Head Tremor
Head Tremor
Head tremor may be characterized as "yes-yes" (nodding, tremblementaffirmatif) when predominantly in the vertical plane, or "no-no" (sideto-side, tremblement negatif) when predominantly in the horizontal plane.
Head tremor may occur in isolation or with evidence of tremor elsewhere (e.g., postural limb tremor, vocal tremor, in essential tremor), or dystonia (e.g., torticollis). In essential tremor the head movements are often intermittent, "yes-yes", and of frequency about 7 Hz. Dystonic head tremor is often jerky and disorganized, with a frequency of less than 5 Hz. Cerebellum and brainstem disease, such as multiple sclerosis, can also produce head tremor (or titubation). Head tremor is an exceptionally rare symptom of Parkinson’s disease. It may also be seen as a consequence of aortic valve regurgitation (De Musset’s sign).
Treatment of head tremor varies with cause. Possible treatments, of variable efficacy, include:
- Essential tremor: propranolol, primidone, nicardipine, gabapentin, topiramate
- Dystonic tremor: anticholinergics, propranolol, botulinum toxin injections
- Cerebellar tremor: isoniazid, carbamazepine, ondansetron
Cross References
