This case report describes a 26-year-old male presenting to the emergency department with acute neck pain and involuntary neck muscle contractions, resulting in torticollis and uncontrollable mouth opening. These symptoms began one hour before arrival and were linked to opioid withdrawal after the patient ceased tramadol use, having abused doses of 400 to 600 mg daily for the past two months. He had Opioid withdrawal symptoms since 2 days such as sweating, agitation, and insomnia, with a Clinical Opiate Withdrawal Scale (COWS) score of 18, indicating moderate withdrawal. Initial assessment showed normal systemic findings except for tachycardia and hypertonia of the neck muscles, with a Glasgow Coma Scale score of 15. The patient was initially treated with promethazine, which was ineffective. Lorazepam was then administered, leading to significant reduction in dystonic symptoms. After psychiatric consultation, 50 mg of tramadol was given to manage withdrawal symptoms. The patient was stabilized over six hours and advised to follow up with psychiatry. This case highlights the complex relationship between acute dystonia and opioid withdrawal, particularly with tramadol. It emphasizes the need for a multidisciplinary approach in managing such patients, focusing on both neurological manifestations and withdrawal symptoms to optimize care and prevent dependency re-establishment.