Previous studies in human and chimpanzee infants have identified a predictive relationship between early rightward head orientation and later right hand use. Data from lemurs suggest a leftward bias in hand preference, but there are no data on head positioning. The purpose of this study was to examine the relationship between head and hand preferences in the black and white ruffed lemur (Varecia variegata variegata). Ruffed lemurs rotate the head vertically during chewing in a behavior called head-tilting. Frequency of head-tilting and bouts of unimanual hand use were measured during normal feeding in a semi-free-ranging population of lemurs. Subjects were provisioned at feeding platforms twice daily with fresh fruits, vegetables, and other food items. Sampling was spontaneous and all observations were videotaped. No group-level bias was found for head-tilting, but a left hand bias emerged for hand use. A positive relationship was found between direction of head-tilting preference and direction of hand use preference such that left head-tilts increased as left hand use increased. Furthermore, left head-tilts increased as the degree of hand preference lateralization increased. When the hand used to bring food to the mouth just before head-tilting was examined, there was a strong bias for the left hand to precede left head-tilts. For right head-tilts, however, lemurs were equally likely to use either hand before head-tilting. Overall a strong relationship was found between the left hand and left head-tilting in black and white ruffed lemurs, suggesting a common link between these behaviors. However, the direction of bias was different from that seen in human and chimpanzee studies. Additional studies on patterns of laterality would be informative for understanding how laterality has changed across the primate order and the adaptive significance of laterality in primates.