Tremor

Tremors can happen at any age. They are more common in older people. Everyone has some tremor when they move their hands. Stress, fatigue, anger, fear, caffeine, and smoking may make this type of tremor worse.

A tremor that does not go away over time may be a sign of a medical problem and should be checked by your health care provider.

Essential tremor is the most common type of tremor. The shaking most often involves small, rapid movements. It usually occurs when you are trying to do something, such as reaching for an object or writing. This type of tremor may also run in families.

A tremor may be caused by:

• Certain medicines
• Brain, nerve, or movement disorders (such as Parkinson disease), including uncontrolled muscle movements (dystonia)
• Brain tumor
• Alcohol use or alcohol withdrawal
• Multiple sclerosis
• Muscle tiredness or weakness
• Normal aging
• Overactive thyroid
• Stress, anxiety, or fatigue
• Stroke
• Too much coffee or other caffeinated drink or food

Your provider will likely suggest self-care measures to help with daily life.

For tremors caused by stress, try ways to relax, such as meditation or breathing exercises. For tremors of any cause, avoid caffeine and get enough sleep.

For tremors caused by a medicine, talk to your provider about stopping the medicine, reducing the dosage, or switching to another medicine. Do not change or stop medicines on your own.

For tremors caused by alcohol use, seek treatment to help you stop drinking alcohol.

Severe tremors may make it hard to do daily activities. You may need help with these activities.

Devices that may help include:

Contact your provider if your tremor:

• Is worse at rest and gets better with movement such as when you reach for something
• Is prolonged, severe, or interferes with your life
• Occurs with other symptoms, such as headache, weakness, abnormal tongue movements, muscle tightening, or other movements that you cannot control

Your provider will perform a physical exam, including a detailed brain and nervous system (neurologic) exam. You may be asked questions to help your provider find the cause of your tremors:

The following tests may be ordered:

• Blood tests such as CBC, blood differential, thyroid function tests, and glucose test
• Electromyography (EMG) or nerve conduction studies to check the functions of the muscles and nerves
• Head CT scan
• MRI of the head
• Urine tests

Once a cause of the tremor has been determined, treatment may be recommended.

You may not need treatment unless the tremor interferes with your daily activities or causes embarrassment.

Treatment depends on the cause. Tremor caused by a medical condition, such as hyperthyroidism, will likely get better when the condition is treated.

If the tremor is caused by a certain medicine, stopping or changing the medicine will usually help it go away. Never stop taking any medicine without first talking to your provider.

You may be prescribed medicines to help relieve symptoms. How well medicines work depends on your overall health and the cause of the tremor.

In some cases, surgery is done to relieve the tremors.

Shaking; Tremor - hand; Hand tremor; Tremor - arms; Kinetic tremor; Intention tremor; Postural tremor; Essential tremor

Haq IU, Liebenow B, Okun MS. Clinical overview of movement disorders. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 105.

Jankovic J, Lang AE. Diagnosis and assessment of Parkinson disease and other movement disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 24.

Okun MS, Ostrem JL. Other movement disorders. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 379.

Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.