Essential Tremor & Tremors: Symptoms, Causes, Types & Treatment

Why Are My Hands Shaking?

Shaking hands have many possible causes, and most are not dangerous. Common reasons include:

• Essential tremor — the most common neurological cause of tremor
• Too much caffeine, stress, anxiety, or fatigue
• Low blood sugar
• Overactive thyroid, also called hyperthyroidism
• Certain medications, such as some asthma drugs or stimulants
• Alcohol or substance withdrawal
• Parkinson's disease and other neurological conditions

What Is a Tremor?

A tremor is an involuntary, rhythmic muscle movement that causes shaking in one or more parts of the body — most often the hands, but it can also affect the head, voice, arms, or legs.

Tremors happen when the parts of the brain that control movement send irregular signals to the muscles. They can occur on their own or as a symptom of another condition.

Types of Tremor

Doctors classify tremors by when they happen, which helps identify the cause:

What Is Essential Tremor?

Essential tremor (ET) is a neurological condition that causes rhythmic shaking, most often in the hands during activity — for example, when writing, eating, holding a cup, or buttoning a shirt.

It's one of the most common movement disorders, can run in families, and tends to become more noticeable with age. While essential tremor is generally not dangerous, it can interfere with daily activities and quality of life — and effective treatments are available.

Essential Tremor Symptoms

Essential tremor most commonly affects the hands, but it can involve other areas too. Signs include:

• Shaking in the hands during tasks like writing, eating, or pouring
• A trembling or quivering voice
• Head shaking, including “yes-yes” or “no-no” movements
• Tremor that worsens with stress, caffeine, fatigue, or strong emotions
• Tremor that briefly improves with rest
• Symptoms that are usually on both sides but may be worse on one

Essential tremor typically appears during action, not at rest, which is one of the features that helps distinguish it from Parkinson's disease.

Essential Tremor vs. Parkinson's Disease

These two are often confused, but they have important differences:

• When the tremor happens: Essential tremor occurs during movement, while a Parkinson's tremor usually occurs at rest and improves with movement.
• Other symptoms: Parkinson's involves additional signs like slowness, stiffness, and balance problems. Essential tremor is mainly the tremor itself.
• Family history: Essential tremor frequently runs in families.

What Causes Essential Tremor?

The exact cause isn't fully understood, but essential tremor is believed to involve abnormal activity in the areas of the brain that coordinate movement. Genetics play a major role — about half of cases are linked to a family history, and it can be passed from parent to child.

Unlike tremors caused by thyroid problems, medications, or caffeine, essential tremor is a condition in its own right rather than a side effect of something else.

How Essential Tremor Is Diagnosed

There is no single test for essential tremor. Diagnosis is based on a careful neurological evaluation that rules out other causes. It typically includes:

• Detailed history — when the tremor occurs, what makes it better or worse, family history, and medications
• Neurological exam — observing the tremor during rest and various movements
• Tests to rule out other causes — such as thyroid function or blood sugar checks
• Imaging when needed — to exclude other neurological conditions

Distinguishing essential tremor from Parkinson's and other conditions is the central goal — and it determines the right treatment.

Essential Tremor Treatment

While there's no cure, essential tremor can often be managed effectively, and many people see meaningful improvement. Treatment is tailored to how much the tremor affects your daily life and may include:

• Medications, including certain blood pressure medicines and anti-seizure medications that are commonly used to reduce tremor
• Lifestyle adjustments, including limiting caffeine, managing stress, and getting enough rest
• Occupational therapy with strategies and adaptive tools to make daily tasks easier
• Advanced options, such as deep brain stimulation or focused ultrasound, for severe tremor that doesn't respond to medication
• Ongoing care to monitor your tremor and adjust treatment over time

When to See a Neurologist

See a neurologist if you have a tremor that:

• Interferes with writing, eating, or other daily tasks
• Is getting worse over time
• Is affecting your quality of life or confidence
• Comes with other symptoms like stiffness, slowness, or balance trouble

At Mir Neurology, our board-certified neurologists diagnose and treat essential tremor and other movement disorders — pinpointing the cause and building a treatment plan to help you regain control.

Serving Western Maryland & the Tri-State Area

With offices in Cumberland and Hagerstown, we serve patients across Western Maryland, the Eastern Panhandle of West Virginia, and South-Central Pennsylvania.

Frequently Asked Questions

Bothered by Shaking Hands or a Tremor?

Find out the cause and get a treatment plan. Mir Neurology provides expert tremor and movement disorder care in Cumberland and Hagerstown.

Request an appointment | (301) 797-7600