Tremor

Summary

What is a tremor?

A tremor is a rhythmic shaking movement in one or more parts of your body. It is involuntary, meaning that you cannot control it. This shaking happens because of muscle contractions.

A tremor is most often in your hands, but it could also affect your arms, head, vocal cords, trunk, and legs. It may come and go, or it may be constant. Tremor can happen on its own or be caused by another disorder.

What are the types of tremor?

There are several types of tremor, including:

• Essential tremor, sometimes called benign essential tremor. This is the most common type. It usually affects your hands, but it can also affect your head, voice, tongue, legs, and trunk.
• Parkinsonian tremor, which is a common symptom in people who have Parkinson’s disease. It is usually affects one or both hands when they are at rest, but it can affect the chin, lips, face, and legs.
• Dystonic tremor, which happens in people who have dystonia. Dystonia is a movement disorder in which you have involuntary muscle contractions. The contractions cause you to have twisting and repetitive movements. It can affect any muscle in the body.

What causes tremor?

Generally, tremor is caused by a problem in the deep parts of the brain that control movements. For most types, the cause is unknown. Some types are inherited and run in families. There can also be other causes, such as:

• Neurologic disorders, including multiple sclerosis, Parkinson’s disease, stroke, and traumatic brain injury
• Certain medicines, such as asthma medicines, amphetamines, caffeine, corticosteroids, and medicines used for certain psychiatric and neurological disorders
• Alcohol use disorder or alcohol withdrawal
• Mercury poisoning
• Hyperthyroidism (overactive thyroid)
• Liver or kidney failure
• Anxiety or panic

Who is at risk for tremor?

Anyone can get tremor, but it is most common in middle-aged and older adults. For certain types, having a family history raises your risk of getting it.

What are the symptoms of tremor?

Symptoms of tremor may include:

• Rhythmic shaking in the hands, arms, head, legs, or torso
• Shaky voice
• Difficulty writing or drawing
• Problems holding and controlling utensils, such as a spoon

How is tremor diagnosed?

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam, which includes checking
  • Whether the tremor happens when the muscles are at rest or in action
  • The location of the tremor
  • How often you have the tremor and how strong it is
• A neurological exam, including checking for
  • Problems with balance
  • Problems with speech
  • Increased muscle stiffness
• Blood or urine tests to look for the cause
• Imaging tests to help figure out if the cause is damage in your brain
• Tests which check your abilities to do daily tasks such as handwriting and holding a fork or cup
• An electromyogram, a test which measures involuntary muscle activity and how your muscles respond to nerve stimulation

What are the treatments for tremor?

There is no cure for most forms of tremor, but there are treatments to help manage symptoms. In some cases, the symptoms may be so mild that you do not need treatment.

Finding the right treatment depends on getting the right diagnosis of the cause. Tremor caused by another medical condition may get better or go away when you treat that condition. If your tremor is caused by a certain medicine, stopping that medicine usually makes the tremor go away.

Treatments for tremor where the cause is not found include:

• Medicines. There are different medicines for the specific types of tremor. Another option is Botox injections, which can treat several different types.
• Surgery may be used for severe cases that do not get better with medicines. The most common type is deep brain stimulation (DBS).
• Physical, speech-language, and occupational therapy, which may help to control tremor and deal with the daily challenges caused by the tremor

If you find that caffeine and other stimulants trigger your tremors, it may be helpful to cut them from your diet.

NIH: National Institute of Neurological Disorders and Stroke

National Institute of Neurological Disorders and Stroke

Children

• Children with Essential Tremor International Essential Tremor Foundation

Clinical Trials

• ClinicalTrials.gov: Essential Tremor National Institutes of Health
• ClinicalTrials.gov: Tremor National Institutes of Health

Start Here

• Essential Tremor American Academy of Family Physicians
• Essential Tremor National Institute of Neurological Disorders and Stroke
• Tremor National Institute of Neurological Disorders and Stroke

Patient Handouts

• Essential tremor Medical Encyclopedia
• Tremor Medical Encyclopedia
• Tremor – self-care Medical Encyclopedia

Living With

• Essential Tremor (ET): Coping Tips for Everyday Living International Essential Tremor Foundation

Treatments and Therapies

• Essential Tremor (ET): Surgical Options International Essential Tremor Foundation
• Treatment of Essential Tremor American Academy of Neurology

Videos and Tutorials

• Essential Tremor Is More Than a Tremor International Essential Tremor Foundation

Related Issues

• Essential Tremor vs. Parkinson’s Disease: How Do They Differ? International Essential Tremor Foundation

Genetics

• Essential tremor: MedlinePlus Genetics National Library of Medicine

Find an Expert

• National Institute of Neurological Disorders and Stroke National Institute of Neurological Disorders and Stroke

Journal Articles

• Tremor