Titubation is a type of involuntary tremor that occurs in the:

  • head
  • neck
  • 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.

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 anytime — 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

Titubation is most often seen in older adults. Your risk for developing neurological conditions may increase with age, but 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 or stroke
  • advanced cases of multiple sclerosis (MS)
  • 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
  • metabolic problems

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

Titubation is diagnosed with a series of neurological tests. But first, your healthcare provider 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 healthcare provider if you have any relatives with these conditions.

If you experience head tremors during your appointment, your healthcare provider 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 a neck ultrasound or brain imaging test. These tests can help rule out another condition that could be causing your tremors.

Your healthcare provider may also test your:

  • gait (how you walk)
  • muscle strength
  • posture
  • reflexes

Speech abnormalities are also assessed.

Titubation itself can’t be cured. However, treating the underlying cause can help manage head tremors. Your healthcare provider may also recommend medications and therapies, or even surgery, to treat symptoms associated with your condition.

Medications for tremors may include:

Sometimes, tremors aren’t easily managed with standard therapies.

Your healthcare provider may consider other medications to control your titubations, especially if you have other medical conditions as well.

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

Avoiding stimulants, such as caffeine and certain herbal supplements, may help to reduce how often you have head tremors.

In severe cases of titubation, your healthcare provider may recommend a type of surgery called deep brain stimulation (DBS).

With DBS, a surgeon implants high-frequency electrodes in your brain to help regulate tremors. According to the National Institute of Neurological Disorders and Stroke, DBS is safe for most people.

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 healthcare provider if you’re already undergoing treatment for a neurological disorder, and if your head tremors have increased or have failed to improve.