Symptoms of head tremor

The main symptom of head tremor is involuntary, rhythmic shaking of the head — side to side, up and down or both — that is usually present when the head is held upright and eases when lying down. The pattern of the shaking and the symptoms that accompany it point to the cause: a regular tremor with shaking hands suggests essential tremor, while jerky shaking with neck pulling suggests dystonia ^[1].

Key facts

The core symptom is rhythmic head shaking when the head is held upright.
It usually fades when lying down and disappears during sleep.
Stress, excitement, fatigue and caffeine make it worse.
Jerky shaking with neck pulling suggests dystonia; regular shaking with hand tremor suggests essential tremor ^[1].
Sudden onset, or tremor with weakness, numbness or slurred speech, needs prompt medical attention.

Common symptoms

Side-to-side (“no-no”) or up-and-down (“yes-yes”) shaking of the head
Shaking that increases with stress, excitement, fatigue, caffeine or attention
Neck muscle tiredness, stiffness or pain; sometimes headaches
A shaky or quivering voice
Difficulty keeping the eyes on a screen, reading or eating
Avoiding meetings, restaurants or photographs because of the tremor

Signs that point to a specific type

What you notice	Most likely type
Regular shaking, hands also shake when holding a cup or writing	Essential head tremor
Jerky, irregular shaking; head pulls or tilts; touching the chin or face eases it	Dystonic head tremor
Head shakes, nothing else in the body does	Isolated head tremor
Slow, coarse shaking that started weeks to months after a stroke, injury or bleed	Holmes tremor
Jaw, lip or chin tremor at rest, with slowness and stiffness	Parkinson’s disease

How symptoms change over the day

Most people notice that the tremor is mildest in the morning or after rest and strongest in the evening, after a tiring day or a stressful conversation. It typically fades when lying down with the head supported and disappears during sleep. These changes are features of tremor itself and do not mean the tremor is “psychological”.

How symptoms tend to develop

Essential tremor: usually starts in the hands; head tremor appears later in some people.
Dystonic tremor: often begins with neck stiffness or pulling; the tremor may change with head position.
Isolated head tremor: head shaking alone, usually progressing slowly over years.
Secondary tremor: appears after an identifiable event or illness, sometimes with a delay of months.

When to see a doctor promptly

The tremor started suddenly or after a head injury
It came with weakness, numbness, double vision, slurred speech or unsteady walking
It appeared after starting a new medicine
It is getting worse quickly

For a tremor that has developed slowly, a neurologist or movement disorder specialist can confirm the type. Our team can also review a video of your tremor online — see how head tremor is diagnosed.

Symptoms that mean DBS may be worth discussing

The tremor stops you working, reading, eating in public or driving comfortably
Neck pain from constant shaking or pulling
Medication has not helped enough or causes side effects
Botulinum toxin injections no longer work as well as before

See DBS for head tremor.

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

Why does my head shake more when people look at me?

Stress and attention increase tremor in most tremor disorders. This is a normal feature of tremor and does not mean the tremor is psychological.

Why does my head tremor stop when I lie down?

Head tremor usually appears when the neck muscles are working to hold the head up. When the head is supported, those muscles relax and the tremor often fades.

Can head tremor cause neck pain?

Yes. The neck muscles work constantly against the tremor, and in dystonia they also pull the head into an abnormal position, which commonly causes pain.

Does head tremor happen during sleep?

No. Tremor disappears during sleep and usually fades when the head is supported while lying down.

Can head tremor affect the voice?

Yes. Voice tremor often accompanies head tremor, especially in essential tremor.

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/