Premonitory Urge: The Feeling Before a Tic

A premonitory urge is an uncomfortable physical sensation that occurs just before a semi-voluntary action, known as a tic, similar to the feeling before a sneeze or an itch. The urge builds until it compels the person to perform the tic, which provides temporary relief. This experience is a central feature for many individuals who live with tic disorders.

The Sensation and Its Cycle

The experience of a premonitory urge varies between people but often manifests as a localized feeling of tension, pressure, or a tickle. For example, a person might feel a building discomfort in their shoulders that leads to a shoulder-shrugging tic. An odd sensation in the eye might only be relieved by blinking.

These sensations are part of a distinct cycle. The urge begins subtly and builds in intensity, creating a strong drive to perform the tic. Once the tic is executed, there is an immediate, though often temporary, feeling of relief from the underlying sensation.

Associated Medical Conditions

Premonitory urges are prominently linked with primary tic disorders like Tourette Syndrome (TS), where they are considered a hallmark feature. The likelihood and type of urge can vary depending on the tic’s location and complexity. For instance, complex motor tics and those involving the head, neck, and shoulders are very commonly preceded by these urges.

These urges are also relevant to Obsessive-Compulsive Disorder (OCD). In OCD, the sensation is often described as a “not just right” feeling or inner incompleteness that compels a compulsive ritual. The presence of these sensory phenomena can help distinguish between individuals who have OCD alone and those who have both Tourette Syndrome and OCD.

Neurological Origins

The origin of premonitory urges is believed to be rooted in dysfunction within the brain’s circuitry governing sensation and movement. Brain regions implicated in generating these urges include the supplementary motor area and the insula. These areas are involved in preparing for motor actions and processing internal bodily sensations.

This neurological activity suggests the urge is a genuine sensory event, not an imaginary one. The basal ganglia, a group of structures responsible for motor control, also plays a part. It is thought that faulty signaling within these brain circuits leads to the inappropriate triggering of a “need to move” sensation. This results in the conscious perception of tension that precedes the tic.

Management and Coping Strategies

Behavioral therapies are a primary method for managing premonitory urges. The most established of these is Habit Reversal Training (HRT), which has two main parts: awareness training and competing response training. Awareness training teaches individuals to recognize the very first signs of the premonitory urge as it begins.

Once awareness is achieved, the next step is to implement a competing response. This involves performing a specific, less noticeable action that is physically incompatible with the tic. For example, if the urge precedes a head-jerking tic, the competing response might be to gently tense the neck muscles until the feeling subsides. Other strategies, such as mindfulness and stress reduction, can also be beneficial.