Will Botulinum Toxin Injections (Botox) Help with Essential Head Tremor?

Head tremor that is socially embarrassing, or interferes with eating, drinking, or social communication, can be significantly reduced with botulinum toxin injections, even when oral medications fail.

Treatable Symptoms

• Head tremor can occur in one direction (head shaking “no-no”, head nodding “yes-yes”) or multiple directions.
• Head tremor is commonly more pronounced in anxious or stressful situations, such as giving presentations or interacting with others, resulting in embarrassment and difficulty effectively communicating.
• Severe head tremor can interfere with eating and drinking, and may be associated with a tremulous voice (vocal tremor).

Treatment Method

Botulinum toxin is injected specifically into the overactive muscles causing the foot cramps, eye twitching, or salivary glands for drooling. The effect comes on gradually over several days with the peak effect in approximately 2 weeks. The benefit lasts for about 3 months. As a result, injections are repeated about every 3 months in order to maintain ongoing benefit.

Prognosis When Untreated

Essential head tremor gradually worsens over time, and is usually also associated with a gradually worsening hand tremor, which can interfere with manual tasks such as writing, use of utensils and drinking from a cup. Furthermore, the tremor may affect the voice (vocal tremor), further impairing communication. Although oral medications may be effective for hand tremor, they usually have poor efficacy for head and vocal tremor.

Prognosis With Treatment

The vast majority of patients with head tremor are substantially improved with botulinum toxin injections of the neck. Selectively weakening the overactive muscles dampens the head tremor, significantly reducing embarrassment and allowing normal communication. Improvement in severe head tremor also improves the ability to eat and drink. Vocal tremor is often worsened by head tremor, and reduction in head tremor may also improve the voice. Botulinum toxin injections may result in difficulties swallowing or excessive neck weakness, but these adverse effects are usually mild and typically last only 2 or 3 weeks. The benefit of the injection is maximized, and risk is minimized, by customizing the injections for each patient in terms of the specific muscles and doses used.

By dampening head tremor, botulinum toxin injections reduce the embarrassment and disability associated with this movement disorder.