“Yes-yes” and “no-no” head tremor

“No-no” tremor is side-to-side shaking of the head; “yes-yes” tremor is up-and-down nodding. Both are forms of head tremor. The direction alone does not give the diagnosis, but together with the regularity of the tremor and the signs that accompany it, it helps distinguish essential tremor from dystonic and other types ^[1].

Key facts

“No-no” is side-to-side shaking; “yes-yes” is up-and-down nodding.
Direction alone does not give the diagnosis ^[1].
“No-no” is most common in essential and isolated head tremor.
Mixed or rotating patterns often point to dystonia.
DBS treats both directions, because it acts on the brain circuit rather than individual muscles.

What the direction suggests

“No-no” (horizontal) — the most common pattern in essential tremor and in isolated head tremor.
“Yes-yes” (vertical) — seen in essential tremor and in dystonia affecting the muscles that bend the neck forward or backward.
Rotating or mixed — often seen in dystonia, especially with a turned head.

See the difference: patient examples

“Yes-yes” (nodding) head tremor

**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.

“No-no” (side-to-side) head tremor

**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 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.

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.

Which muscles are involved

Side-to-side shaking comes mainly from the muscles that rotate the head; nodding comes from the muscles that bend the neck forward and backward. In dystonia, the overactive muscles also pull the head into a turned, tilted or bent position. This is why botulinum toxin injections are planned muscle by muscle.

Does direction change the DBS plan?

Not directly. DBS acts on the brain circuit that generates the rhythm, not on individual neck muscles, so both directions respond. The DBS plan is based on the type of tremor — essential, dystonic, isolated or secondary — and both sides of the brain are treated because both control the neck.

Treatment

Treatment follows the cause rather than the direction. See the treatment guide and DBS for head tremor.

Recording the direction for your doctor

Film yourself from the front and from the side for 30 seconds while sitting upright without a headrest, then while turning the head slowly to each side. This shows the direction, regularity and any null point clearly. See how to record a useful video.

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 a nodding head tremor more serious than a shaking one?

No. The direction does not indicate severity; the cause and the effect on daily life matter more.

Can the direction of my tremor change over time?

Yes, especially in dystonia, where the pattern of muscle involvement can shift.

Does “yes-yes” tremor respond to DBS?

Yes. DBS acts on the circuit that generates the rhythm, so vertical and horizontal tremors both respond.

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/