When head tremor is the presenting feature, prioritize dystonic tremor in the differential before assuming essential tremor or PD, since idiopathic parkinsonian tremor almost never starts in the head. In Huntington disease, initiate psychiatric management alongside movement control from the outset, because depression, apathy, and behavioral symptoms are often more disabling than chorea, and genetic counseling for first-degree relatives is essential.

Low-dose clonazepam is our established first-line therapy; Parkinsonian tremor can present with a postural component or manifest as a re-emergent tremor during an action; If that is insufficient, primidone, valproic acid, and gabapentin serve as effective second-line choices; Immediately suspect a dystonic tremor, because idiopathic parkinsonian tremors almost never start directly in the head; High-frequency tremor that causes a striking sense of unsteadiness strictly while standing, which completely resolves the moment the individual sits down or starts walking