Tremor Types, Causes, and Treatments
This article explains the different types and causes of tremor. It also discusses tremor symptoms, when to contact a doctor, diagnostic tests for tremor, and treatment options, if necessary.
The term “tremor” most accurately refers to a small, rhythmic shaking movement that occurs in a back-and-forth pattern. These are involuntary movements, which means that you are not trying to make them happen.
Tremor symptoms include hand shaking, head shaking, and trembling while performing a task, such as gripping a fork or pencil. Tremor can also occur while you are at rest (not moving).
Tremors can occur at any age, but they most commonly affect middle-aged and older adults, according to the National Institute of Neurological Disorders and Stroke (NINDS). Tremor is a classic symptom of Parkinson’s disease, but most people with tremor have essential tremor. This type affects 7–10 million people in the United States.
Tremors can be classified as rest or action tremors.
Rest tremors are movements that occur while your body is at rest, such as shaking of the arms or hands while they are supported on your lap. The extent of the tremor may increase during times of mental stress.
Rest tremor symptoms are characteristic of Parkinson’s disease.
Action tremors are movements that occur when the affected body part is intentionally performing a voluntary action, such as extending your arm or signing your name.
The NINDS further classifies action tremors based on the specific movements or tasks that trigger the tremor. For example:
- Postural: Tremor occurs when you extend your arm or leg, for example.
- Isometric: Tremor occurs when you are holding something, such as a hand tremor as you hold up a book.
- Intention: Tremor occurs when you attempt to touch something, such as reaching for a fork and bringing it to your mouth.
- Kinetic: Tremor occurs when you are making purposeful movements, such as opening and closing your hand.
- Task specific: Tremor occurs when you are making purposeful movements, but only ones that require fine motor skills, such as writing with a pen in cursive.
Action tremor symptoms are characteristic of a variety of conditions, including essential tremor, drug withdrawal, strokes, brain tumors, and MS. Tremors are also a side effect of some medications.
According to the NINDS, there are more than 20 types of tremor. Examples include:
- Essential tremor: This commonly affects the hands and arms when you are at rest or performing purposeful movements. The exact cause of essential tremor is not known, but many cases involve a genetic component. This means that you can inherit essential tremor from your parents. Essential tremor is usually amplified by extreme emotion, stress, physical exhaustion, and low blood sugar.
- Dystonic tremor: This occurs in people with dystonia. This is a movement disorder wherein nerve impulses from the brain force muscle contractions, sometimes putting the body into an unusual posture, for instance.
- Parkinsonian tremor: This results from changes in the brain that lead to uncontrollable movements. It is a common symptom of Parkinson’s disease, but people without this condition can have it as well. People with Parkinson’s disease also experience rigidity of the arms, legs, and trunk. People with Parkinson’s disease also have problems with balance and coordination.
- Cerebellar tremor: This is due to brain damage from a stroke, a tumor, or a progressive condition such as MS. Alcohol use disorder can also cause cerebellar tremor. It affects the hands during particular actions, such as reaching out for something or touching the tip of your nose. “Intention tremor” is another term for it.
- Psychogenic tremor: This may affect all body parts. It often has a sudden onset, and it can spontaneously go into remission. These tremors increase during stress and decrease or disappear when you are distracted. Many people with this type of tremor have a psychiatric condition.
- Physiologic tremor: This occurs in all healthy people. This type of tremor is rarely visible to the naked eye. It usually involves fine shaking of both hands and fingers, and it results from physical properties of the body, such as your normal heartbeat.
- Enhanced physiologic tremor: This is more noticeable than normal physiologic tremor. It can be a reaction to drugs, alcohol withdrawal, or medical conditions such as an overactive thyroid or low blood sugar, rather than due to a neurological condition. It usually stops after treating the underlying cause.
Tremor can be due to a range of conditions and disorders, from lifestyle practices to brain injuries. The sections below look at some causes in more detail.
Common causes of tremor
Some common causes of tremor symptoms include:
Causes of tremor related to medical conditions
Medical conditions that can cause tremor symptoms include:
- low blood sugar
- an overactive thyroid
- alcohol use disorder and alcohol withdrawal
- nerve damage
- a psychological condition
- kidney failure
- liver failure
- mercury poisoning
- a movement disorder, such as dystonia
- Parkinson’s disease
- a brain injury
- a brain tumor
- a stroke
Medications that potentially cause tremor symptoms
Medications and drug withdrawals that can produce tremor symptoms include:
- antiseizure medications
- benzodiazepine withdrawal
According to the NINDS, tremor may occur with other symptoms, depending on the underlying cause. Symptoms include:
- frequent urination
- impaired balance and coordination
- numbness or tingling in any part of the body
- a quavering voice
- a shuffling walk
- signs of an overactive thyroid
- signs of MS
- a stooped posture
As soon as you notice persistent tremor symptoms, you should contact a doctor for an evaluation. Most tremors are not a cause for concern, but your doctor will still want to rule out potentially serious causes. This includes testing for thyroid anomalies, Parkinson’s disease, electrolyte abnormalities, and dystonia.
Your doctor will likely also check to ensure that none of your current medications are causing your tremor symptoms.
When to seek prompt medical care
If you have been under medical care for tremor, contact your doctor promptly when:
- Your tremor symptoms interfere with your day-to-day activities.
- You develop a new tremor.
- You experience side effects from your tremor medication.
When to seek immediate medical care
Call 911 or go to your nearest emergency department for tremor if it occurs after a head injury or is accompanied by any of the following symptoms of a problem involving the brain:
- muscle tightening or paralysis
- unusual tongue motions or slurred speech
- changes in vision or vision loss
- shortness of breath or difficulty breathing
- tremor on just one side of the body
- difficulty walking
- a loss of consciousness
A healthcare professional will perform a physical exam, ask you about your symptoms, and use a series of diagnostic tests to evaluate tremor and determine what might be causing it. These include the following.
Neurological function tests
Your doctor will:
- examine your muscle strength and tone
- evaluate how you walk
- check your reflexes
- evaluate your posture and coordination
- test your ability to feel certain sensations
Your doctor will also evaluate how you:
- write or draw
- drink water
- hold your arms in an outstretched position
Your doctor may order urine or blood tests to check for certain conditions, such as thyroid disease, the side effects of drugs, problems with your metabolism, and chemicals that may cause tremor.
Your doctor may order a head CT scan or an MRI scan to see if there is a cause of tremor in the brain.
Questions your doctor may ask
Questions your doctor may ask include:
- How long have you been experiencing tremors?
- In what parts of the body do you have tremors?
- Is there a history of tremors in your family?
- Do specific movements or activities improve or worsen your symptoms? If so, please explain.
- Have you had a fall or head injury in the past?
It is not always possible to diagnose an underlying cause of tremor. If the problem persists and your healthcare professional cannot determine a cause, seeking a second opinion may give you more information and answers.
If your tremor does not interfere with your day-to-day activities, you may not need treatment. However, if you have difficulty performing your daily activities, your doctor may try one or more treatments to relieve your symptoms.
According to the NINDS, there are many treatment options available that fall into three main categories: medications, lifestyle changes, and surgery.
Medications that may help reduce tremor include:
- Beta-blockers: These drugs can reduce tremor, but they may also cause lightheadedness, fatigue, or heart problems. Doctors do not recommend these drugs to people with certain heart problems or asthma.
- Antiseizure medications: If a beta-blocker is not effective, your doctor may try an antiseizure medication, such as primidone (Mysoline), gabapentin (Neurontin, Gralise), or topiramate (Eprontia, Topamax).
- Tranquilizers: If you have tension or anxiety that amplifies your tremors, your doctor may prescribe a benzodiazepine to alleviate that. Examples include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin). The drawback to these medications is that they can be habit-forming.
- Botox: In some cases, Botox injections can reduce tremor, particularly if you have head or voice tremor.
Strategies that may help reduce tremor include:
- eliminating caffeine and alcohol from your diet
- reducing stress
- trying deep breathing exercises, yoga, and other relaxation techniques
Occupational therapy can also be beneficial for people with tremor. An occupational therapist can teach you how to adapt to the everyday tasks that you need or want to perform. For example, occupational therapy may involve wearing wrist weights or using wide grip pens instead of regular pens. Improving muscle strength, control, and coordination may also help reduce tremor symptoms.
Surgery and other procedures
People with severe tremor may be candidates for procedures that target the thalamus. This is an area of the brain where tremors are thought to begin. Procedures include:
- Deep brain stimulation: A surgeon inserts a thin electrical probe into the thalamus. The probe connects to a device similar to a pacemaker. The device sends painless electrical pulses to the probe to block the brain signals that cause tremor.
- Thalamotomy: A surgeon uses a radio wave to heat and temporarily inactivate the nerves in the thalamus.
- Focused ultrasound thalamotomy: Your care team uses MRI to send sound waves to the brain to stop the tremor. This is a relatively new, noninvasive technique to control tremor, and it has approval for use in people with tremor that does not respond to antiseizure medications or beta-blockers.
Although tremor can be disruptive, it is not a life threatening condition. Your outlook depends on the cause and severity of the tremor. For example, if you have essential tremor or tremor that is not due to a permanent medical condition, you have a good outlook.
If your tremor gets worse, there are several treatment options that have varying effectiveness. It may take some trial and error to find the right blend of treatments to reduce your symptoms to a comfortable level.
If a medical condition is the likely cause of your tremor, treating it may reduce or eliminate the tremor. However, some conditions that cause tremor are progressive and worsen with time.
Your doctor is the best person to ask about your personal outlook.
Although tremor itself is not a health threat, a pronounced tremor can cause embarrassment and make it difficult to perform daily tasks, including activities at home and work. Some possible complications of tremor include:
- impaired balance and coordination
- social isolation or withdrawal
Tremor causes uncontrollable movements in a specific body area. It is a type of movement disorder. The most common form of tremor is essential tremor, which typically involves the hands. Essential tremor can run in families.
Although the cause of tremor can be difficult to pinpoint, it can be a symptom of many different neurological conditions, including MS and Parkinson’s disease. It can also be due to drug side effects and other temporary conditions.
For people with moderate to severe chronic tremor, making lifestyle changes and taking medications can help reduce the symptoms. Visit your doctor regularly to monitor for changes in tremor and to adapt treatments as necessary.