A tremor is an involuntary, rhythmic movement caused by alternating muscle contractions. When this shaking occurs in the neck, it results in an involuntary head movement, a symptom sometimes called titubation. Head tremors are a common form of movement disorder, and they can manifest in two primary patterns: a vertical “yes-yes” movement or a horizontal “no-no” motion. Because these movements are not consciously controlled, they can significantly interfere with daily activities and cause social difficulty. Understanding the underlying cause of a neck tremor is the first step toward finding an appropriate management strategy.
Essential Tremor
Essential Tremor (ET) is recognized as the most frequent cause of an isolated head tremor. This condition is a primary neurological disorder. The tremor is specifically classified as an action tremor, which includes both postural and kinetic forms.
A postural tremor occurs when the head is held against gravity, such as sitting upright, while a kinetic tremor happens during voluntary movement, like reaching for an object. Unlike a resting tremor, the shaking in ET is often minimal or absent when the neck muscles are completely relaxed. When ET affects the head, the movement is typically rhythmic, often between 6 to 12 Hertz.
The head tremor in ET is most commonly a horizontal “no-no” pattern, though a vertical “yes-yes” motion can also occur. While ET most often begins in the hands, about a third of patients will experience a head tremor, which can also be accompanied by a voice tremor. This condition is often progressive, worsening slowly over time. It has a significant hereditary component, with approximately 50% to 70% of cases being familial.
Cervical Dystonia
Cervical dystonia, also known as spasmodic torticollis, is a distinct neurological movement disorder often confused with Essential Tremor. This condition is characterized by sustained or intermittent involuntary contractions of the neck muscles. These abnormal muscle spasms lead to repetitive twisting, jerking, or an abnormal posture of the head and neck.
The resulting movement may resemble a tremor, but its underlying cause is fundamentally different; it arises from an abnormal, sustained muscle pull, not a pure rhythmic oscillation. This movement is often classified as a dystonic tremor because it occurs in a body part affected by dystonia. The tremor tends to be jerky and irregular in its rhythm, contrasting with the regular oscillation seen in Essential Tremor.
A defining feature of cervical dystonia is an abnormal, fixed head position, such as tilting (laterocollis) or rotation (torticollis). Patients may also discover a “sensory trick,” or geste antagoniste, where touching a specific spot on the face or neck can temporarily reduce the involuntary muscle contractions and the associated tremor. This temporary relief helps distinguish dystonic head movement from the rhythmic shaking of Essential Tremor.
Neurological Conditions Causing Symptomatic Tremors
In some instances, a neck tremor is not a primary disorder but a symptom of a larger, underlying neurological disease. These are known as symptomatic tremors, indicating a broader disease process beyond an isolated tremor syndrome. One such condition is Parkinson’s disease, which is classically associated with a resting tremor, meaning the shaking is most noticeable when the muscles are fully relaxed.
While Parkinson’s disease primarily affects the hands with a characteristic “pill-rolling” motion, head tremor is relatively uncommon. When a head tremor does occur, it is secondary to the disease’s core pathology: the loss of dopamine-producing neurons in the brain’s basal ganglia. The neck tremor in Parkinson’s disease is often asymmetrical, initially affecting one side of the body more than the other.
Another group of symptomatic tremors is linked to dysfunction in the cerebellum, the brain’s movement coordination center. Cerebellar tremors are typically slow and have a large amplitude, often manifesting as an intention tremor. This type of tremor worsens significantly as the individual attempts a purposeful, targeted movement, such as guiding a fork to the mouth. Damage to the cerebellum can disrupt motor control and result in these pronounced intention tremors that may involve the neck.
Reversible and Temporary Factors
Not all neck tremors are the result of a chronic neurological disease; some are temporary or reversible, often categorized as an enhanced physiological tremor. This type of tremor is a natural, low-amplitude oscillation that becomes more pronounced due to various external or physiological factors. High levels of emotional stress, intense anxiety, or physical fatigue can acutely amplify this normal physiological shaking.
Dietary and substance-related factors are also common temporary causes. Excessive consumption of caffeine or the effects of drug or alcohol withdrawal can increase the excitability of the nervous system, leading to a noticeable tremor. Additionally, certain medications can induce or worsen tremors as a side effect, including specific asthma drugs, corticosteroids, or psychiatric medications. Identifying and removing the causative factor usually leads to the resolution or significant reduction of the tremor.