Tremors: Types, Causes, Treatments, and More

Tremor is a movement disorder that causes involuntary movements, typically shaking, in various parts of your body. The shaking often happens in a rhythmic pattern as certain muscles contract. The most common place you’ll notice tremors are in the hands, but people can also experience them in their arms and legs, head, vocal cords, and torso. 

Some tremors are caused by other types of disorders, such as Parkinson’s disease, but some types don’t have any other existing cause. 

Why Tremors Happen

Generally, tremors happen when the part of the brain that controls movement somehow misfires, or sends the wrong signals to the body. This causes muscle groups to contract involuntarily. 

Tremors are a symptom of several types of disorders, especially neurological disorders (conditions affecting the brain and spinal cord). They can happen for other reasons, too, such as taking certain medications, drinking caffeinated beverages, or feeling intense anxiety or panic. 

Classification of Tremors

There are two main classifications of tremors based on when they happen: resting and action. Resting tremors occur when you are not moving your body and action tremors occur when you’re making voluntary movements. Action tremors can also be broken down into three more specific categories:

• Kinetic tremors, which occur during any kind of voluntary movement
• Postural tremors, which occur when you extend a limb out against the force of gravity
• Intention tremors, which occur during direct movement toward an object 
  

Whether you experience resting or action tremors usually depends on their cause. For example, people with Parkinson’s disease commonly have rest tremors, while people with essential tremor typically have action tremors.  

Types of Tremors

Differentiating between the types of tremors—recognizing how and when they happen, and how they appear—helps your healthcare provider determine whether tremors are a sign of a larger problem or not. It can also help them make the right diagnosis if the tremors seem to be a symptom of a medical condition. There are many types of tremors, but these are some of the most common.   

Physiologic Tremor

These are tremors that everyone has, including people without any other medical conditions. If you’ve ever stretched your hand out and tried to hold it still for more than a few seconds, you’ve probably experienced a physiologic tremor.

Most people don’t notice these tremors; they tend to be very subtle. They can become more exaggerated if you’re feeling especially anxious, stressed, or sleep-deprived, or if you’ve had a large cup of coffee or used an inhaler for asthma.

Essential Tremor

Essential tremor is a movement disorder that can affect your limbs, head, and vocal cords. Experts don't know for sure what causes it, though it’s thought to be inherited (passed down from parent to child) in about 50% of cases. It can happen as early as childhood or into middle age, and is typically mild.  

Essential tremors are usually the intention or postural type, so you may have trouble with your handwriting or speak with a shaky voice.

Parkinsonian Tremor

These tremors are a common symptom of Parkinson’s disease. They are seen most frequently in the hands and arms, but they can affect other body parts, too. 

Because resting tremors are most likely to occur in Parkinson’s disease, they can be a major clue to providers when making a diagnosis. People with Parkinson’s disease also frequently have postural tremors.

Dystonic Tremor

People with the neurological movement disorder dystonia have dystonic tremors. Dystonia causes muscle contractions that result in slow, repetitive or sustained movements and abnormal postures. Dystonic tremors may start out as action tremors, such as kinetic tremors occurring during voluntary movements, but can progress to resting tremors over time.

Psychogenic Tremor

Psychogenic tremor is the most common type of psychogenic movement disorder (PMD). These tremors have psychological causes rather than neurological ones. Psychogenic tremor is often caused by extreme stress, as well as anxiety, depression, and childhood trauma.

These types of tremors are also known as functional tremors because they don’t often follow any specific pattern or occur at predictable times. They may come and go, change sides, or worsen under stress.

Cerebellar Tremor

When the cerebellum (a portion of the brain at the back of the head) and its brain pathways are damaged, a person may have cerebellar tremor. This type of damage is usually caused by traumatic brain injury, stroke, tumor, or alcohol use disorder.

Cerebellar tremors are usually intention tremors, and are characterized by a slow, noticeable appearance.

Orthostatic Tremor

Orthostatic tremor is a rare disorder affecting the legs. When a person stands up, they experience a rapid shaking that makes them feel unsteady or unstable until they begin moving or sit back down again. Drops in blood pressure can also happen with orthostatic tremor. Experts don’t know what causes orthostatic tremors.

Treatment for Tremors

There’s no cure for tremors, but if they’re caused by another disorder, then treating that disorder can help reduce how often they occur. Several treatments exist to help you manage your symptoms if they are affecting your daily life.

Medications

Various medications are used to treat tremors in people without Parkinson’s disease. These include:

• Beta-blockers: This is a type of medication that lowers blood pressure and is usually used to treat heart and circulatory issues. Inderal (propranolol) is commonly used for the treatment of essential tremor.
• Anti-seizure medications (anticonvulsants): While these are, as the name implies, generally used to treat seizures, they can also be used for tremor if you don't respond well to beta blockers—especially Mysoline (primidone). Neurontin (gabapentin) and Topamax (topiramate) are sometimes prescribed.
• Benzodiazepines (sedatives): These drugs are best for tremor that is caused by anxiety and stress, and may also be used as a treatment option for people who don't respond to beta blockers or anti-seizure medications. Commonly used benzodiazepines for tremor include Ativan (lorazepam) or Klonopin (clonazepam). These medications are not recommended for people with substance use disorder.

These medications work well for essential tremors, for example. People with Parkinson’s disease are usually prescribed medications like levodopa, or drugs known as anticholinergics.

Surgery

There are a few surgical procedures that can be used when other treatments don’t work and symptoms are severe. The most common is deep brain stimulation, which involves sending electrical signals to the brain to stop tremors on a temporary basis. The other is radiofrequency ablation, which has a similar goal but involves sending an electric current to a misfiring nerve to stop it from causing tremors.

Botox Injections

Botox injections are often used for medical reasons as well as cosmetic ones; because botox freezes muscles and can also block nerve pain, injections may help muscle groups that are experiencing tremors. This treatment may be especially helpful for people with hand, head, and vocal cord tremors.

Focused Ultrasound

This is a non-invasive treatment similar to radiofrequency ablation, where areas of the thalamus (a part of the brain) are targeted with thermal energy generated by the ultrasound. It works quickly and is considered safer than traditional ablation, and is approved for use in treating essential tremors.

Physical and Occupational Therapy

Many people with tremors benefit from therapy programs designed to strengthen muscles and teach proper body mechanics or the use of adaptive devices. Physical therapy can be helpful for people with Parkinson’s disease, while occupational therapy can improve quality of life for people with essential tremor.

Lifestyle Changes

With certain types of tremors, all that’s needed for treatment is avoiding triggers that cause your tremors. For example, you can reduce or eliminate caffeine or other stimulants if you experience physiologic tremors, and can also work to lower your stress level and get appropriate amounts of sleep.

A Quick Review

Tremors are often caused by neurological or movement disorders like Parkinson’s disease, dystonia, and essential tremor. They are typically classified as resting or action tremors; Parkinson’s disease is the most common cause of resting tremors. 

Whatever type of tremor you have, if your symptoms are interfering with your daily life, consider talking with your healthcare provider. Knowing what is causing your tremors can help you reduce them, and most types of tremors can be managed with the right combination of treatments.