The first symptoms of Tourette Syndrome are most commonly facial tics such as eye blinking, nose twitching or grimaces. As time goes on other tics that are more complex may appear such as head jerking, neck stretching, foot stamping, or body twisting. These are distinct, coordinated patterns of successive movements which involve several muscle groups. People with TS may also continuously clear his or her throat, cough, sniff, grunt, yelp, bark, shout, or utter unacceptable sounds or phrases. In extreme cases they can demonstrate self harming behaviors like lip biting and head banging against very hard objects.
Tics can increase and decrease in severity, and change in number, frequency, type, and location.
There is no certainty as to when or how long tics can occur. The effort of of holding back a sneeze is very similar to that of a person with TS trying to suppress their tics. There is an incredible amount of tension that the tic eventually reaches a point of escape. Tics almost always worsen in stressful situations but can improve when the person is involved in an activity or relaxed. In most cases tics tend to decrease greatly during sleep.