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What causes tremors | Types of hand tremors | Diagnosis | Medications that cause tremors | Treatment | Surgery | Natural remedies | When to see a doctor
Tremors are involuntary muscle contractions that can occur in one or more areas of the body. Tremors are usually associated with the hands, but can also affect the head, vocal cords, arms, trunk, and legs. Living with hand tremors can be frustrating and make daily activities such as eating or dressing oneself difficult. Approximately 10 million people in the United States experience some form of hand tremors.
There are numerous types of tremors and reasons why they happen. Some are temporary and go away on their own, and others are linked to more severe health problems. Learn more about what causes hand tremors, how to stop shaky hands, and when to seek medical advice from a healthcare professional about hand tremors.
What causes tremors?
Many things from diet and lifestyle changes to medications and health conditions can cause hand tremors. Shaky hands in the morning could be the result of fatigue or too much caffeine. Shaking in older adults could be due to a vitamin deficiency or a medication side effect. Tremors can also be a warning sign of alcohol withdrawal, stress, anxiety, blood pressure problems, and other health conditions.
Types of hand tremors
Treatment options for tremors of the hands may also vary based on what type you have. A healthcare professional can help you determine which type of hand tremor you or a loved one has. Here are some common types of hand tremors.
Physiologic tremor/enhanced physiologic tremor
Everyone has physiologic tremor, which is a very fine shaking of the hands and fingers and is rarely visible. This is a normal human phenomenon and is not considered a disease or medical condition.
Enhanced physiologic tremor is a more noticeable form of physiologic tremor. It is usually not associated with a neurologic disease, but by reaction to certain medications, going through alcohol withdrawal, or medical conditions like hypoglycemia (low blood sugar) or overactive thyroid (hyperthyroidism). Usually, removing the cause/treating the condition will reverse the tremor.
Parkinson’s disease tremor
Many people often associate shaking hands and limbs with the neurological disorder, Parkinson’s disease. Nearly 80% of individuals with Parkinson’s have tremors, which often occur in the resting state (called resting tremors) and often in the hand/fingers but may also affect the chin, lips, face, and legs. These tremors may initially start in one area or one side of the body but may spread to both sides as the condition progresses. Patients with further developed Parkinson’s disease can have continuous and severe tremors, which seriously interfere with everyday tasks such as eating or tying their shoes.
Essential tremor
Hands shake rhythmically and involuntarily with essential tremor, one of the most common movement disorders. Although essential tremor is neurological, it is not in the same category as tremors associated with Parkinson’s disease. Although essential tremor is not curable, there are various treatments that may help symptoms. Extreme temperatures, stress, anxiety, smoking cigarettes, and caffeine can trigger and worsen essential tremors.
Psychogenic tremor
Psychogenic tremor, also known as functional tremor, is often the result of a psychological condition such as stress, anxiety, trauma, or psychiatric disorder. Spasms and involuntary body movements can develop from a rapid increase in blood pressure and heart rate associated with stress.
Cerebellar
A cerebellar tremor can occur when the cerebellum or pathways to the brain have been injured or damaged. Stroke patients can develop tremors if the cerebral arteries are damaged. A tumor is another example of damage to the cerebellum, causing hand or body tremors.
Diagnosis of Tremor
Your healthcare provider will perform a physical exam and take a detailed medical history and family history. They will look at the type and location of tremors, look for causes, and rule out other conditions and causes.
Your doctor may also order:
- A neurologic exam to test muscle strength and tone, reflexes, balance, and speech. This will help identify if the tremor occurs when the muscles are at rest or in motion, the location(s) of the tremor, and the frequency and appearance of the tremor.
- Lab work to test blood and urine. This will help rule out contributing factors to the tremor, like thyroid conditions or diabetes.
- Diagnostic imaging, including imaging to look at the brain, and an electromyogram to measure muscle activity and response to nerve stimulation.
- Performance tests to evaluate how you complete tasks like writing, drawing a spiral, or holding utensils.
Medications that cause tremors
Hand tremors are a potential side effect of numerous medications. Certain prescription drugs used to treat depression, asthma, cancer, and hypothyroidism are among many that can cause shaky hands. Some antibiotics, weight loss medications, and antivirals are also on the list of drugs that can result in temporary hand tremors.
Antidepressants and Antipsychotics
Although effective in treating depression, shaky hands are a side effect of many antidepressants. Antipsychotic medications also cause tremors which are known as tardive dyskinesia. Common medications include:
- Tricyclic antidepressants, such as amitriptyline, doxepin, amoxapine
- Serotonin reuptake inhibitors (SSRIs), such as Zoloft, Prozac, Lexapro
- Mood stabilizers, such as lithium, Depakote, and Lamictal
Asthma medication
Side effects of asthma or bronchodilators can lead to movement disorders in the fingers and hands. Prescription inhalers or nebulized medications such as Proventil and Ventolin (albuterol) are among those that stimulate the nervous system, potentially causing shaky hands. The hand tremors are only temporary, lasting 30 to 60 minutes after using the medication, and are not to be considered harmful.
Acid reflux medication
Prilosec (omeprazole) can also cause hand tremors as a side effect. Omeprazole interferes with vitamin B12 absorption, which is an essential vitamin for the nervous system. Shakiness should stop upon discontinuing the use of the drug.
Anti-nausea medicine
Reglan (metoclopramide) has the potential side effect of tremor, so you should notify your healthcare professional if you experience this side effect.
Treatment for tremors
There is no cure for essential tremor, but there are certain medications that can be used to treat it. Anticonvulsants, beta blockers, Parkinson’s disease medications, and benzodiazepines are among some of the commonly prescribed drugs to reduce shaky hands.
Primidone and other anticonvulsants
Mysoline (primidone) is a prescription medication used to treat seizures, but can also be useful in reducing hand tremors. This prescription drug is a barbiturate anticonvulsant, and it helps stabilize the brain’s electrical pulses. Other medications used to treat seizures are sometimes used off-label (for a use that is not FDA approved) to treat tremor.
Beta blockers
Inderal (propranolol) is the only beta blocker that is FDA approved to treat essential tremor. Some healthcare professionals will prescribe primidone in combination with propranolol if one or the other medication is not effective alone. Sometimes, a different beta blocker will be prescribed, such as Tenormin (atenolol) or Lopressor (metoprolol).
Carbidopa/levodopa
Carbidopa/levodopa is used to treat tremor due to Parkinson’s disease. Individuals who take carbidopa/levodopa should avoid iron supplements, and should not eat a high-protein diet, as these could decrease the medicine’s absorption.
Benzodiazepines
A benzodiazepine, such as Valium (diazepam), may be prescribed to temporarily reduce tremor symptoms. However, these medications have many side effects and drug interactions, especially in older adults. They are also controlled substances so they have the potential for abuse and dependence. For these reasons, they are not preferred medications to use to treat tremor.
Botox
Botox injections can treat tremor, with a reduction in symptoms lasting for about three months. However, side effects may include muscle weakness and difficulty swallowing.
Focused ultrasound
This treatment is only approved when symptoms do not respond well to beta blockers or anticonvulsants. This procedure uses magnetic resonance imaging to deliver focused ultrasound that creates a lesion in areas of the thalamus thought to be causing tremor. It is an invasive procedure and leaves a permanent lesion.
Surgery for hand tremors
In some cases, when tremor symptoms do not respond to medication and lifestyle changes, surgery may be necessary. The most common surgery for tremor is called deep brain stimulation (DBS). Similar to a pacemaker, the implanted neurostimulator device sends an electrical pulse that can prevent tremors from occurring. The procedure is considered effective and low-risk.
Other, less common surgical procedures include:
- Thalamotomy: A small lesion in the thalamus is created to reduce abnormal brain activity and calm tremor. This procedure only treats tremor on one side of the body.
- Gamma-knife surgery: This procedure uses radiation beams to burn a small piece of tissue in the thalamus, similar to thalamotomy. Effects are seen in a few weeks or months.
Natural remedies for hand tremors
Although hand tremors can affect your quality of life, there are some other things you can try, in addition to prescription medications or other recommended treatments from your healthcare provider:
- Follow the Mediterranean diet, incorporating plenty of fruits, vegetables, beans, nuts, seafood, and whole grains
- Drink plenty of water to stay hydrated
- Avoid or limit caffeine and alcohol
- Ask your doctor if you should take a vitamin B supplement
- Go to physical or occupational therapy
- Use a weighted hand glove
- Employ relaxation techniques such as breathing exercises, meditation, massage therapy, and yoga
- Get plenty of rest, which helps the body and nervous system function properly
When should someone see a doctor for shaky hands?
If you have hand tremors, seeking professional help sooner than later could prevent the worsening of a severe medical condition. Medications that slow the onset and progression of neurological or other disorders could be an essential step to managing your wellness. On the other hand, your healthcare professional may inform you that you just need to reduce stress in your life or switch to decaf. Either way, finding out why you have hand tremors should be a priority.
