Tremors (Shaking): Types, Causes and Treatment (2023)

Anxiety, fear, feeling generally unwell and fever can all make you feel trembly - the expression 'shaking in his boots' is one we all recognise. Of course, feeling shaky without knowing what's causing it can make you feel anxious - which can lead to a vicious cycle of shakiness.

If you feel shaky as a one-off, it's likely that a temporary cause like fever, fear or stress is to blame. But if you have repeated or persistent episodes, there's a long list of possible causes. It's important to remember that essential tremor, or other causes not related to a serious underlying medical problem, are by far the most likely explanation for tremor if you feel otherwise well.

What is a tremor?

A tremor is a repetitive, rhythmical movement of a part of your body. Many of the muscles of your body come in pairs, which 'oppose' each other; in other words, contracting one muscle moves your body part in one direction, while contracting the opposing muscle moves it the opposite way. Tremor comes about when these opposing muscle groups contract in turn. It is involuntary. This means that it is generally not controllable and happens without you deciding to move that body part. It is often felt as a trembling or shaking sensation.

A slight tremor is present in all people. That is called physiological tremor. It may not be noticeable. Certain things can make a physiological tremor more noticeable, so you may only notice it now and then.

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Who has tremors?

Tremor symptoms severe enough to seek medical help are remarkably common - in fact, tremor is the most common movement disorder seen in specialist neurology clinics in hospital. Conditions like essential tremor often run in families. What affects your risk of getting tremor as a result of other conditions, such as those below, depends very much on what that condition is.

Tremor causes

Tremor is a symptom, rather than a medical condition on its own. Sometimes there is no obvious cause; sometimes it's a magnification of your normal physiological tremor, brought on by a temporary stimulant such as caffeine or medication.

Among the most common and important causes of tremor are the following:

Essential tremor

The most common cause of significant, persistent tremor is essential tremor. The medical term for it used to be 'benign essential tremor', on the basis that it wouldn't do you any harm, wouldn't lead to any other condition and didn't affect your life expectancy. But for many patients, uncontrollable shaking is anything but harmless. It can make the simplest daily activities a challenge, and has a huge effect on their self-esteem.


Anxiety, like excitement, stimulates release of a hormone called adrenaline (epinephrine), the so-called 'fight or flight' hormone. This has profound effects on many parts of your body, mostly aimed at increasing your alertness, muscle strength and ability to run away from danger or turn to face it. Adrenaline stimulates your nerve endings, raising your awareness, and increases the blood flow to the muscles in your arms and legs. Both of these factors make you more likely to tremble. As well as the obvious feeling of being anxious, anxiety-related tremor is often accompanied by rapid heartbeat (palpitations), shortness of breath, dry mouth and sometimes chest pain.

Low blood sugar

Episodes of low blood sugar, also known as hypoglycaemia, or 'hypos', are most common if you have diabetes treated with insulin, or type 2 diabetes treatment with sulfonylurea (SU) tablets. SU tablets stimulate your pancreas to produce more insulin, which can drop your blood sugar too low. Other symptoms include sweating, feeling very hungry, irritability, poor concentration, feeling sick, blurred vision and palpitations.


Like adrenaline, caffeine is a stimulant, which raises your level of alertness and stimulates your nerves. While it can be useful for keeping you alert, large quantities of caffeine in a short period can lead to tremor and palpitations.


Culprits include too much salbutamol (used to relieve asthma symptoms); lithium carbonate (usually used in bipolar disorder); some epilepsy medicines; and some cancer treatments. Some antidepressants can also make you feel trembly, especially when you first start them.

Recreational drugs

A variety of recreational drugs including MDMA and amfetamines can lead to tremor and other movement disorders, which may persist after you stop using them.

Alcohol withdrawal

if you're dependent on alcohol, withdrawal can lead to severe symptoms including shaking, anxiety, confusion, sweating, palpitations and even seizures. This tremor can persist, even weeks after you stop drinking. Alcohol can also damage your brain, including your cerebellum, which is responsible for your balance and for co-ordinating your movements. Some people who are dependent on alcohol go through frequent 'mini-withdrawal' within hours of their last drink, so they frequently have tremor.

Parkinson's disease

Tremor is one of the three 'key features' of Parkinson's disease, although it doesn't always happen. When it does, it tends to affect your hands and arms and it tends to be worse when you're not moving. The other main symptoms of Parkinson's disease - slowness of movement and stiffness - may start at about the same time as the tremor, but may be put down to getting older or to general unfitness. Therefore tremor is often the first symptom people bring to a doctor's attention and this often leads to a diagnosis.

Overactive thyroid gland

Along with feeling shaky, an overactive thyroid gland can often lead to weight loss despite eating more, anxiety, palpitations, sweating, intolerance to heat, diarrhoea and shortness of breath. You may start off with just one or two symptoms, with more developing over a few weeks.

Multiple sclerosis (MS)

Tremor can be a symptom of MS, but it's highly unlikely to be the only symptom you get, and other causes are much more likely. In fact, tremor is usually a relatively late symptom, and the average time from diagnosis of MS to developing tremor is 11 years.

Vitamins and minerals

Vitamin deficiency, particularly of vitamin B1, can lead to tremor. So can Wilson's disease, an inherited condition in which too much copper builds up in your body. Rare causes like poisoning with arsenic or heavy metals can cause a variety of symptoms including tremor.

How is tremor diagnosed?

Because tremor is a symptom rather than a medical condition, your doctor will concentrate on finding out what is causing your tremor. This is key, because the treatment for tremor depends on what is causing it. They can often narrow down the cause of your tremor by asking key questions. These include:

  • Does your tremor happen when you're not moving? This sort of 'rest tremor' is most often associated with conditions affecting your nervous system, such as Parkinson's disease or MS. In Parkinson's disease, the tremor often gets better when you're moving your limb.
  • Do you get tremor when you try to hold part of your body (usually your arm) out against gravity? This kind of tremor, which can also be brought on by movement, can be due to physiological tremor (which may be exaggerated if your thyroid gland is overactive or you're anxious or have drunk a lot of caffeine); by some medications; by certain diseases of the nervous system; and by long-term alcohol misuse.
  • Does your tremor get worse when you try to point at something specific - the closer you get, the wider your aim is from your goal? This is called intention tremor, and may suggest a problem with part of your brain called your cerebellum.
  • Which part or parts of your body are affected by tremor? For instance, essential tremor often starts in one hand or arm, as does the tremor of Parkinson's disease.
  • Is it there all the time (ie permanently or whenever you carry out a movement that brings it on) or are you sometimes able to sit still, or move around, without any tremor? If it is intermittent, what brings it on (for example, caffeine, when you're feeling stressed)?
  • Do you have any other symptoms along with your tremor? In about 7 in 10 people diagnosed with Parkinson's disease, tremor is the first symptom they tell their doctor about.

Tremor treatment

The treatment your doctor suggests will depend very largely on the cause. For instance, if your thyroid gland is overactive, correcting the levels of this hormone in your body should stop your tremor. If you are anxious, your doctor may recommend talking therapy like cognitive behavioural therapy (CBT). If it's related to medication, changing or reducing the dose of your medication may help, although you should only do this with advice from your doctor. There are lots of alternative medications for treating type 2 diabetes apart from sulfonylureas, which can cause hypos - your doctor can discuss this with you.

Whatever the cause of your tremor, too much caffeine may make it worse. It's therefore worth thinking about cutting down on your caffeine intake (from tea, coffee, cola drinks and chocolate) or cutting it out altogether. And while alcohol can sometimes improve tremor in the short term, too much alcohol can lead to severe, disabling tremor, as well as other life-threatening complications. As a consequence, doctors never recommend that you 'self-medicate' with alcohol.

The possible treatments of essential tremor, the most common cause of tremor, are outlined in detail in the separate leaflet called Essential Tremor. Sometimes these treatments are used if you have another kind of tremor, especially if it is having a major impact on your life.


Tremors (Shaking): Types, Causes and Treatment? ›

Sometimes, body tremors are due to an underlying neurological condition, such as stroke, Parkinson's Disease, or multiple sclerosis. However, they may also be a side effect of medications, anxiety, fatigue, or stimulant use. A doctor will work to determine the cause and provide appropriate treatments.

What are the 5 types of tremors? ›

Common types include resting tremor, postural tremor, kinetic tremor, task-specific tremor, and intention tremor.

What can cause shakes and tremors? ›

Some known causes include:
  • Medicines. ...
  • Alcohol abuse or withdrawal. ...
  • Diseases or disorders, such as stroke, multiple sclerosis, traumatic brain injury, or Parkinson's disease.
  • Mercury poisoning from food or the environment. ...
  • Too much caffeine.
Mar 13, 2023

What is the most common cause of tremors? ›

A tremor is a type of involuntary movement of the body, distinct from a muscle spasm or twitch. Causes can include lifestyle factors (like having too much caffeine) and medical conditions such as stroke or Parkinson's disease.

What neurological disorder causes tremors? ›

Some neurological disorders can produce tremor, such as: multiple sclerosis, stroke, traumatic brain injury and neurodegenerative diseases that damage or destroy parts of the brainstem or the cerebellum.

What neurological disorders have tremors? ›

Essential tremor (ET) is a neurological disorder that causes your hands, head, trunk, voice or legs to shake rhythmically. It is often confused with Parkinson's disease. Essential tremor is the most common trembling disorder.

How do you get rid of body tremors? ›

To reduce or relieve tremors:
  1. Avoid caffeine. Caffeine and other stimulants can increase tremors.
  2. Use alcohol sparingly, if at all. Some people notice that their tremors improve slightly after they drink alcohol, but drinking isn't a good solution. ...
  3. Learn to relax. ...
  4. Make lifestyle changes.
Mar 29, 2023

What is difference between tremor and shaking? ›

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, tongue, or vocal cords. Muscular atrophy is the decrease in size and wasting of muscle tissue.

What is the best medicine for tremors? ›

Propranolol and primidone are the drugs used most often. Propranolol is the only drug approved for essential tremor by the US Food and Drug Administration. Evidence shows propranolol and primidone are effective treatments.

What deficiency causes tremors? ›

However, tremors and other movement disorders are associated with vitamin deficiency, most vitamins B1, B6 and especially B12. B12 is very important for keeping your nervous system in good working order. Severe lack of Vitamin B12 is rare, but shakiness and tremors can occur even in mild deficiency.

When should I worry about tremors? ›

See a GP if: You have a tremor or shaking hands and: it's getting worse over time. it's affecting your daily activities.

What medications cause tremors? ›

The most common drugs associated with tremor include amiodarone, selective serotonin (and norepinephrine) reuptake inhibitors (SSRIs/SNRIs), amitriptyline, lithium, valproate, β-adrenoceptor agonists, dopamine receptor antagonists, VMAT2 inhibitors, or drugs of abuse: ethanol, cocaine, etc.

How do I know if I have tremors or Parkinson's? ›

Essential tremor may affect the voice box, but Parkinson's does not. Essential tremors are usually felt more when in motion, but Parkinson's tremors are felt more when at rest. Essential tremor symptoms can progressively get worse, but won't necessarily shorten the patient's life span.

What tremors are not Parkinson's? ›

Other causes for tremors include hyperthyroidism, pheochromocytoma, Wilson's disease (a rare condition in which copper accumulates in the brain and liver) and other disorders. An evaluation by a neurologist familiar with movement disorders will help distinguish essential tremor from Parkinson disease.

What is the difference between tremors and Parkinson's? ›

Tremor is an unintentional, rhythmic muscle contraction that leads to shaking in one or more parts of the body. Parkinson's disease is a neurological disorder that causes tremors, stiffness in limbs and loss of coordination.

Should I see a neurologist for tremors? ›

If you are having symptoms of Essential Tremor, you should seek the care of a neurologist. During the evaluation, your doctor will ask you questions about your health, your family medical history, medicines you may be taking, and any surgeries you have had.

What autoimmune disease causes tremors? ›

Tremor can be a sign of a neuropathy, a disorder of the peripheral nerves, or the nerves that bring messages from the brain and spinal cord to rest of the body. In particular, neuropathies caused by autoimmune syndromes such as chronic inflammatory demyelinating polyneuropathy (CIDP) can have tremor as a component.

What makes tremors worse? ›

The tremors may: Occur during movement (action-related tremor) and may be less noticeable with rest. Come and go, but often get worse with age. Worsen with stress, caffeine, lack of sleep, and certain medicines.

What type of neurologist treats tremors? ›

Neurologists, particularly movement disorders specialized, are essential to the diagnosis and early management of essential tremor. They are best equipped to confirm the diagnosis following extensive clinical evaluation, and they are familiar with all of the latest medical treatment options to help relieve symptoms.

What do neurogenic tremors feel like? ›

Neurogenic Tremors and Trauma

That is the flight-fight response kicking in and we literally shake with fear. This shaking is known as neurogenic tremors. These tremors help to reduce over-activity in the hypothalamus-pituitary-adrenal axis.

Are tremors a symptom of neuropathy? ›

Tremors may occur in the setting of peripheral neuropathy; however, the pathophysiology of neuropathy-related tremors remains poorly understood. A compensatory mechanism in the central nervous system, in response to peripheral neuropathy, has been postulated as a mechanism for such tremor generation.

Can anything stop tremors? ›

There's no cure for essential tremor, but there are ways to treat it. The main treatment options are medications, assistive devices, botulinum toxin, deep brain stimulation and focused ultrasound.

What to avoid for tremors? ›

Avoid drinks or foods with caffeine if they make your tremors worse. These include tea, cola, coffee, and chocolate. Wear a heavy bracelet or watch. This adds a little weight to your hand.

What is the new treatment for essential tremors? ›

Focused ultrasound is a rapidly evolving, noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with essential tremor.

What are the two types of shaking? ›

The dry shake is shaking the drink without ice, and the wet shake is with ice added.

Does shaking mean you have Parkinson's? ›

Tremor (shaking) is one of the main symptoms of Parkinson's, alongside slowness of movement and rigidity (stiffness). Not everyone will experience all of these symptoms. Having a tremor doesn't necessarily mean you have Parkinson's. It can also be a symptom of other conditions.

How I cured my essential tremor naturally? ›

Top Essential Tremor Natural Remedies
  • Skull Cap Herb. ...
  • Passionflower. ...
  • Omega Fatty Acids. ...
  • Mucuna Pruriens (also known as velvet bean or cowhage) ...
  • Magnesium. ...
  • Avoid aspartame in food and drinks. ...
  • Practice yoga, meditation, and other relaxation techniques. ...
  • Use adaptive devices made to alleviate ET symptoms.
Jan 21, 2022

What vitamin helps with tremors? ›

Intramuscular administration of thiamine appears to be highly effective for the treatment of essential tremor. Metformin can cause thiamine deficiency. The use of thiamine is also safe for prolonged treatments over time. The improvement of the symptoms, while continuing the treatment, persists over time.

Does Benadryl help tremors? ›

Some of the antihistamines are also used to prevent motion sickness, nausea, vomiting, and dizziness. In patients with Parkinson's disease, diphenhydramine may be used to decrease stiffness and tremors. Also, the syrup form of diphenhydramine is used to relieve the cough due to colds or hay fever.

Does magnesium help tremors? ›

Based on its use in many conditions, magnesium sulfate may have therapeutic potential for patients with tremors.

Can low vitamin D cause shaking? ›

Q. Can low vitamin D cause neurological symptoms? Yes, low levels of vitamin D can cause certain neurological symptoms such as tremors and depression.

What are the seven signs of vitamin B12 deficiency? ›

Here are seven warning signs associated with vitamin B-12 deficiency.
  • Dizziness. Frequent bouts about dizziness and vertigo can indicate B12 deficiency. ...
  • Forgetfulness. ...
  • Muscle Weakness. ...
  • Pale Complexion. ...
  • Pins and Needles. ...
  • Unexplained Fatigue. ...
  • Vision Issues.

Are tremors a symptom of anxiety? ›

When you're feeling anxious, your muscles may become tenser, since anxiety primes your body to react to an environmental “danger.” Your muscles may also twitch, shake, or tremble. Tremors that are caused by anxiety are known as psychogenic tremors.

Do tremors get worse with age? ›

Certain medicines, caffeine, or stress can make your tremors worse. Tremor may improve with ingestion of a small amount of alcohol (such as wine). Tremors get worse as you age. Tremors don't affect both sides of your body in the same way.

Are tremors a normal part of aging? ›

Not all older adults experience shaking as they age — but if movement disorders run in your family, there's a higher chance you will develop trembling as well. Age-related tremor is still being studied, but according to the National Center for Biotechnology Information, it is likely a sign of neurodegeneration.

Can heart problems cause tremors? ›

Feeling weak or shaky is a common acute symptom of a heart attack in a female. This weakness or shaking may be accompanied by: anxiety. dizziness.

What is the finger test for Parkinson's? ›

The finger tapping test evaluates bradykinesia, focusing on decrement in rate, amplitude, or both with repetitive action. Vertical positioning of the hands during this task may also be clinically relevant.

What are usually the first signs of Parkinson's? ›

Tremors, muscle stiffness and slowness of movement are all common early symptoms of Parkinson's – but there are also other signs to be aware of. Sleep and night-time problems are common in Parkinson's. People with Parkinson's are more likely to experience insomnia due to certain symptoms which can disrupt sleep.

What are the five 5 signs of Parkinson disease? ›

  • Tremor. Rhythmic shaking, called tremor, usually begins in a limb, often your hand or fingers. ...
  • Slowed movement, known as bradykinesia. ...
  • Rigid muscles. ...
  • Impaired posture and balance. ...
  • Loss of automatic movements. ...
  • Speech changes. ...
  • Writing changes.
May 26, 2023

How do you test yourself for Parkinson's disease? ›

At present, there is no self-test you can use to find out whether you have Parkinson's disease. Discussing your medical history and symptoms with a healthcare professional can help you in getting a clear diagnosis. They can rule out any other possible explanations for the symptoms you're having.

What body parts shake with Parkinson's? ›

Characteristically occurring at rest, the classic slow, rhythmic tremor of Parkinson's disease typically starts in one hand, foot, or leg and can eventually affect both sides of the body. The resting tremor of Parkinson's disease can also occur in the jaw, chin, mouth, or tongue.

Where do Parkinson's tremors start? ›

Parkinson's disease tremors often start in the fingers or hands with what's called a pill-rolling motion. Imagine holding a pill between your thumb and index finger and rolling it back and forth. 2. Foot.

What can mimic Parkinson's disease? ›

Several conditions can mimic Parkinson's disease, including:
  • Dementia with Lewy bodies. ...
  • Essential tremor (ET). ...
  • Viral parkinsonism. ...
  • Normal pressure hydrocephalus (NPH). ...
  • Multiple system atrophy (MSA). ...
  • Progressive supranuclear palsy (PSP). ...
  • Arteriosclerotic parkinsonism. ...
  • Corticobasal syndrome (CBS).
Dec 5, 2022

What do early Parkinson's tremors feel like? ›

A Parkinsonian tremor is an involuntary rhythmic shaking or slight movement in the body. It is often the first symptom people notice. The tremor tends to occur in the hands, though it may affect the chin, lips, face, or legs.

When should you go to the ER for tremors? ›

Your tremor is severe and it interferes with your life. Your tremor occurs with other symptoms, such as headache, weakness, abnormal tongue motion, muscle tightening, or other movements that you cannot control. You are having side effects from your medicine.

What are early signs of tremors? ›

10 Early Signs
  • Bradykinesia (Slowness of Movement)
  • Dizziness or Fainting.
  • Drooling.
  • Dyskinesia.
  • Dystonia.
  • Facial Masking.
  • Postural Instability (Trouble with Balance & Falls)
  • Rigidity.

What is the first line treatment for tremors? ›

Beta-adrenergic blockers (principally propranolol) and primidone are the first-line treatments for essential tremor.

What do MS tremors look like? ›

Tremors from MS may look like shaking, trembling, jerking, or twitching. An intention tremor will cause unwanted movement in the affected limb when a person is using it, such as reaching for a cup. A postural tremor will cause unwanted movement when a person is maintaining a certain posture, such as when sitting.

What is the root cause of essential tremors? ›

The exact cause of essential tremor is unknown. Studies show essential tremor is accompanied by a mild degeneration of the cerebellum, which is the part of your brain that controls movement. In some people, certain medications can cause tremor.

What is the difference between tremors and shakes? ›

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, tongue, or vocal cords.

Where do Parkinson's tremors usually start? ›

Parkinson's tremors usually start on one side of the body, commonly in the hands, and progress to the other side. The movements tend to be more forceful (high amplitude) with lower frequency. The disease carries many other symptoms that help distinguish it from essential tremor, as well.

What is usually the first symptom of Parkinson disease? ›

Tremors, muscle stiffness and slowness of movement are all common early symptoms of Parkinson's – but there are also other signs to be aware of. Sleep and night-time problems are common in Parkinson's.

How can I test myself for Parkinson's? ›

At present, there is no self-test you can use to find out whether you have Parkinson's disease. Discussing your medical history and symptoms with a healthcare professional can help you in getting a clear diagnosis. They can rule out any other possible explanations for the symptoms you're having.

What does stage 1 Parkinson's look like? ›

Stage One. During this initial stage, the person has mild symptoms that generally do not interfere with daily activities. Tremor and other movement symptoms occur on one side of the body only. Changes in posture, walking and facial expressions occur.


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