Trembling (trembling) | Types, causes and treatment (2023)

Anxiety, fear, general malaise and fever can leave you feeling shaky - the expression "shivering in your boots" is one we all recognize. Of course, feeling shaky without knowing what's causing it can make you feel anxious, which can lead to a vicious cycle of shakiness.

If you only feel shaky once, a temporary cause such as fever, fear, or stress is likely to blame. But if you have recurrent or persistent episodes, there is a long list of possible causes. It is important to remember thatessential tremor, or other causes unrelated to a serious underlying medical problem, are by far the most likely explanation for the tremor if you feel fine.

What is a tremor?

A tremor is a repetitive, rhythmic movement of a part of your body. Many of your body's muscles come in pairs, which "oppose" each other; In other words, contracting one muscle moves your body part in one direction, while contracting the opposite muscle moves it in the opposite direction. Tremor occurs when these opposing muscle groups successively contract. it's involuntary, meaning it's usually not controllable and occurs without you deciding to move that body part. It often feels like a shivering or shivering sensation.

A slight tremor is present in every person. This is called a physiological tremor. It may not be noticeable. Certain things can make a physiological tremor more noticeable, so you may only notice it every now and then.

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Who has tremors?

Tremor symptoms severe enough to require medical help are remarkably common; in fact, tremor is the most common movement disorder seen in hospital neurology clinics. Conditions like essential tremor often run in families. What affects the risk of tremors as a result of other conditions, such as the following, depends a lot on what that condition is.

Causes of tremor

Tremor is a symptom, not a medical condition in itself. Sometimes there is no obvious cause; sometimes it is an increase in your normal physiological tremor caused by a temporary stimulant like caffeine or medication.

Among the most common and important causes of tremor are the following:

essential tremor

The most common cause of significant and persistent tremor is essential tremor. The medical term for this used to be "benign essential tremor", based on the fact that it wouldn't do any harm, wouldn't cause any other conditions, and wouldn't affect your lifespan. But for many patients, uncontrollable tremor is anything but harmless. It can make even simpler daily activities a challenge and has a huge effect on your self-esteem.


AnxietyLike arousal, it stimulates the release of a hormone called adrenaline (epinephrine), the so-called "fight or flight" hormone. This has profound effects on many parts of your body, primarily aimed at increasing your alertness, muscle strength, and ability to flee from danger or turn around to face it. Adrenaline stimulates nerve endings, heightens awareness and increases blood flow to the muscles in the arms and legs. These two factors make you more prone to shaking. In addition to the obvious feeling of anxiety, anxiety-related tremor is often accompanied by a rapid heartbeat (palpitations), shortness of breath, a dry mouth, and sometimes chest pain.

Low blood sugar

Episodes of low blood sugar, also known ashypoglycemia, or 'hypo', are more common if you have diabetes treated with insulin or type 2 diabetes treated with sulfonylurea (SU) tablets. SU pills stimulate the pancreas to produce more insulin, which can lower blood sugar too much. Other symptoms include sweating, extreme hunger, irritability, poor concentration, nausea, blurred vision and palpitations.


Like adrenaline, caffeine is a stimulant that increases alertness and stimulates the nerves. While it can be helpful in keeping you alert, large amounts of caffeine in a short period can cause the tremors. and palpitations.


The culprits also includesalbutamol(used to relieve asthma symptoms);lithium carbonate(often used in bipolar disorder); some epilepsy medications; and some cancer treatments. Some antidepressants can also make you feel shaky, especially when you start them.

recreational drugs

A variety of recreational drugs, including MDMA and amphetamines, can cause tremors and other movement disorders, which can persist after you stop using them.

alcoholic abstinence

if you aredependentand alcohol,Withdrawal can lead to severe symptomsincluding tremors, anxiety, confusion, sweating, palpitations and even seizures. This tremor can persist even weeks after you stop drinking. Alcohol can also damage the brain, including the cerebellum, which is responsible for balance and movement coordination. Some people who are dependent on alcohol experience frequent "mini-crashes" within hours of their last drink, which is why they often experience shakiness.

Parkinson disease

Tremor is one of the three "key features" ofParkinson disease,though it doesn't always happen. When this happens, it tends to affect your hands and arms and tends to be worse when you're not moving. The other main symptoms of Parkinson's disease (slowness of movement and stiffness) can start at about the same time as the tremor, but can be attributed to aging or general lack of fitness. Therefore, tremor is often the first symptom that people come to a doctor's attention, and this often leads to a diagnosis.

overactive thyroid gland

In addition to feeling shaky, aoveractive thyroid glandit can often lead to weight loss despite eating more, anxiety, heart palpitations, sweating, heat intolerance, diarrhea and shortness of breath. It can start with just one or two symptoms and develop more over a few weeks.

multiple sclerosis (MS)

Tremor can be a symptom ofEM, but it's highly unlikely to be the only symptom you're having, and other causes are much more likely. In fact, tremor is usually a relatively late symptom and the average time from MS diagnosis to develop tremor is 11 years old.

vitamins and minerals

Vitamin deficiency, particularly vitamin B1, can cause tremors. So you canwilson's disease, an inherited condition in which too much copper builds up in your body. Rare causes such as arsenic or heavy metal poisoning can cause a variety of symptoms, including tremor.

How is tremor diagnosed?

Since tremor is a symptom and not a medical condition, your doctor will focus on finding out what is causing the tremor. This is critical because the treatment of tremor depends on what is causing it. They can often narrow down the cause of your tremor by asking leading questions. These include:

  • Does your tremor occur when you are not moving? This type of "resting tremor" is most often associated with conditions that affect the nervous system, such as Parkinson's disease or multiple sclerosis. In Parkinson's disease, the tremor usually improves when you move the limb.
  • Do you experience tremors when you try to hold a body part (usually your arm) against gravity? This type of tremor, which can also be triggered by movement, may be due to physiological tremor (which can be exaggerated if your thyroid gland is overactive or if you are anxious or have had a lot of caffeine); for some medications; for certain diseases of the nervous system; and prolonged alcohol abuse.
  • Does your tremor get worse when you try to point to something specific? The closer you get, the farther your target will be from your target. This is called an intention tremor and can suggest a problem with a part of the brain called the cerebellum.
  • What part or parts of your body are affected by the tremor? For example, essential tremor often starts in a hand or arm, as does the tremor in Parkinson's disease.
  • Is it there all the time (i.e. all the time or every time you make a move that triggers it) or can you sometimes just stand still or move without shaking? If it's intermittent, what triggers it (e.g. caffeine when you're stressed)?
  • Do you have any other symptoms along with the tremor? In about 7 out of 10 people diagnosed with Parkinson's disease, tremor is the first symptom reported to the doctor.

tremor treatment

The treatment suggested by your doctor will largely depend on the cause. For example, if your thyroid gland is overactive, correcting the levels of this hormone in your body should stop the twitching. If you are anxious, your doctor may recommend talk therapy, such ascognitive behavioral therapy (CBT). If it is medication related, changing or reducing the dose of your medication may help, although this should only be done on the advice of your doctor. There are many alternative medications to treat type 2 diabetes in addition to sulfonylureas, which can cause hypoglycemia; your doctor can discuss this with you.

Whatever the cause of your tremor, too much caffeine can make it worse. Therefore, it is worth thinking about reducing caffeine intake (from tea, coffee, cola and chocolate) or eliminating it altogether. And while alcohol can sometimes improve tremor in the short term, too much alcohol can lead to severe, disabling tremors, as well as other life-threatening complications. As a result, doctors never recommend that you self-medicate with alcohol.

Possible treatments for essential tremor, the most common cause of tremor, are described in detail inthe separate booklet called Essential Tremor. These treatments are sometimes used if you have another type of tremor, especially if it has a big impact on your life.

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