Tremor

Definition

A tremor is a type of shaking movement. A tremor is most often noticed in the hands and arms. It may affect any body part, including the head or vocal cords.

Alternative Names

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

Considerations

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 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.

Causes

Tremor may be caused by:

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

Home Care

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 drug, 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:

• Buying clothes with Velcro fasteners or using button hooks
• Cooking or eating with utensils that have a larger handle
• Using a sippy cup to drink
• Wearing slip-on shoes and using shoehorns

When to Contact a Medical Professional

Call 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

What to Expect at Your Office Visit

Your doctor will perform a physical exam, including a detailed brain and nervous system (neurologic) examination. You may be asked questions to help your doctor 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
• 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 will be prescribed.

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 the drug will usually help it go away. Never stop taking any medicine without first talking to your doctor.

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.

Images

References

Fasano A, Deuschl G. Therapeutic advances in tremor. Mov Disord. 2015;30:1557-1565. PMID: 26293405 pubmed.ncbi.nlm.nih.gov/26293405/.

Haq IU, Tate JA, Siddiqui MS, Okun MS. Clinical overview of movement disorders. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 84.

Jankovic J, Lang AE. Diagnosis and assessment of Parkinson disease and other movement disorders. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 23.