Tics in Adults: Causes, Stress and Tics, and Treatment

Neurodevelopmental tics, including Tourette syndrome, begin in childhood, worsen around early adolescence and in many people fade by early adulthood, although in some they persist and can be troublesome. In the DSM-5 classification, tic disorders presuppose an onset before the age of 18. A first-ever tic in a 30- or 50-year-old is therefore not simply ‘late Tourette’s’ and calls for a different look: one checks whether it is a functional tic, a side effect of a drug or substance or, rarely, a brain disease.

Many adults with tics have not had them treated for years, because they learned to mask them (for example by turning a tic into a seemingly purposeful gesture) or decided it was a ‘nervous habit’. It is worth knowing that awareness of the tension that precedes a tic (the so-called premonitory urge) and the ability to suppress a tic briefly are typical of neurodevelopmental tics and can help in diagnosis. Suppression is, however, tiring, and tics may briefly intensify once it ends.

In recent years a surge of sudden tic-like behaviours has been described, especially in young women, termed functional tic-like behaviors. They are functional in nature, meaning they involve a disturbance of nervous system functioning without classic structural damage, and they are sometimes mistaken for late-onset Tourette syndrome.

A later topical review (Andersen et al., 2026), covering 24 papers, indicates that patients with functional tics generally have greater symptom severity and complexity and more anxiety and depression than people with Tourette syndrome, while people with Tourette syndrome more often have simple tics and ADHD and OCD. Follow-up observations show that symptoms decrease over time, but spontaneous remission is rare, and cognitive therapies worked well in treatment (data from only two papers). It is an example of how little hard data we have on treatment itself: the number of studies is small.

For the reader the conclusion is cautious: if tics began suddenly in adulthood, are violent and complex, coexist with anxiety or stress and the diagnosis of Tourette syndrome ‘does not fit’, it is worth considering an assessment by a neurologist or a psychiatrist experienced in movement disorders. A diagnosis of functional tics is made on the basis of the clinical picture and requires other causes to be excluded — it does not mean ‘pretending’, and the symptoms are real and troublesome.

Tics are variable: they wax and wane in cycles, and their severity depends on the situation. The most frequently described aggravating factors are stress and emotional tension, sleep deficit and tiredness, intense excitement, and the time after mental effort when a person stops concentrating on a task. Conversely, tics may be weaker during intense, absorbing activity such as sport or playing an instrument. These are clinical observations, not the result of a single study, and they differ between individuals.

What about caffeine and other substances? There are no solid studies showing that caffeine causes tics in healthy adults, but in people with tics large doses of caffeine and energy drinks are often cited as an aggravating factor — mainly because of general arousal and worse sleep. Stimulant drugs (used in ADHD), in turn, have historically raised concerns about worsening tics; the evidence is ambiguous, and the decision on their use always rests with the doctor. Some other substances and drugs can cause involuntary movements or syndromes resembling tics, so a complete list of what you take is an important part of the history.

Not every involuntary movement is a tic. Differentiation is the neurologist’s job, but knowing a few features helps to understand why assessment is sometimes needed. Tics are usually brief, stereotyped, repetitive and can be briefly suppressed; they are often preceded by an urge. Dystonia is a sustained muscle contraction leading to twisting movements or abnormal postures. Myoclonus is a very brief, sudden jerk without a premonitory urge and without the ability to stop it. Chorea consists of irregular, flowing movements. A single, brief twitch of the eyelid (myokymia) is usually harmless and associated with fatigue, stress or excess caffeine.

When the picture is unclear, a neurologist may order further tests: blood count and biochemistry, sometimes an EEG (see our knowledge-base entry on electroencephalography) or magnetic resonance imaging of the head, but in most people with tics of a typical course these tests are normal and are not needed routinely.

The basis of treatment of tics, when they are troublesome, is a specific behavioural therapy: the Comprehensive Behavioral Intervention for Tics (CBIT) and the related habit reversal training. It involves becoming aware of the early signals of a tic (the premonitory urge), learning a competing movement that makes the tic impossible to perform, and analysing situations that worsen tics, as well as relaxation techniques.

The guideline accompanying this review (Pringsheim et al., 2019, 46 recommendations) stresses that treatment should be individualized and decided jointly by patient and doctor after weighing benefits, harms and coexisting conditions. Options include watchful waiting, CBIT and drugs, and deep brain stimulation is considered only in adults with severe, treatment-refractory tics. It is worth remembering that not every tic needs treatment: when it does not interfere with life, explanation and observation are enough.

The main caveats: the Wilhelm trial assessed adults with Tourette syndrome or chronic tics, not specifically tics of sudden onset in adulthood or functional tics. The availability of trained CBIT therapists may be limited, and we did not check what it looks like in Poland, so we give no information here on availability or reimbursement. The choice of drug always rests with the doctor, and all the drugs mentioned have adverse effects.

We do not recommend supplements ‘for tics’, including magnesium, as treatment: we have no good evidence for them in adults with tics, and using them diverts attention from proper assessment. Deficiencies confirmed by testing should of course be corrected, but that is a separate matter.

What we do not cover: details of drug dosing, neurosurgical procedures or tics in children, which require a separate approach. We also do not describe hypotheses of tics after infections, because the evidence is ambiguous and does not concern typical adult patients.

For an adult with tics the key distinction is whether it is an old problem from childhood that waxes and wanes, or a new symptom that requires other causes to be excluded. In the first case there are effective non-drug methods worth knowing about; in the second, specialist assessment is the key. In both situations there is no reason for shame — tics are a symptom that can be understood and, to a large extent, eased.