Dystonic head tremor

Dystonic head tremor is a jerky, often irregular head tremor that occurs in people with cervical (neck) dystonia, in which neck muscles contract involuntarily and pull the head into a turned or tilted position. It is one of the hardest tremors to treat: botulinum toxin injections help many patients, and for those they do not help, deep brain stimulation of thalamic or subthalamic targets has improved dystonic head tremor in published series ^[1],[2].

Key facts

Dystonic head tremor is jerky, irregular head shaking in cervical dystonia.
A null point and a sensory trick are typical features.
Botulinum toxin is the usual first treatment; its effect lasts about 3–4 months.
When tremor dominates, thalamic or subthalamic DBS improves head tremor ^[1],[2].
In our published series, tremor was abolished in 3 of 4 dystonic tremor patients ^[3].

How to recognize it

Irregular, jerky rather than smooth shaking
The head turns, tilts or pulls to one side
A null point — a head position where the tremor stops
A sensory trick — lightly touching the chin, cheek or back of the head eases it
Neck pain and muscle tightness

Dystonic or essential head tremor?

	Dystonic head tremor	Essential head tremor
Rhythm	Irregular, jerky	Regular
Head posture	Turned or tilted	Normal
Null point / sensory trick	Often present	Absent
Hand tremor	May be absent or asymmetric	Usually present

The distinction matters because the best DBS target differs. See DBS for dystonic head tremor.

Why it is hard to treat

Dystonic tremor has an irregular rhythm and amplitude and is driven by more than one brain circuit ^[3]. Medication often helps only partly. Botulinum toxin relaxes the overactive muscles but has to be repeated every few months, and over time some people respond less. Thalamic stimulation alone tends to improve the tremor component more than the dystonia itself ^[3],[4].

Treatment options

Botulinum toxin injections into the overactive neck muscles — the usual first treatment
Physiotherapy for posture, stretching and pain
Oral medication — partial benefit in some people
Deep brain stimulation — GPi when dystonia dominates; Vim/PSA (often double target) when the tremor dominates

In our published double-target series, 3 of 4 patients with dystonic tremor had their tremor abolished, and their dystonia scores improved by 72% on average ^[3].

When to consider DBS

DBS is considered when injections no longer control the tremor or pulling, when they cause weakness or swallowing difficulty, or when the effect wears off too quickly. The target depends on whether the tremor or the dystonia is the main problem. See DBS for dystonic head tremor.

Patient videos

**40 Years of Head Tremor, 3 Years After DBS: Lasting Relief** — A patient with 40 years of head tremor, three years after DBS.
Shared with the patient’s written consent. Individual results vary.

**Head Tremor Before & After DBS: A 43-Year-Old from Uzbekistan** — A 43-year-old patient from Uzbekistan treated for head tremor.
Shared with the patient’s written consent. Individual results vary.

**Progressing Tremor Before & After DBS: A 42-Year-Old from Uzbekistan** — A 42-year-old patient from Uzbekistan treated with DBS for a progressing tremor; an example of “yes-yes” head tremor.
Shared with the patient’s written consent. Individual results vary.

**Head Tremor 5 Years After DBS: Still Free of Shaking** — A head tremor patient five years after deep brain stimulation; an example of “no-no” head tremor.
Shared with the patient’s written consent. Individual results vary.

**Visible Head Tremor Before & After DBS in Turkey** — A patient whose head tremor was visible to everyone, before and after DBS.
Shared with the patient’s written consent. Individual results vary.

Watch many more head tremor patientsOur YouTube playlist: many head tremor patients filmed before and after DBS

Open the head tremor video library on this site.

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 ^[3].

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

Can dystonic head tremor go away on its own?

Occasionally cervical dystonia improves spontaneously, but in most people it persists and needs treatment.

Do botulinum toxin injections stop dystonic head tremor?

They reduce pulling and tremor in many patients. The effect lasts about three to four months, so injections must be repeated, and some patients respond less over time.

If my head pulls only to one side, is one-sided surgery enough?

Occasionally a clearly one-sided dystonic tremor can be treated on one side. Because these conditions tend to progress, we usually recommend treating both sides.

Is dystonic head tremor the same as torticollis?

Torticollis (cervical dystonia) is the twisting of the neck; dystonic head tremor is the shaking that often comes with it.

Sources

Pauls KA, et al. Deep brain stimulation in the ventrolateral thalamus/subthalamic area in dystonia with head tremor. Mov Disord 2014;29(7):953–960. doi.org/10.1002/mds.25884
Thalamic deep brain stimulation for dystonic head tremor: a long-term study of 18 patients. Mov Disord Clin Pract. onlinelibrary.wiley.com/doi/abs/10.1002/mdc3.70266
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/
Tsuboi T, Au KLK, Deeb W, Almeida L, Foote KD, Okun MS, Ramirez-Zamora A. Motor outcomes and adverse effects of deep brain stimulation for dystonic tremor: a systematic review. experts.umn.edu/en/publications/motor-outcomes-and-adverse-effects-of-deep-brain-stimulation-for-/