If you have a tremor (an involuntary, rhythmic shaking), you are not alone. Millions of people experience tremors, and it's common to worry that it means you have Parkinson's disease. However, the world of tremors is complex. Not all tremors are the same.

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What is a tremor?

A tremor is a movement that occurs when opposing muscle groups contract and relax alternately. It can affect your hands, head, voice, legs, or trunk.

Neurologists classify tremors based on when they occur.

1. Rest tremor - When muscles are relaxed (like hands resting on your lap). This usually disappears when you reach for something.
2. Action tremor - During any voluntary muscle activity. This happens when writing, eating, or holding a position.

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Main types of tremor

1. Essential tremor (ET)

This is the most common movement disorder. ET is often misunderstood, but it is far more common than Parkinson's disease.

It looks like a bilateral action tremor (shaking when you use or hold your hands/arms) that is noticeable during activities like writing or drinking. It can also affect the head or voice.

ET does not cause the slowness or stiffness associated with Parkinson's. Many patients notice it temporarily improves with a small amount of alcohol. It often runs in families.

2. Parkinson's disease (PD) tremor

Typically, this is a rest tremor (shaking while the limb is relaxed) that is slow and often described as "pill-rolling" (thumb and fingers rubbing). It usually starts on one side of the body.

The diagnosis of PD requires more than just tremor. It must also include slowness of movement (bradykinesia), muscle stiffness, and other non-motor symptoms, such as a reduced sense of smell or sleep issues.

3. Cerebellar tremor (Intention tremor)

It looks like a slow tremor that gets significantly worse as you approach a target (e.g., reaching for a glass, inserting a key). It results from cerebellar damage and is often accompanied by other coordination and balance issues (ataxia).

4. Dystonic tremor

This occurs in a body part that is held in an abnormal, sustained posture (dystonia). The shaking is often irregular or jerky. The tremor may temporarily stop in a specific position (null point) or if the patient lightly touches the affected area (sensory trick).

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Other causes of tremors

Many tremors are temporary or linked to other manageable factors:

• Medication side effects: Many common medications, including some for asthma, depression, and mood stabilization, can temporarily cause or worsen a tremor.
• Drug or alcohol withdrawal: Stopping substances abruptly can cause significant, temporary shaking.
• Lifestyle factors: High levels of stress, fatigue, anxiety, or too much caffeine frequently trigger or intensify shaking.
• Health conditions: An overactive thyroid (hyperthyroidism), mental health conditions, or low blood sugar can sometimes cause tremors.

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Treatment options for tremors

Tremor treatment isn’t one-size-fits-all. It really depends on what’s causing the shaking and how it shows up day to day.

For Essential Tremor (ET), first-line treatment usually involves oral medications such as propranolol or primidone. In more severe cases, procedures like focused ultrasound (FUS) may be considered.

For Parkinson’s disease (PD) tremor, treatment often centers on restoring dopamine levels using medications like levodopa or dopamine agonists. Some people may also benefit from Deep Brain Stimulation (DBS).

If a tremor is triggered by a medication, we consider adjusting or discontinuing the drug to see if symptoms improve. Regardless of the cause, the goal is always the same: reduce the tremor enough to make daily life easier.

For tremors that remain disabling despite medication, options like DBS or focused ultrasound can be life-changing. Choosing the right procedure depends on getting the diagnosis right.

If you or someone you care about is dealing with a tremor, don’t self-diagnose or assume you have to “just live with it.” Getting evaluated by a neurologist or movement disorder specialist is the safest first step.

Neura Health offers fast access to board-certified neurologists who can help you understand what type of tremor you’re experiencing and what treatment options make sense for you. Book a video visit today!

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