Oral antipsychotics are used to treat motor and behavioural disturbances in Huntington's disease (HD). However, patients with behavioural disturbances are often non-compliant, thus the oral route is inappropriate. The effects of antipsychotic long-acting injections (LAI) in HD are significantly underrepresented in literature. Paliperidone LAI (P-LAI), an atypical antipsychotic, has benefits over other antipsychotics LAI with its long dosing interval and no initial oral overlap, but has no documented cases for this indication. This case of a 45-year-old female highlights the use of P-LAI for severe aggression and chorea secondary to HD causing failed placement in assisted-care accommodation and mobility via an electronic-wheelchair. Three weeks after commencing treatment, she could walk unassisted, and displayed no aggression. After 10 months, she still had significant improvements and resided in the same accommodation for 6 months without any concern. Thus, this case suggests that P-LAI may be a treatment option for non-compliant HD patients.