How to recognise motor tics & Tourette syndrome, and manage them with nutrition

If you or your loved one has exaggerated eye blinking, sudden head jerks or constant throat clearing, then it’s important to take notice, as these little quirks could be warning signs of motor tics.

These involuntary movements are often temporary, however if they become more entrenched, it can turn into a chronic tic disorder. If they last for more than a year this is likely Tourette syndrome.

It is also vital to understand that motor tics are soft signs the neurological system is being challenged, and these little twitches and grimaces can mean that your nutrition needs some TLC.

I was brought to tears this summer at Glastonbury, seeing how Lewis Capaldi delivered such as stellar performance without a single hint of a tic. Whereas only two years ago he lost his voice and was completely incapacitated by his tics on that same Pyramid stage. It meant he had to cancel the rest of his tour in 2023 as his symptoms of Tourette Syndrome were affecting him so badly back then. I am so proud of the strides he has made over the last couple of years to work on this debilitating neurological condition which so many people live with these days.

Having motor tics and Tourette’s Syndrome in your life can be incredibly challenging and most of the time these symptoms are involuntary which mean they are not in your control. The ripple effect of living with tics can create a complex web of emotional and behavioural challenges. They can invoke feelings of under confidence, low self-esteem and being very self-conscious about these involuntary movements and sounds. Children can often be bullied and teased by other kids who do not understand why they have jerky movements, twitches or blurt out unusual sounds.

What’s more, motor tics frequently come hand-in-hand with anxiety, obsessive-compulsive behaviours (OCD), with difficulties with attention and focus (ADHD) as well as alongside autism.

And what is not spoken about enough, is that repetitive movements like blinking, shoulder shrugging or throat clearing can lead to muscle tension and soreness and even chronic pain. These physical discomforts can increase stress and fatigue, which in turn worsens tics becoming a vicious cycle.

As a naturopath and nutritionist working with hundreds of families who are navigating a wide variety of motor and vocal tics, I have found that these spontaneous movements and vocalisations often wax and wane and can easily switch from one type to another over time. You might have several types of tics at once, or as one goes away, another appears. And tics can be exacerbated by stress, fatigue, infections and even certain nutrient deficiencies.

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What do motor tics look like?

Here are some examples of motor tics. As you can see there are multiple types and presentations, and some may look more obvious than others.

Eye blinking: frequent, excessive blinking that seems more intense than usual.
Eye rolling: sometimes with exaggerated eye movements.
Facial grimacing: scrunching up the face or making unusual expressions.
Facial twitching: small, rapid movements in parts of the face.
Lip biting or chewing: repetitive biting of chewing of the lips
Jaw clenching or popping: sudden tightening or movement of the jaw.
Head jerking: sudden movements of the head to one side or up and down.
Hair flicking or head tossing: quick movements involving the hair or head.
Shoulder shrugging: repetitive lifting of the shoulders.
Nose twitching: wrinkling or flaring the nose repeatedly.
Arm or hand flapping: quick, repetitive movements of the arms or hands.
Piano fingers: flicking or fluttering fingers in the air.
Finger tapping: tapping fingers on surfaces repeatedly.
Neck stretching or twisting: frequent, sudden movements to stretch or twist the neck.
Jumping or hopping: brief, involuntary jumps or hops.
Repetitive stretching or posturing: holding or repeating certain body positions.
Self-hitting or tapping: lightly hitting oneself on the chest, legs, or arms.
Touching objects or people: repetitive touching or tapping of nearby items or people.
Toe curling or foot tapping: involuntary movements of the feet or toes.

Vocal tics are also very common, especially amongst children and can sound like:

Throat clearing: frequent, repetitive clearing of the throat.
Sniffing: repeated sniffing sounds without having a cold.
Grunting: low grade, involuntary grunting noises.
Coughing: frequent coughing that isn’t due to illness.
Humming: repetitive humming sounds.
Whistling: short bursts of whistling.
Squeaking or squealing: high-pitched noises made involuntarily.
Clicking sounds: tongue or mouth clicks.
Echolalia: repeating words or phrases just heard from others.
Palilalia: repeating one’s own words or phrases.
Animal sounds: barking, meowing or other noises.
Non-verbal sounds: such as gasping, sighing, or throat noises.
Shouting or sudden vocal outbursts: loud, unexpected sounds or words.
Swearing or inappropriate words: known as coprolalia, though this is rare and not present in most children with tics.

Why do people develop motor tics?

Despite tic disorders often being shared within families amongst siblings and cousins, still after years of research, no one specific gene has been identified. However, there are several shared genetic SNPs that you can inherit within your genetic blueprint which can affect how you regulate certain neurotransmitters and areas of your brain and can predispose you to developing tics.

Motor tics are involuntary movements that often arise when the brain’s movement system becomes dysregulated. This system involves a network of brain regions known as the Cortico-Striato-Thalamo-Cortical loop, which includes the basal ganglia, thalamus, motor cortex and cerebellum. These areas work together to control and fine-tune movement, but when the balance is off – especially within the basal ganglia – unwanted movements can sneak in.

On a biochemical level, motor tics are often linked to an imbalance in neurotransmitters, which are the chemical messengers that help our brain cells communicate. Dopamine, which plays a key role in movement and reward, tends to be elevated in children with tics. Too many brain messengers such as excitatory glutamate and inflammatory aspartic acid, or even excess levels of serotonin may also contribute to the motor tic picture. At the same time, calming neurotransmitters like GABA may be insufficient, reducing the brain’s ability to inhibit these movements.

Even too much systemic histamine from different allergic or atopic tendencies such as asthma, hay fever, rhinitis or eczema may predispose someone more to developing tics. Managing excess levels of histamine in the brain and the body can in some cases help to calm down the tics.

Research is now emerging that people living with tics may also experience gut-related issues such as irritable bowel syndrome or dysbiosis. This isn’t just a coincidence as the gut and brain are in constant communication via the gut-brain axis, a superhighway of nerves, hormones and immune signals. When the gut microbiome is out of balance, it can lead to inflammation and disrupt the balance of neurotransmitters such as dopamine, serotonin and GABA which are key players in motor control.

More established research and clinical practice points towards infections as triggers for tic disorders, especially streptococcal (Strep A), Lyme disease and Mycoplasma pneumoniae which can worsen tics in genetically susceptible people. In some cases, this is due to an autoimmune response where the body mistakenly attacks its own brain cells, leading to inflammation and altered neurotransmitter function, particularly in the basal ganglia. This is found in conditions like PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections), where tics, anxiety and OCD symptoms can appear suddenly after an infection. You can read more about PANDAS here.

Thankfully the key nutrients that help to calm down motor tics also work on keeping all of these neural pathways in balance.

Medical treatments for motor tics and Tourettes

Habit Reversal Therapy (HRT) is a psychological intervention where you are trained to be made aware of the sensation that happens before a tic happens and you learn to adopt a competing behaviour to keep it in check.

Antipsychotic medications such as risperidone and aripiprazole maybe prescribed for Tourette’s syndrome, however these come with well recognised side effects such as weight gain, blurred vision, insomnia and nausea, so they tend to be prescribed as the very last resort.

If your child is diagnosed with PANDAS the medical treatment is usually a course of antibiotics and ibuprofen for several weeks.

How can diet and nutrition play a role in managing motor tics?

Children with Tourette’s syndrome tend to consume fewer portions of fruit and vegetables and consume less foods containing important vitamins such as B3, B6 and C as well as less selenium and phosphorus compared to children without Tourette’s. Low levels of zinc, iron, copper and vitamin D have also been associated with the development of Tourette’s.

Caffeine may further stimulate an already overactive dopaminergic system in Tourette’s, so if you or your teenager have tics, then avoid caffeine as this can exacerbate them. Look out for caffeine in energy drinks, tea, coffee, green tea, dark chocolate or cocoa.

Several key nutrients play a role in tic regulation, and you may want to trial some of these to see if you can get some relief. Here are the ones with the most research:

Magnesium

Known as the “calming mineral,” magnesium helps relax muscles and regulate nerve signals. It also helps to calm down excess levels of dopamine and serotonin and is a helpful buddy to help make more zen-like GABA. A magnesium deficiency can lead to heightened anxiety and increased tic activity.

Magnesium-rich foods include dark green vegetables, salad leaves, nuts, seeds and dark chocolate and many people choose to supplement when their tics are bothering them.

Vitamin D

We get vitamin D from sunshine, but if you live in the UK, you may find it hard to get enough sunny vitamin D throughout the year. This is partly why the NHS recommends we all supplement with vitamin D during the autumn and winter months.

Vitamin D levels in children with chronic tic disorders have been found to be lower compared with their peers. One study found that high-dose vitamin D3 supplementation is more effective than low-dose supplementation in reducing tic severity and increasing serum vitamin D levels in children with chronic tic disorders and may help with the management of Tourette’s.

Iron

Children and adults with Tourette’s and tic disorders often have lower levels of iron and ferritin (iron stores) and since iron is essential for healthy brain development and helps to regulate dopamine production it is important to check iron levels if tics develop. When iron stores are low, it may affect key areas of the brain like the caudate and putamen which are regions that help control movement, making someone more prone to developing tics or experiencing more severe ones. It can also influence the size and function of the cortex, which plays a role in impulse control, meaning that low iron might make it harder to suppress tics.

That’s why checking iron levels and bolstering the diet with iron rich foods such as red meat, liver, green veggies, eggs and pulses, as well as correcting deficiencies with supplements can be a helpful way to managing tics naturally.

Other nutrients

L-Theanine is an amino acid found in green tea, matcha and black tea. It is the non-caffeinated part of these hot drinks which helps to calm an overactive nervous system and has been specifically found to enhance the calming GABA pathways.

Studies on tic disorders have combined theanine and vitamin B6 and this is most likely because this vitamin is essential for neurotransmitter production and vitamin B6 encourages an appropriate balance of dopamine and serotonin.

Round up

If you live with tics or have a child who has a tic disorder, know that you’re not alone and that there are gentle and natural ways to help.

Emerging research is finding that certain infections and nutrient deficiencies can pose a greater risk for developing tic disorders and Tourette’s syndrome and are worth exploring if these motor tics are taking over your life. And with the right nutritional and lifestyle support, many families see improvements not just in tics, but also in mood, sleep, digestion and overall resilience.

If you would like to run some tests to understand if a bacterial or viral infection is part of your motor tic picture, or to find out if you have shortfalls in your nutrition, then get in touch with our NatureDoc clinical team who can provide 1 to 1 support for you and your loved ones.

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How to recognise motor tics & Tourette syndrome, and manage them with nutrition

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What do motor tics look like?

Why do people develop motor tics?

Medical treatments for motor tics and Tourettes