Essential head tremor

Essential head tremor is head shaking caused by essential tremor, the most common tremor disorder. The shaking is usually regular and side to side, and in most people the hands shook first — head tremor tends to appear once hand tremor is well established ^[1]. When medication does not control it, thalamic deep brain stimulation improves head tremor in most treated patients ^[2],[3].

Key facts

Essential head tremor is regular head shaking in a person with essential tremor.
Hand tremor usually comes first ^[1].
Thalamic DBS improves head tremor in most treated patients ^[2],[3].
Treating both sides adds further improvement in head and voice tremor ^[6].
We operate on both sides and plan a trajectory through the Vim and the PSA.

Typical features

Regular “no-no” (sometimes “yes-yes”) shaking
Hand tremor when holding a cup, writing or eating
Often a shaky voice
Frequently a family history of tremor
No neck pulling or abnormal head posture (that would suggest dystonia)

How it develops

Essential tremor usually progresses slowly over many years. Hand tremor typically comes first; head and voice tremor may follow. The rate varies a great deal, and some people have mild tremor all their lives while others become disabled by it.

How it is diagnosed

The diagnosis is clinical: regular action tremor of both arms, sometimes with head or voice tremor, without signs of dystonia, Parkinson’s disease or another cause ^[4]. When the head shakes but the hands do not, the diagnosis is usually isolated head tremor instead. See diagnosis.

Treatment

Medication helps hand tremor more reliably than head tremor; botulinum toxin injections into the neck muscles are an option for head tremor ^[5]. When these are not enough, DBS for essential head tremor is considered. In the largest clinical trial dataset of DBS for essential tremor, stimulation of the thalamus on one side significantly improved head tremor, and adding the second side improved it further ^[2].

Living with essential head tremor

Use a high-backed chair or headrest when reading or working
Reduce caffeine and get enough sleep
Physiotherapy can relieve neck strain
Tell colleagues and friends what the tremor is — it often reduces the stress that makes it worse

When to consider DBS

DBS is considered when head tremor limits your daily or social life despite medication, or when medication causes side effects you cannot accept. After a successful operation the tremor is usually controlled from the day the stimulator is switched on. See DBS for essential head tremor.

Patient videos

**Head Tremor Before & 1 Year After DBS — Surgery Without Shaving Her Head** — A woman with constant head tremor, filmed before DBS and one year after surgery; her operation was performed without shaving her head. An example of “no-no” head tremor.
Shared with the patient’s written consent. Individual results vary.

**Head Tremor Before & After DBS: How DBS Gave Her Life Back** — A head tremor patient before and after DBS in Istanbul.
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 ^[1].

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 essential head tremor the same as isolated head tremor?

No. In essential tremor the hands are almost always affected. When only the head shakes, the current classification calls it isolated head tremor ^[4].

Does alcohol reduce essential tremor?

Many people with essential tremor notice a short-lived improvement after a small amount of alcohol, followed by a rebound. It is not a treatment and should not be used as one.

Will DBS help both my hands and my head?

Yes. Bilateral DBS treats both hands and the midline symptoms — head and voice — in the same operation ^[6].

Can essential head tremor be cured?

No, but it can be controlled. DBS treats the tremor without curing the underlying condition.

Sources

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/
Mitchell KT, et al. Benefits and risks of unilateral and bilateral ventral intermediate nucleus deep brain stimulation for axial essential tremor symptoms. Parkinsonism Relat Disord 2019;60:126–132. scholars.duke.edu/publication/1349961
Anis S, et al. Efficacy of ventral intermediate nucleus deep brain stimulation for head tremors in essential tremor: a single-center retrospective analysis (54 patients). Mov Disord 2025;40(suppl 1) — congress abstract. www.mdsabstracts.org/abstract/efficacy-of-ventral-intermediate-nucleus-deep-brain-stimulation-for-head-tremors-in-essential-tremor-a-single-center-retrospective-analysis/
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
Mayo Clinic News Network. When to consider deep brain stimulation for essential tremor (2023). newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-when-to-consider-deep-brain-stimulation-for-essential-tremor/
Putzke JD, Uitti RJ, Obwegeser AA, Wszolek ZK, Wharen RE. Bilateral thalamic deep brain stimulation: midline tremor control. J Neurol Neurosurg Psychiatry 2005;76(5):684–690. pmc.ncbi.nlm.nih.gov/articles/PMC1739619/