized Education Program (IEP) for special education services or a 504 plan if they do not; accommodations can include different seating, extra testing time or computer access for writing (CDC). Tourette’s is recognized as a disability under the Individuals with Disabilities Education Act (CDC).
  • Tell the people around you. Educating teachers, coaches, employers and peers can reduce teasing and bring more helpful accommodations, and CDC notes tic symptoms may lessen when people with Tourette’s have more support (CDC). The NHS suggests telling the school if your child is diagnosed (NHS).
  • Parents. Parent training in positive reinforcement and effective discipline has been shown to help children with Tourette’s and disruptive behaviors (CDC).
  • Don’t punish tics. NINDS stresses that tics are unwanted and unintentional and that tics in response to a trigger can appear voluntary or purposeful but are not (NINDS).

Another approach

Stigma, bullying and mental health

Misunderstanding is common. In a 2024 survey of Germans who had heard of Tourette’s, 87% associated it with swearing tics, although these are uncommon, and the authors concluded that knowledge was poor and stereotypes were widespread (population survey, 2026). CDC says children with Tourette’s experience more bullying than other children, which can cause serious, lasting problems including depression, loneliness, anxiety, missed school and suicidal thoughts; adults can help by talking about bullying and building a safe school environment (CDC).

It is worth saying plainly that the risks are real:

  • In a Swedish register study of 7,736 people with Tourette’s or chronic tic disorders, they were about 4 times as likely to die by suicide and attempt suicide as matched people from the general population (odds ratios 4.39 and 3.86); the risk fell after accounting for other psychiatric conditions but stayed substantial, and tics that persisted past young adulthood and a previous suicide attempt were the strongest predictors of dying by suicide (Swedish register study, 2017).
  • A review of 20 studies found self-injurious behavior in about 35% of patients, mostly from specialist clinics (systematic review, 2020).
  • In an online survey of 601 U.S. adults with Tourette’s run by TAA (a convenience sample), higher stigma was linked to self-harm, suicidal thoughts and suicide attempts (adult survey, 2026).

If you or someone you love is struggling, tell a clinician, and call, text or chat 988 any time (988 Lifeline). Counseling, treatment of depression and anxiety, and a school or workplace that understands tics matter as much as treating the tics.

Another approach

Finding care and support

Start with a primary care provider, pediatrician or mental health specialist; unusual presentations may need more expertise (NINDS). The Tourette Association of America lists knowledgeable medical and allied professionals and Centers of Excellence, and local chapters offer support groups (TAA); NINDS lists TAA’s phone line as 888-486-8738 (NINDS). CDC notes TAA offers free CBIT training for health professionals (CDC). In the UK, the NHS points to Tourettes Action for information and groups (NHS).

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