Relaxation techniques, such as exercise, yoga and meditation may be useful in relieving the stress that can aggravate tics. Beyond HRT, the majority of behavioral interventions for Tourettes (for example, relaxation training and biofeedback) have not been systematically evaluated and are not empirically supported. Medication
Children with tics typically present when their tics are most severe, but because the condition waxes and wanes, medication is not started immediately or changed often. Tics may subside with education, reassurance and a supportive environment. When medication is used, the goal is not to eliminate symptoms. Instead, the lowest dose that manages symptoms without adverse effects is used, because adverse effects may be more disturbing than the symptoms being treated with medication.The classes of medication with proven efficacy in treating tics—typical and atypical neuroleptics—can have long-term and short-term adverse effects. Some antihypertensive agents are also used to treat tics; studies show variable efficacy but a lower side effect profile than the neuroleptics. The antihypertensives clonidine and guanfacine are typically tried first in children; they can also help with ADHD symptoms, but there is less evidence that they are effective for adults. The neuroleptics risperidone and aripiprazole are tried when antihypertensives are not effective, and are generally tried first for adults. Because of lower side effects, aripiprazole is preferred over other antipsychotics. The most effective medication for tics is haloperidol, but it has a higher risk of side effects. Methylphenidate can be used to treat ADHD that co-occurs with tics, and can be used in combination with clonidine.
Functional tics are "not fully sterotypical", do not respond to medications, do not demonstrate the classic waxing and waning pattern of Tourettic tics, and do not progress in the typical fashion, in which tics often first appear in the face and gradually move to limbs.Other conditions that may manifest tics include Sydenhams chorea; idiopathic dystonia; and genetic conditions such as Huntingtons disease, neuroacanthocytosis, pantothenate kinase-associated neurodegeneration, Duchenne muscular dystrophy, Wilsons disease, and tuberous sclerosis. Other possibilities include chromosomal disorders such as Down syndrome, Klinefelter syndrome, XYY syndrome and fragile X syndrome. Acquired causes of tics include drug-induced tics, head trauma, encephalitis, stroke, and carbon monoxide poisoning. The extreme self-injurious behaviors of Lesch-Nyhan syndrome may be confused with Tourette syndrome or stereotypies, but self-injury is rare in TS even in cases of violent tics. Most of these conditions are rarer than tic disorders and a thorough history and examination may be enough to rule them out without medical or screening tests. Screening for other conditions
Although not all those with Tourettes have comorbid conditions, most presenting for clinical care exhibit symptoms of other conditions along with their tics. ADHD and OCD are the most common, but autism spectrum disorders or anxiety, mood, personality, oppositional defiant, and conduct disorders may also be present. Learning disabilities and sleep disorders may be present; higher rates of sleep disturbance and migraine than in the general population are reported.