If a tremor is affecting your head or voice, you may be offered injections to block the nerves and relax the muscles. In rare cases, brain surgery may be an option to treat a severe tremor that is not helped by medicine. The NTF also offers support and information on tremor if it's affecting your life. Page last reviewed: 30 November Next review due: 30 November Tremor or shaking hands.
When a tremor is normal It's normal to have a slight tremor. Sometimes a tremor becomes more noticeable. This often happens: as you get older when you're stressed, tired, anxious or angry after drinking caffeine for example, in tea, coffee or cola or smoking if you're very hot or cold Some medicines and conditions can also cause a tremor. Stress, fatigue, anger, fear, caffeine and cigarette smoking may temporarily worsen normal tremor to the point that it becomes visible to the naked eye.
Chronic essential tremor can occur at any age but is most common in people older than It is a relatively benign condition, affecting movement or voice quality, but with no other effects. It involves a rhythmic, moderately rapid tremor of voluntary muscles. Over time, essential tremor may involve hands, arms, head, voice box, eyelids, or other muscles. An essential tremor rarely affects the legs or feet.
It is generally not caused by a neurological disease but by reaction to certain drugs, alcohol withdrawal, or medical conditions including an overactive thyroid and hypoglycemia. It is usually reversible once the cause is corrected. Generally, symptoms include shaking in one or both hands at rest.
It may also affect the chin, lips, face, and legs. The tremor may initially appear in only one limb or on just one side of the body. As the disease progresses, it may spread to both sides of the body. The tremor is often made worse by stress or strong emotions. Orthostatic tremor is a rare disorder characterized by rapid muscle contractions in the legs that occur when standing. People typically experience feelings of unsteadiness or imbalance, causing them to immediately attempt to sit or walk.
Because the tremor has such a high frequency very fast shaking it may not visible to the naked eye but can be felt by touching the thighs or calves or can be detected by a doctor examining the muscles with a stethoscope. In some cases the tremor can become more severe over time.
The cause of orthostatic tremor is unknown. During the physical evaluation, a doctor will assess the tremor based on:. The doctor will also check other neurological findings such as impaired balance, speech abnormalities, or increased muscle stiffness.
Blood or urine tests can rule out metabolic causes such as thyroid malfunction and certain medications that can cause tremor. These tests may also help to identify contributing causes such as drug interactions, chronic alcoholism, or other conditions or diseases. Diagnostic imaging may help determine if the tremor is the result of damage in the brain. Additional tests may be administered to determine functional limitations such as difficulty with handwriting or the ability to hold a fork or cup.
Individuals may be asked to perform a series of tasks or exercises such as placing a finger on the tip of their nose or drawing a spiral. The doctor may order an electromyogram to diagnose muscle or nerve problems.
This test measures involuntary muscle activity and muscle response to nerve stimulation. Although there is no cure for most forms of tremor, treatment options are available to help manage symptoms. Finding an appropriate treatment depends on an accurate diagnosis of the cause.
Tremor caused by underlying health problems can sometimes be improved or eliminated entirely with treatment. For example, tremor due to thyroid hyperactivity will improve or even resolve return to the normal state with treatment of thyroid malfunction. Also, if tremor is caused by medication, discontinuing the tremor-causing drug may reduce or eliminate this tremor. If there is no underlying cause for tremor that can be modified, available treatment options include:.
The treatment is approved only for those individuals with essential tremor who do not respond well to anticonvulsant or beta-blocking drugs. When people do not respond to drug therapies or have a severe tremor that significantly impacts their daily life, a doctor may recommend surgical interventions such as deep brain stimulation DBS or very rarely, thalamotomy. While DBS is usually well tolerated, the most common side effects of tremor surgery include dysarthria trouble speaking and balance problems.
Tremor is not considered a life-threating condition. Although many cases of tremor are mild, tremor can be very disabling for other people. It can be difficult for individuals with tremor to perform normal daily activities such as working, bathing, dressing, and eating. The symptoms of essential tremor usually worsen with age. Unlike essential tremor, the symptoms of physiologic and drug-induced tremor do not generally worsen over time and can often be improved or eliminated once the underlying causes are treated.
The mission of the National Institute of Neurological Disorders and Stroke NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. Researchers are working to better understand the underlying brain functions that cause tremor, identify the genetic factors that make individuals more susceptible to the disorder, and develop new and better treatment options.
Brain functioning It can be difficult to distinguish between movement disorders such as Parkinson's disease and essential tremor. These debilitating movement disorders have different prognoses and can respond very differently to available therapies. NINDS researchers are working to identify structural and functional changes in the brain using non-invasive neuroimaging techniques to develop sensitive and specific markers for each of these diseases and then track how they change as each disease progresses.
Other researchers are using functional magnetic resonance imaging technology to better understand normal and diseased brain circuit functions and associated motor behaviors.
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