Tremors: what they are and how to get them under control

Not all shaking is the same. A tremor is an involuntary rhythmical shaking of a body part — most often hands, head, voice or legs. It can be annoying, embarrassing, or a sign of an underlying issue. This page helps you spot the kinds of tremors, what usually causes them, and practical steps you can take right away.

Common types and causes

Essential tremor is the most common. It often runs in families and usually shows up when you try to use your hands — for example, holding a cup or writing. Parkinson’s disease causes a distinct resting tremor (shaking while the limb is relaxed) plus slowness and stiffness. Other causes to know about: medication side effects (some antidepressants, mood stabilizers, bronchodilators, stimulants), overactive thyroid, too much caffeine, anxiety, and withdrawal from alcohol or sedatives. Acute illness, head injury, or certain metabolic problems can also trigger tremor.

Quick check: does the shaking start when you move or when your hand is at rest? Action tremor points toward essential tremor or medication effects. Resting tremor suggests Parkinsonism. That difference helps your doctor decide what tests to run.

Tests, treatments, and things you can try now

When should you see a doctor? If tremor starts suddenly, gets worse quickly, affects daily tasks, or comes with other symptoms like numbness, weakness, confusion, or changes in speech or balance, seek medical help. Your doctor will do a neurological exam, review your medicines, and often order blood tests (thyroid, electrolytes) or imaging (MRI) if needed. Sometimes an EMG helps if a nerve or muscle problem is suspected.

Treatment depends on the cause. If a medication is the trigger, changing dose or switching drugs often helps. For essential tremor, first-line medicines are propranolol (a beta-blocker) or primidone (an anti-seizure drug). Other options include gabapentin, topiramate, botulinum toxin injections for head/voice tremors, and deep brain stimulation for severe cases that don’t respond to drugs. Parkinson’s tremor is usually treated as part of Parkinson’s disease management, not by tremor drugs alone.

Practical tips you can use today: cut back on caffeine and stimulants, get enough sleep, and manage stress — anxiety makes tremors worse. Try weighted utensils or wrist weights for tasks like eating or writing. Occupational therapy can give simple tools and strategies to keep independence. Avoid sudden dose changes of prescribed meds without talking to your provider.

Want more? Check with your clinician about which tests make sense for your situation and ask for a medication review. If tremor affects work, hobbies, or mood, a specialist (neurologist or movement disorders clinic) can open up treatment options beyond pills.