Are Hand Tremors a Cause for Concern?

Answer: It’s not surprising that you associate tremor with Parkinson’s disease. But it is much more likely that you have essential tremor, a very common disorder.

Tremor is the shaky movements of your hands, limbs, head or voice that you can’t control. Sometimes tremor is a normal reaction to a situation such as fear, fatigue or anger. It also can be a side effect of too much caffeine, a medication, or withdrawal from alcohol, a drug or medicine. When a tremor occurs during activities and there is no emotional or chemical cause, essential tremor is a likely possibility.

Essential tremor is different from Parkinson’s disease. Essential tremor is most noticeable when your body is in action, such as when you are writing, typing or pouring a beverage. The shakiness is often called an “intention tremor” because it worsens when a person is trying to do something.

In contrast, people with Parkinson’s watch their hands shake when they rest in their lap. But when they reach out to grab or hold something, such as a cup of coffee, the shaking stops.

Essential tremor usually starts in mid-life or later. As many as one in four people develop essential tremor as they age.

The name of this condition indicates that the cause is unknown and that it occurs on its own, without another explanation. You are more likely to develop essential tremor if you have a parent or sibling with the condition. In fact, genetic mutations have been linked to “benign familial tremor.”

The most common initial symptom is shaking of the hands, but other areas, including the arms, legs and head are frequently involved. A trembling voice may be a symptom of essential tremor.

For mild symptoms, no treatment is needed. Avoiding caffeine and stress and getting plenty of rest can be helpful. In social situations, slowly consuming one alcoholic beverage can reduce hand tremors.

However, for symptoms that impair quality of life, most doctors prescribe either a beta blocker, usually propranolol, or primidone, an anti-seizure medicine. If the initial choice doesn’t work well enough, you can try the other, and sometimes taking both helps the most. Alternative medications are topiramate and gabapentin, both are anti-seizure drugs but often used for other indications, such as migraine and chronic pain.

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.

©2023 Harvard University. For terms of use, please see https://www.health.harvard.edu/terms-of-use. Distributed by Tribune Content Agency, LLC.

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