Titubation

Medically reviewed by Seunggu Han, MD on November 20, 2017Written by Kristeen Cherney on November 20, 2017

What is titubation?

Titubation is a type of involuntary tremor that occurs in the head, neck, and trunk area. It’s most commonly associated with neurological disorders. Titubation is a type of essential tremor, which is a nervous system disorder that causes uncontrollable, rhythmic shaking.

Head tremors are linked to involuntary muscle contractions. The subsequent shaking may be constant, or it may happen in spurts throughout the day. Treating head tremors depends on their underlying causes.

What are the symptoms of titubation?

Tremors (uncontrollable shaking) are the main symptoms of titubation. Essential tremors generally affect your hands more than any other part of your body. However, unlike most forms of essential tremors, the shaking associated with titubation affects your head and neck.

The most notable symptoms are involuntary shaking that looks like a “yes” or a “no” movement. These tremors can occur at any time — you might be sitting still when they occur, or you could be standing up engaged in an activity.

Other symptoms of titubation include:

  • speaking difficulties
  • vocal tremors
  • difficulty eating or drinking
  • unsteady stance when walking

These symptoms may worsen if you:

  • have stress or anxiety
  • smoke
  • consume caffeine
  • live in areas that have hot weather
  • are hungry or fatigued

What causes titubation?

Titubation is most often seen in older adults. Although age has nothing to do with this condition, your risk for developing neurological conditions may increase with age. Titubation can occur in people of all ages — even in young children.

Neurological conditions can cause titubation. It’s often seen in people who have the following conditions:

  • brain injuries
  • advanced cases of multiple sclerosis
  • Parkinson’s disease, though people are more likely to experience tremors around the chin and mouth
  • Joubert syndrome, which is often diagnosed during infancy or early childhood and may also be associated with hypotonia (low muscle tone); children with Joubert syndrome tend to shake their heads in a horizontal rhythm

In some cases, titubation may have no underlying cause. These are known as sporadic tremors.

How is titubation diagnosed?

Titubation is diagnosed with a series of neurological tests. But first, your doctor will look at your medical history and perform a physical exam. Since neurological disorders and tremors can run in families, it’s important to tell your doctor if you have any relatives with these conditions.

If you experience head tremors during your appointment, your doctor will measure their range and frequency. They will also ask you how often you have these tremors, as well as the length of time that the shaking lasts on average.

Neurological testing can involve imaging exams, such as an ultrasound. Your doctor may also test your:

  • gait, or how you walk
  • muscle strength
  • posture
  • reflexes

Head tremors may be diagnosed before a neurological disorder, or vice versa. Speech abnormalities are also assessed.

How is titubation treated?

Titubation itself can’t be cured, but treating the underlying cause can help manage head tremors. Your doctor may recommend medications and therapies, or even surgery.

Medications for tremors may include:

  • anti-seizure medications
  • benzodiazepines (Valium, Ativan)
  • beta-blockers
  • botulinum toxin (Botox) injections

Your doctor may also refer you to a physical therapist. This type of specialist can help you control head tremors with muscle-control exercises. Over time, your coordination may also improve.

Cutting out stimulants, such as caffeine and herbal supplements, may reduce the frequency of head tremors.

In severe cases of titubation, your doctor may recommend a type of surgery called deep brain stimulation (DBS). With DBS, a surgeon implants high-frequency electrodes in the brain to help regulate tremors. According to the National Institute of Neurological Disorders and Stroke, DBS is safe for most people.

What is the outlook for titubation?

As with other types of tremors, titubation isn’t life-threatening. However, these types of tremors can make everyday tasks and activities challenging. Depending on the frequency of head tremors, titubation can be disabling for some people. The symptoms can also worsen with age.

Addressing the underlying causes of head tremors can help reduce their frequency while improving your ability to participate in daily activities. Talk to your doctor if you’re already undergoing treatment for a neurological disorder and if your head tremors have increased or have failed to improve.

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