What is head tremor?

Head tremor is an involuntary, rhythmic shaking of the head. It can move side to side (“no-no”), up and down (“yes-yes”) or in a rotating pattern. Tremor is classified by the body part involved and by the other signs that come with it; the most common causes of head tremor are essential tremor and dystonia ^[1]. Head tremor is not dangerous in itself, but it can make eating, reading, working at a screen and social life difficult, and it often responds less well to medication than hand tremor ^[2].

Key facts

Head tremor is involuntary rhythmic shaking of the head: “no-no”, “yes-yes” or rotating ^[1].
The most common causes are essential tremor and dystonia; others include multiple sclerosis, brain injury and stroke.
It often responds less well to medication than hand tremor ^[2].
Deep brain stimulation is the most effective option when medication and injections fail.
In our published double-target series, mean tremor reduction was 89% ^[3].

What head tremor looks like

Direction: horizontal (“no-no”), vertical (“yes-yes”) or rotational. See “yes-yes” and “no-no” tremor.
When it appears: usually while sitting or standing upright, when the neck muscles hold the head up; it often settles when lying down with the head supported.
What makes it worse: stress, excitement, anger, tiredness, caffeine, being watched.
What can come with it: hand tremor, a shaky voice, neck pulling or a tilted head, neck pain.

Why head tremor happens

Smooth movement depends on a loop of brain circuits that runs from the cerebellum through the thalamus to the motor cortex. In tremor disorders this loop starts to oscillate — it produces a rhythm that the muscles follow. In the neck, the muscles that turn and nod the head are driven by both sides of the brain at once, which is one reason head tremor is harder to treat than the tremor of one hand. More detail on the causes of head tremor.

The main types

Essential head tremor

Rhythmic “no-no” or “yes-yes” shaking, usually with hand tremor.

Dystonic head tremor

Jerky, irregular shaking with neck pulling or a tilted head.

Isolated head tremor

Head shaking with no tremor anywhere else in the body.

Holmes tremor

Slow, coarse tremor appearing months after a brain injury or stroke.

Secondary head tremor

Caused by multiple sclerosis, trauma, stroke or other conditions.

Parkinson’s and head tremor

Why true head tremor is uncommon in Parkinson’s disease.

How head tremor differs from other movement disorders

Tremor is rhythmic and to-and-fro. Other movement disorders look different: dystonia produces sustained pulling or twisting postures, tics are brief, repeated movements that can be briefly held back, myoclonus consists of sudden shock-like jerks, and chorea consists of irregular, flowing movements. Some people have a combination — for example dystonia with tremor — which is why an examination by a movement disorder specialist, ideally supported by video, is the first step ^[1].

How head tremor affects daily life

Reading, using a phone or computer, and watching television become tiring because the image moves.
Eating and drinking in public become stressful, and many people stop going to restaurants or meetings.
Neck muscles ache from constant work; some people develop headaches.
Photographs, video calls and presentations are avoided.
Many people are asked whether they are nervous or ill, which adds to the strain.

These are good reasons to seek treatment, even though head tremor is not life-threatening.

When head tremor needs treatment

Treatment is worth considering when the tremor interferes with daily life, causes neck pain, or makes you avoid social situations. The treatment guide explains each option in order. When medication and injections no longer control the tremor, deep brain stimulation is the next step.

Head tremor in numbers from our center

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 ^[3]. In our own case series of patients treated with DBS for head tremor, average improvement was 87%, and more than 70% of patients reached near-complete resolution (our case series; results vary).

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 ^[3].

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 head tremor serious?

Head tremor is not life-threatening, but it can be disabling and should be examined by a neurologist so the cause is identified. A new tremor that appears suddenly, or together with weakness, numbness or trouble walking, needs prompt medical attention.

Is head tremor a sign of Parkinson’s disease?

Usually not. True head tremor is uncommon in Parkinson’s disease, which more often causes tremor of the hands, jaw, lips or chin. See Parkinson’s and head tremor.

Does head tremor get worse with age?

Head tremor caused by essential tremor or dystonia often progresses slowly over years. The rate varies widely from person to person.

Can head tremor be treated without surgery?

Yes, for many people. Medication and botulinum toxin injections into the neck muscles are tried first. Surgery is considered when these do not help enough or cause side effects. See the treatment guide.

Can children have head tremor?

Yes, but it is uncommon and has different causes from adult head tremor. A child with head shaking should be examined by a pediatric neurologist.

Is head tremor the same as head nodding?

Head nodding is one form of head tremor — the “yes-yes” type. See “yes-yes” and “no-no” 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
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/
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/