What causes head tremor?

Most head tremor is caused by essential tremor or by dystonia, two conditions in which the brain circuits that control movement produce an unwanted rhythm. Less common causes are multiple sclerosis, a brain injury, a stroke or bleed in the brainstem or cerebellum, metabolic problems such as liver disease, and some medicines ^[1]. In some people the head is the only part that shakes — this is called isolated head tremor.

Key facts

Essential tremor and dystonia cause most head tremor ^[1].
Isolated head tremor is now classified as a separate entity ^[2].
Secondary causes include multiple sclerosis, brain injury, stroke, liver disease and some medicines.
Tremor develops in 25–58% of people with multiple sclerosis ^[2].
The cause decides which treatment and which DBS target are most likely to work.

The tremor circuit

Movement is smoothed by a loop that runs from the cerebellum through the thalamus to the motor cortex. In tremor disorders this loop produces an abnormal rhythm. The fibers carrying the cerebellar signal toward the thalamus pass through the posterior subthalamic area (PSA) in a compact bundle and then reach the ventral intermediate nucleus of the thalamus (Vim). Deep brain stimulation works by interrupting the rhythm inside this loop — at the Vim, at the PSA, or at both ^[2].

Primary causes

Essential tremor — the most common tremor disorder; often runs in families; usually starts in the hands and may later involve the head and voice. More on essential head tremor.
Dystonia — involuntary muscle contractions; in the neck (cervical dystonia) they can cause a jerky head tremor. More on dystonic head tremor.
Isolated head tremor — tremor confined to the head, now classified as its own entity rather than a variant of essential tremor ^[2].

Secondary causes

Multiple sclerosis affecting the cerebellar pathways; tremor develops in 25–58% of people with multiple sclerosis ^[2]
Traumatic brain injury
Stroke, bleeding or tumors in the midbrain, thalamus or cerebellum — sometimes producing Holmes tremor
Liver disease and other metabolic causes
Medicines — some drugs cause or worsen tremor; your doctor can review your medication list

See secondary head tremor for how these are treated.

Things that make head tremor worse

Stress, anxiety, anger and excitement
Fatigue and poor sleep
Caffeine and other stimulants
Some medicines
Holding the head upright for a long time without support

None of these cause a lasting tremor disorder by themselves, but reducing them can make the tremor milder.

Risk factors

A family history of tremor
Older age (essential tremor becomes more common with age)
A history of brain injury, stroke or multiple sclerosis

Why the cause matters for treatment

Each cause responds differently. Botulinum toxin is most useful in dystonic tremor; medication helps essential tremor more than other types; and the best DBS target depends on whether the tremor is essential, dystonic, isolated or secondary. See how head tremor is diagnosed.

Your surgeon

Prof. Atilla YILMAZ, MD

Every operation is performed personally by Prof. YILMAZ, a stereotactic and functional neurosurgeon who has carried out 1,200+ neuromodulation procedures, including 800+ DBS surgeries, for patients from 60+ countries. He is the first author of the published double-target Vim+PSA series for rare tremor syndromes ^[2].

President, Middle-Eastern Society for Stereotactic and Functional Neurosurgery (MSSFN); Board of Directors, WSSFN and International Neuromodulation Society
Proctor for Medtronic, Abbott and Boston Scientific — the three leading DBS manufacturers appoint him to train other neurosurgeons on their systems
40+ neurosurgeons trained from 30 countries; first-ever DBS surgeries performed in six countries
Trained at the University of Florida (observership with Prof. Okun and Prof. Foote) and Umeå University Hospital, Sweden

Full profile and credentials

Frequently asked questions

Is head tremor hereditary?

Essential tremor often runs in families, so head tremor caused by it can be inherited. Head tremor from dystonia or a brain injury usually is not.

Can stress cause head tremor?

Stress makes an existing tremor worse but does not by itself cause a lasting tremor disorder.

Can a head injury cause head tremor?

Yes. Tremor can develop after a traumatic brain injury, sometimes weeks or months later. See Holmes tremor.

Can medicines cause head tremor?

Yes. Several drugs can cause or worsen tremor. Your doctor can review your medication list; do not stop any medicine without advice.

Is head tremor caused by anxiety?

Anxiety makes existing tremor worse, but it is not the cause of a lasting tremor disorder.

Sources

Bhatia KP, et al. Consensus Statement on the classification of tremors from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord 2018. utsouthwestern.elsevierpure.com/en/publications/consensus-statement-on-the-classification-of-tremors-from-the-tas
Yilmaz A, Eray HA, Cakir M, Ceylan M, Blomstedt P. Deep Brain Stimulation with Double Targeting of the VIM and PSA for the Treatment of Rare Tremor Syndromes. Stereotact Funct Neurosurg 2024;102:224–239. DOI 10.1159/000539162. pubmed.ncbi.nlm.nih.gov/38934181/