Isolated head tremor

Isolated head tremor is shaking of the head with no tremor anywhere else in the body and no signs of dystonia. It used to be labelled essential tremor, but because head tremor in essential tremor usually follows hand tremor, isolated head tremor is now regarded as a separate entity ^[1],[2]. It responds poorly to medication. In Prof. YILMAZ’s peer-reviewed series of 22 patients with rare tremor syndromes treated with double-target Vim+PSA DBS, the mean tremor reduction was 89% (range 50–100%), and 6 of 7 patients with isolated head tremor had a tremor score of 0 at 12 months, as rated blindly by two movement disorder specialists ^[2].

Key facts

Isolated head tremor affects only the head, with no hand tremor and no dystonia.
It is now classified as its own entity, not a form of essential tremor ^[1],[2].
There is no reliably effective medication for it.
In our published series, 6 of 7 patients reached a tremor score of 0 after double-target DBS ^[2].
Both sides of the brain are always treated.

Who gets isolated head tremor

It typically begins in adulthood and progresses slowly. In our published series, the patients with isolated head tremor had had symptoms for at least four years, and none had tremor in other body parts or dystonic signs ^[2].

How it is diagnosed

The diagnosis is made when the head shakes and careful examination finds no hand, voice or leg tremor and no dystonia — no neck pulling, no null point and no sensory trick. Because dystonic and essential head tremor can look similar, video review by an experienced specialist matters. See diagnosis.

Why medication rarely works

There is no medication that works reliably for isolated head tremor. Botulinum toxin injections into the neck muscles can reduce the amplitude temporarily, but they must be repeated, and higher doses can weaken the neck or affect swallowing.

Why DBS works well here

The neck muscles are controlled by both sides of the brain, and it is difficult to tell which side drives a head tremor. For this reason we treat both sides. Using a trajectory that reaches both the Vim and the PSA gives the programmer more options to find the point that stops the tremor ^[2]. In our series, 6 of 7 patients reached a tremor score of 0; the seventh improved from 4 to 1 after an electrode had to be repositioned and later replaced because of infection ^[2].

**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.

Next step

See DBS for isolated head tremor for the operation, programming and recovery.

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 isolated head tremor dangerous?

No, but it is often socially and physically disabling, and it rarely improves without treatment.

Will my hands start shaking later?

Some people with an initially isolated head tremor later develop tremor elsewhere; many do not. Treating both sides of the brain covers this possibility.

Is isolated head tremor the same as essential tremor?

Not according to the current classification. Isolated head tremor lacks the arm tremor that defines essential tremor ^[1].

What is the best treatment for isolated head tremor?

When the tremor is disabling, double-target DBS on both sides gave the best results in our experience: In Prof. YILMAZ’s peer-reviewed series of 22 patients with rare tremor syndromes treated with double-target Vim+PSA DBS, the mean tremor reduction was 89% (range 50–100%), and 6 of 7 patients with isolated head tremor had a tremor score of 0 at 12 months, as rated blindly by two movement disorder specialists ^[2].

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/