What is tremor (shaking)?
Tremor is an involuntary, rhythmic shaking of one or more parts of the body. It occurs most often in the hands, and sometimes in the head, legs, trunk or even the vocal cords.
A certain degree of hand shaking is normal even in healthy people — this is called physiological tremor and is usually hard to see with the naked eye. If the tremor becomes strong enough to interfere with everyday tasks (writing, drinking tea, doing up buttons), its cause should be investigated.
What are the causes and types of tremor?
Factors that increase physiological tremor
- Tiredness and lack of sleep
- Too much caffeine
- Stress, excitement, anxiety
- Low blood sugar
- Alcohol withdrawal
- Certain medicines — hormonal medicines, some antidepressants, lithium preparations, asthma medicines, etc.
If you are taking any medicine and the tremor started after it, note the time between starting the medicine and the onset of the tremor and tell your doctor. However, do not stop a prescribed medicine without consulting your doctor.
Endocrine and other causes
An overactive thyroid gland (hyperthyroidism) can cause both nervousness and hand tremor — in this case an endocrine assessment is needed. Liver and kidney failure and certain toxic substances can also cause tremor.
Types of neurological tremor
- Essential tremor — the most common type of neurological tremor. The shaking mainly increases during movement and when holding a position (for example, with the arms stretched out in front), often affects both hands and may also involve the head and voice. It often runs in families.
- Parkinsonian tremor — seen mainly at rest, when the hand is resting on the knee; it decreases with movement and often starts on one side. Read more: Parkinson’s disease.
- Dystonic tremor — occurs in people with dystonia (involuntary muscle contractions).
- Cerebellar tremor — shaking that gets stronger as the hand approaches a target; it can be seen in stroke, multiple sclerosis or damage to the cerebellum.
When should I see a doctor or seek emergency help?
If the tremor interferes with your daily activities, is gradually getting worse, started on one side, or is accompanied by other signs such as walking difficulties or slowness of movement, make a routine appointment with a neurologist. Sometimes a tremor that seems ordinary can be a sign of a serious neurological condition.
If the tremor starts suddenly together with weakness on one side of the body, speech problems, facial drooping or a sudden loss of balance, call 103 immediately. Tremor accompanied by a high temperature, confusion or impaired consciousness also requires urgent assessment.
How is tremor diagnosed?
The diagnosis is based on a detailed neurological examination. The doctor assesses whether the tremor increases at rest, in a particular position or during movement, which parts of the body are affected, and its severity using simple tests such as writing and drawing a spiral. You will be asked about the medicines you take, your caffeine and alcohol use, and whether anyone in your family has a tremor. Where necessary, thyroid hormone, blood sugar and other tests are ordered, and in some cases an MRI scan or EMG.
How is tremor treated?
Treatment depends on the cause. If the tremor is related to medication, caffeine, stress or a hormonal disorder, the main approach is to remove that cause. If essential tremor interferes with daily life, the doctor may prescribe medicines that reduce the tremor; the choice of medicine and dose are determined individually. Botulinum toxin injections are used for some types of tremor. In severe cases not controlled by medication, surgical methods such as deep brain stimulation may be considered. Physiotherapy and occupational therapy help teach ways of making everyday tasks easier.
What helps in everyday life?
- Cut down on caffeine (coffee, strong tea, energy drinks).
- Get enough sleep and try to manage stress.
- Items such as a weighted wrist band, a heavy spoon and a heavy cup make everyday tasks easier for some people.
- Rest your elbow on the table when writing and eating.
- Do not use alcohol as a “medicine” to reduce the tremor.
Frequently asked questions
Is shaking of the hands always a sign of illness?
No. Everyone has a slight physiological tremor, and it can increase with tiredness, excitement and caffeine. A tremor that interferes with everyday tasks or is getting worse, however, needs to be assessed.
Does essential tremor turn into Parkinson’s?
Essential tremor is a separate condition. A medical examination is needed to tell the two conditions apart.
Can tremor be cured completely?
A tremor whose cause can be removed may go away. Although most neurological tremors cannot be cured completely, the symptoms can be reduced considerably with treatment.
Is hand tremor normal in young people?
A slight tremor with excitement, lack of sleep and too much coffee also occurs in young people and is usually harmless. However, if the tremor is constant, interferes with writing and everyday tasks, or is accompanied by other symptoms, a medical examination is needed. Essential tremor can also begin at a young age.
Which doctor should I see about a tremor?
First, a neurologist. If a thyroid problem or another physical cause is found during the assessment, the relevant specialist, for example an endocrinologist, joins the treatment. When you come for the appointment, bring a list of the medicines you take and, if possible, a short video of the tremor, and find out whether anyone in your family has similar symptoms.