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A tremor is a type of involuntary shaking movement. Involuntary means you shake without trying to do so. A tremor is often most noticeable in your hands, but may affect any body part (even your head or voice).

There are three main types of tremors:

• Resting or static tremors occur when your hand or affected body part is at rest.
• Kinetic and intention tremors occur when you are moving your hand or affected body part when you are doing something like pressing a button or touching the tip of your nose with your finger. The tremor will usually disappear while the affected body part is at rest.
• Postural or action tremors occur when you are holding your hand or affected body part in a particular position for a period of time. This may happen when you are writing, holding a cup, or when you stand up straight.

Tremor - hand; Hand tremor; Tremor - arms; Kinetic tremor; Intention tremor; Postural tremor

Tremors can happen at any age but tend to be more common in older people. Everyone has some tremor when they move their hands. Stress, fatigue, anger, fear, caffeine, and cigarettes may temporarily make this type of tremor worse.

However, a tremor that does not go away over time may be a sign of an underlying medical problem and should be evaluated. You may learn that your tremor is perfectly normal, but eliminating medical reasons for the shaking is important.

Essential tremor is the most common tremor. It is rarely seen when the hands are not being used. It becomes most apparent when you are trying to do something, such as reaching for an object or writing. It is not caused by an underlying disease. This type of tremor may also run in families.

Tremor may be caused by:

• Too much coffee or other caffeinated drink
• Excessive alcohol consumption, alcoholism, or alcohol withdrawal
• Stress, anxiety, or fatigue can cause a postural tremor
• Normal aging
• A variety of drugs and prescription medicines
• Low blood sugar
• Parkinson's disease -- a classic cause of a resting tremor that is often accompanied by slowness of movement, muscle rigidity, and an abnormal gait
• Multiple sclerosis -- can cause an intention tremor
• Other brain, nerve, or movement disorders, including dystonia and certain inherited peripheral neuropathies (such as Charcot-Marie-Tooth disease)
• Overactive thyroid -- can cause a postural tremor
• Stroke
• Brain tumor

For tremors caused by stress, try relaxation techniques like meditation, deep relaxation, or breathing exercises. For tremors of any cause, avoid caffeine and get enough sleep.

For tremors caused by a medication, consult with your doctor about stopping the drug, reducing the dosage, or switching medications. Do NOT change or stop medications on your own.

For tremors caused by alcohol abuse, seek treatment and support to help you avoid alcohol.

Severe tremors may interfere with your ability to perform daily activities. Assistance with these activities may be necessary. Precautions should be taken to avoid injury during activities such as walking or eating.

Call your doctor if:

• Your tremor is worse at rest and gets better with movement, like when you reach for something.
• Your tremor is prolonged, severe, or interferes with your life.
• Your tremor occurs with other symptoms, such as headache, weakness, abnormal tongue motion, muscle tightening or contractions, or other movements that you cannot easily control.

Your doctor will perform a physical examination, including a detailed neurologic examination. The following medical history questions may help your doctor evaluate the cause of your tremors:

• Is your tremor regular or irregular?
• Does it occur with activity, at rest, or when you have been holding your hand (or other body part) in a particular position for a long time?
• Are the movements small (fine) or large (coarse)?
• Are both hands affected? To the same degree on both sides?
• Are other body parts affected, including your voice or head?
• Does the tremor impair your ability to use your hands or other body parts?
• Does emotional stress or excitement make it worse?
• Does drinking an alcoholic beverage make the tremor better or worse?
• Do you have any other symptoms?

• Blood tests such as CBC, blood differential, thyroid function tests, and glucose test
• Urine tests
• Head CT scan
• MRI of the head
• EMG or nerve conduction studies

Once a cause of the tremor has been determined, the appropriate treatment for the disease will be prescribed.

Treatment may not be necessary unless the tremor interferes with your daily activities or causes embarrassment.

Treatment depends on the cause. Tremor caused by a medical condition, such as hyperthyroidism, will likely get better when the condition is treated.

If the tremor is caused by a certain medicine, stopping the drug will usually help it go away. Never stop taking any medicine without first talking to your doctor. See: Drug-induced tremor

Medicines may help relieve symptoms. How well medicines work depends on the individual patient and the cause of the tremor.

See also:

• Essential tremor
• Parkinson's disease

Fahn S. Hypokinesia and hyperkinesia. In: Goetz CG. Textbook of Clinical Neurology. 3rd ed. St. Louis, Mo: WB Saunders; 2007:chap 34.