Isolated vertical head tremor: A diagnostic challenge

Essential tremor (ET) is the most common tremor disorder, typically affecting the upper limbs, while isolated head tremor is uncommon and diagnostically challenging. We report a 56-year-old woman with a more than 30-year history of isolated head tremor without limb or voice involvement. The tremor consisted of vertical ( yes yes ) oscillations, worsened with stress, and was also present at rest. Neurological examination showed no evidence of cervical dystonia. Notably, the patient demonstrated clinical improvement with propranolol. This case supports isolated head tremor as a rare manifestation within the ET spectrum, characterized by long-term stability and therapeutic responsiveness.