Parkinson’s disease and head tremor

True head tremor is uncommon in Parkinson’s disease. Parkinson’s typically causes a rest tremor of the hands and, often, of the jaw, lips or chin, which can look like head shaking. A clear side-to-side or up-and-down head tremor points more toward essential tremor or dystonia, so a careful examination is needed before treatment is chosen.

Key facts

True head tremor is uncommon in Parkinson’s disease.
Parkinson’s more often causes rest tremor of the hand, jaw, lips or chin.
A clear head tremor points toward essential tremor or dystonia.
People can have both Parkinson’s disease and a separate head tremor.
DBS can be planned to treat both.

Clues that the tremor is from Parkinson’s disease

Tremor at rest, often starting on one side
Slowness of movement and stiffness
Jaw, lip or chin tremor rather than whole-head shaking
Smaller handwriting, reduced facial expression, softer voice
A good response of the tremor to Parkinson’s medication

When Parkinson’s and head tremor occur together

Some people have both Parkinson’s disease and a separate head tremor — for example from essential tremor. The two need different approaches: the Parkinson’s symptoms are treated with medication and, when appropriate, DBS of the subthalamic nucleus or globus pallidus internus, while the head tremor may need a tremor target. An experienced team plans DBS to cover both.

How to tell them apart

	Parkinson’s tremor	Essential or dystonic head tremor
When it appears	At rest	When holding the head up
Main location	Hand, jaw, lips, chin	Whole head
Other signs	Slowness, stiffness	Hand tremor or neck pulling

Dopamine transporter imaging can help when the diagnosis is uncertain. See diagnosis.

Treatment

Parkinson’s tremor is treated with medication first; when it no longer controls the symptoms, DBS of the subthalamic nucleus or globus pallidus internus is used. Parkinson’s DBS is covered in detail on our sister site, dbsinturkey.com.

Questions to discuss with your neurologist

Is my head movement a tremor, or jaw and chin tremor that looks like head shaking?
Does it improve with my Parkinson’s medication?
Is there a second tremor condition as well?
If DBS is considered, which target would cover both problems?

Patient videos

**Tremor-Dominant Parkinson's Before & After DBS** — A patient with tremor-dominant Parkinson’s disease before and after DBS.
Shared with the patient’s written consent. Individual results vary.

**Parkinson's Tremor: No Benefit from STN DBS Abroad, Then a New Start in Istanbul** — A tremor-dominant Parkinson’s patient who had no benefit from STN DBS at another center abroad, after DBS in Istanbul.
Shared with the patient’s written consent. Individual results vary.

**Parkinson's Before & After DBS: A Woman from Kyrgyzstan** — A woman from Kyrgyzstan with Parkinson’s disease, 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

Can DBS help jaw tremor in Parkinson’s disease?

Yes, jaw and chin tremor often improve with DBS, as limb tremor does. The response is assessed individually.

My head shakes and I have Parkinson’s. Which doctor should I see?

A movement disorder neurologist, who can tell whether the head tremor is part of Parkinson’s disease or a separate tremor.

Does Parkinson’s DBS help head tremor?

Parkinson’s DBS mainly treats Parkinson’s symptoms. If a separate head tremor is present, the plan must account for it; this is decided individually.

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/