Most people have experienced a slight hand tremble, maybe from too much caffeine, nerves before a big presentation, or after strenuous activity. But for millions of adults, tremor is a persistent, involuntary shaking that can interfere with daily life. It can make simple tasks like writing, eating, or using a phone challenging and frustrating.

Tremor can be more than a minor inconvenience. While it’s not always a sign of a serious health problem, it can be a symptom of an underlying condition. Understanding the cause can help identify treatments and management strategies.

What Is Tremor?

Tremor is an involuntary, rhythmic movement of part of the body, most often the hands, but it can also affect the arms, head, face, voice, legs, or trunk. Tremor is a symptom, not a diagnosis in and of itself, and it can be more pronounced with emotional stress, fatigue, caffeine or extreme temperatures.

By far the most common type is essential tremor (ET), a neurological disorder that tends to run in families and can appear earlier in subsequent generations. Symptoms typically present in mid-to-later life and can worsen with advancing age. Essential tremor may also be referred to as benign or familial tremor. Unlike tremors associated with Parkinson’s disease, essential tremor usually occurs during movement and activity rather than at rest, often making eating and writing more difficult.

Parkinsonian tremor, another common type, is often accompanied by other symptoms such as stiffness, slow movement, and postural instability. There are also tremors caused by medications, anxiety, alcohol withdrawal, overactive thyroid, or neurological injury.

When to See a Doctor

If you notice persistent shaking that interferes with your daily activities or seems to be getting worse over time, it’s a good idea to speak with your healthcare provider. A neurologist will typically evaluate your medical history, perform a physical and neurological exam, and may order blood tests or imaging studies to determine the underlying cause. Although tremor is usually benign, its impact on quality of life can be significant. Fortunately, there are several effective treatment options available.

Treatment Options

Tremor treatment depends on its cause, severity, and how much it interferes with your daily life. In many cases, a combination of therapies may be most effective.

1. Medications

Medications are usually the first line of treatment for essential tremor, and some Parkinsonian tremors. Common medication options include beta-blockers, such as propranolol, and anti-seizure medications, like primidone, are particularly effective for essential tremor. Dopamine related medications like carbidopa / levodopa are the first line treatment for tremors related to Parkinson’s disease. Not all patients respond equally to medication, and side effects can vary, so it may take time to find the right regimen.

2. Deep Brain Stimulation (DBS)

DBS is a surgical treatment used for severe, medication-resistant tremors. A small device is implanted in the brain to deliver electrical impulses that help control abnormal movements. DBS is most often used for essential tremor and Parkinson’s disease and has been very successful at addressing tremor and rigidity for many patients.

3. MRI-Guided Focused Ultrasound

A non-invasive procedure approved by the FDA, focused ultrasound uses sound waves to target and permanently destroy brain tissue that causes tremor. It is an outpatient procedure performed in the hospital and offers significant permanent improvement for many people with essential tremor.

4. Botox Injections

In some cases, Botox (botulinum toxin) injections can help manage tremors, especially in the hands, head, or voice. The injections temporarily weaken the overactive muscles causing the tremor. Effects typically last for several months and may need to be repeated.

5. Therapy and Assistive Devices

Occupational and physical therapists can teach strategies to cope with tremor, and recommend adaptive tools, such as weighted or self-stabilizing utensils, voice amplifiers, or specialized writing aids, that make everyday tasks more manageable.

Living With Tremor

Living with tremor can be emotionally and physically challenging. It may cause embarrassment or frustration, especially in social or professional settings. But with an accurate diagnosis and the right combination of treatments, many people can regain a sense of control and confidence.