Tremors Explained: Your Guide to Common Types and Causes
Understand tremors with this complete guide. Learn the common types, including Essential Tremor, Parkinsonian, Dystonic, and Cerebellar; along with their causes, symptoms, diagnosis, and treatment options to manage involuntary shaking effectively.
Written by Dr. Dhankecha Mayank Dineshbhai
Reviewed by Dr. Mohammed Kamran MBBS, FIDM
Last updated on 11th Sep, 2025
Introduction
That occasional slight shake in your hand when you’re nervous or after too much coffee is something most people experience. But what if the shaking becomes more frequent, persistent, or disruptive? Tremors, the involuntary, rhythmic shaking of a body part, are among the most common movement disorders. While often associated with Parkinson's disease, that's just one piece of a much larger puzzle. This guide demystifies the world of tremors, breaking down the common types, from the widespread Essential Tremor to the characteristic Parkinsonian Tremor and beyond. Understanding the differences is the first step toward finding the right management strategies and knowing when it's crucial to seek professional help. Whether you're seeking answers for yourself or a loved one, we’ll explain the key characteristics, causes, and contexts of these neurological conditions to empower you with knowledge.
What is a Tremor? The Basics of Involuntary Shaking
A tremor is an unintentional, rhythmic muscle contraction that leads to shaking movements in one or more parts of the body. It’s most common in the hands but can also affect the arms, head, vocal cords, torso, and legs. Tremors can be intermittent or constant and can occur on their own or be a symptom of another neurological disorder.
How Tremors Are Classified, State and Cause?
Neurologists primarily classify tremors based on two factors:
1. When they occur (State):
Resting Tremor: Occurs when the muscle is relaxed and fully supported against gravity (e.g., a hand shaking while resting on a lap). Common in Parkinson's disease.
Action Tremor: Occurs during any voluntary muscle contraction. This is further divided into:
Postural Tremor: When holding a position against gravity (e.g., holding arms outstretched).
Kinetic Tremor: During any voluntary movement (e.g., moving a hand to the mouth).
Intention Tremor: A specific kinetic tremor that worsens at the end of a purposeful movement (e.g., finger-to-nose testing).
2. Their underlying cause: Whether they are a primary condition (like Essential Tremor) or secondary to another disease, medication, or toxin.
The Most Common Types of Tremors, A Detailed Look
1. Essential Tremor (ET)
Essential Tremor is the most prevalent movement disorder, affecting far more people than Parkinson's disease. It's often called a "benign" tremor as it isn't life-threatening, but its impact on quality of life can be significant.
Key Characteristics of Essential Tremor:
Type: Primarily a postural and kinetic tremor.
Location: Most often affects the hands and arms, but can also involve the head ("no-no" or "yes-yes" motion) and voice.
A key sign: The tremor typically improves at rest and worsens with purposeful movement, like drinking from a glass or using a tool.
What Causes Essential Tremor?
ET is often hereditary, with a strong genetic component. If a parent has ET, a child has a 50% chance of inheriting the gene. It's linked to miscommunication in the cerebellum, the part of the brain that controls movement coordination.
2. Parkinsonian Tremor
This is the classic tremor associated with Parkinson's disease, a progressive nervous system disorder.
Distinguishing Parkinson's Tremor from ET
The core difference is the state of occurrence. A Parkinsonian tremor is predominantly a resting tremor. It often starts as a "pill-rolling" tremor in the hand, where the thumb and forefinger rub together. It usually disappears with voluntary action and reappears when the limb is at rest. It is also accompanied by other symptoms like slowness of movement (bradykinesia), rigidity, and postural instability. If you notice a persistent resting tremor, it is vital to consult a neurologist on Apollo 24|7 for a comprehensive evaluation.
3. Dystonic Tremor
This tremor occurs in people with dystonia, a movement disorder where incorrect brain signals cause muscles to contract excessively. The tremor is irregular and can often be relieved by completely resting the affected body part or through "sensory tricks" (like touching the affected body part). The shaking is typically associated with abnormal posturing.
4. Cerebellar Tremor
This is a classic intention tremor caused by damage to the cerebellum from a stroke, tumor, multiple sclerosis (MS), or chronic alcoholism. The shaking is coarse and gets significantly worse at the end of a guided movement. For example, a person's finger will shake more violently the closer it gets to touching their nose.
5. Psychogenic Tremor (Functional Tremor)
Also known as a functional movement disorder, this tremor can vary greatly in type and location. It may start suddenly, lessen or disappear when distracted, and is often linked to an underlying psychological factor or stressor. Diagnosis involves ruling out other neurological causes.
6. Orthostatic Tremor
A rare but distinctive tremor characterized by a feeling of unsteadiness and fast, rhythmic muscle contractions in the legs and trunk immediately upon standing. The tremor stops when sitting or walking. It is diagnosed through a specific electromyography (EMG) test.
7. Physiological and Enhanced Physiological Tremor
Everyone has a slight, fast tremor that is normally unnoticeable. This physiological tremor can be "enhanced" by factors like stress, anxiety, caffeine, fatigue, low blood sugar, certain medications (e.g., asthma drugs, antidepressants), alcohol withdrawal, or an overactive thyroid. This is often the cause of tremors in young adults during periods of high anxiety or stress.
How Are Tremors Diagnosed? The Path to Understanding
Diagnosing a tremor involves a detailed clinical examination. A doctor, often a neurologist, will:
Take a full medical and family history.
Perform a neurological exam, assessing nerve function, muscle strength, and reflexes.
Observe the tremor itself: its location, frequency, and amplitude.
Conduct tests, such as drawing a spiral or holding a cup.
In some cases, order blood tests to rule out thyroid problems or metabolic causes, or imaging like an MRI to check for structural issues.
Apollo 24|7 offers convenient home collection for these blood tests, making the diagnostic process smoother.
When to See a Doctor About Your Shaking?
You should consider seeking medical advice if your tremor:
Suddenly appears or worsens.
Interferes with daily activities like writing, eating, or working.
It is accompanied by other symptoms like headache, muscle weakness, or trouble walking.
Causes significant emotional distress or social embarrassment.
If symptoms persist beyond two weeks, consult a doctor online with Apollo24|7 for further evaluation and guidance.
Conclusion
While the prospect of a chronic tremor can be daunting, understanding the different types is a powerful first step. From the action-triggered shakes of Essential Tremor to the distinct resting tremor of Parkinson's, each type has its own characteristics and management pathways. Treatments vary widely and may include lifestyle modifications (reducing caffeine, stress management), medications (like beta-blockers for ET), physical therapy, or in severe cases, advanced interventions like deep brain stimulation (DBS). The journey begins with a proper diagnosis. If you or someone you know is struggling with persistent shaking, don't hesitate to seek professional advice. Effective management strategies can significantly improve quality of life and provide a sense of control.
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Consult Top neurologist
Dr. Aditendraditya Singh Bhati
Neurosurgeon
18 Years • MBBS(2004), DNB Neurosurgery(2014); MNAMS; Fellow Neuroendoscopy
Delhi
Apollo Hospitals Indraprastha, Delhi
(100+ Patients)
Dr. Ganeshgouda Majigoudra
Neurologist
10 Years • MBBS, MD ( GENERAL MEDICINE) DM (NEUROLOGY)
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. E Prabhakar Sastry
General Physician/ Internal Medicine Specialist
40 Years • MD(Internal Medicine)
Manikonda Jagir
Apollo Clinic, Manikonda, Manikonda Jagir
(125+ Patients)
Dr Rajashekar Mummadi
Neurologist
3 Years • MBBS, DNB General Medicine, DRNB Neurology
Hyderabad
Dr Ram's Neuro Clinic, Hyderabad
Dr Debnath Dwaipayan
Neurosurgeon
9 Years • MBBS, MS(Gen. Surgery), DrNB (Neurosurgery)
Delhi
Apollo Hospitals Indraprastha, Delhi
Frequently Asked Questions
What is the difference between an essential tremor and a Parkinson's tremor?
The main difference is when the tremor occurs. An Essential Tremor is primarily an action tremor—it happens when you're using your hands. A Parkinson's tremor is primarily a resting tremor—it's present when the muscle is relaxed and supported and often diminishes with voluntary movement.
Can anxiety cause tremors?
Absolutely. Anxiety and stress are common causes of an enhanced physiological tremor. This is a temporary worsening of the very slight shake everyone has. It's typically fast and fine and affects the hands. Managing the underlying anxiety often resolves the tremor.
Are there any natural ways to stop hand tremors?
For mild tremors, lifestyle changes can help: reducing or eliminating caffeine, getting adequate sleep, practicing stress-reduction techniques (like yoga or meditation), and using adaptive devices like heavier utensils can make a significant difference. However, these are management techniques, not cures.
When should I be worried about a tremor?
You should seek medical advice if a tremor is new, persistent, worsening, interfering with daily life, or accompanied by other neurological symptoms like muscle weakness, slurred speech, or changes in gait.
Can tremors be cured?
It depends on the cause. Tremors from conditions like hyperthyroidism or medication side effects may be completely cured by treating the underlying issue. For chronic neurological tremors like Essential Tremor or Parkinson's, there is no cure, but there are many effective treatments to control symptoms and maintain quality of life.