Tremor

What is a Parkinson’s tremor? 

A Parkinson’s tremor usually appears as a resting or action tremor. However, it’s possible to have both.  You might have heard a tremor called "the shakes" before.

If your tremor is mild, you may not notice it all the time. You might first notice IT if, for example, you spill a drink or have difficulty writing.

Resting tremor 

This is the most common Parkinson’s tremor. It usually happens when your body is relaxed, such as when you’re lying in bed. It often affects your hands and legs. 

It most often appears as a "pill-rolling" tremor, which looks like you're trying to roll a pill between your thumb and the finger next to it (your index finger). 

A resting tremor can sometimes start or get worse when you:

• feel stressed
• concentrate on something, such as signing your name, buttoning your shirt or zipping up your jacket
• listen to or watch something exciting, like a football match on TV
• move other parts of your body (such as walking, which might cause a tremor in your hand).

Action tremor 

This type of tremor is less common in Parkinson’s. It’s sometimes called postural or kinetic tremor. It happens when you’re moving or lifting your arms.

Internal tremors

You might notice a tremor in other parts of your body, such as your chin, tongue or jaw.

These can sometimes be internal tremors. These are tremors that you feel within your body but which other people can’t see. It might feel like your body is shaking or vibrating.

The treatment for internal tremor is the same as typical "external" Parkinson's tremors.

Tremor-dominant Parkinson’s

For some people, tremor is the main Parkinson’s symptom that needs managing. This is called "tremor-dominant" Parkinson’s. 

If you have tremor-dominant Parkinson’s, your non-movement (non-motor) symptoms, such as constipation or fatigue, may be less severe, and your Parkinson’s may progress more slowly. You may also be less likely to fall and have fewer movement problems. If you take levodopa to treat your Parkinson’s, you may also be less likely to have involuntary movements (dyskinesia) as a side effect.  

What causes a Parkinson’s tremor? 

People with Parkinson’s don’t have enough of a chemical called dopamine, which plays an important role in helping you move your body. This is because Parkinson’s damages the nerve cells in the brain that make dopamine. 

This lack of dopamine causes Parkinson's symptoms, including tremor. But more research is needed into exactly how tremors in Parkinson's develop, which may be different from other movement (motor) symptoms.

Tremor and medication 

Some drugs can sometimes make a Parkinson’s tremor worse. These include some:

• antidepressants
• asthma medications
• epilepsy medications
• anti-sickness pills. 

Any medication you are prescribed should come with a patient information leaflet. This can tell you whether the medicine can cause a tremor or make one worse. 

However, you might still benefit from taking these drugs. If you have any concerns about your medication or your tremor getting worse, speak to your GP, specialist or Parkinson’s nurse.

Managing a tremor 

There is no cure for a tremor, but there are things you can do to manage it. 

In the early stages of Parkinson’s, some people might be able to reduce their hand tremor by rolling or squeezing a ball, pen or similar object. 

It may also help to:

• change how you’re sitting
• sit on your hand. 

There are lots of other things that may help with a tremor. These include things you can try yourself and medical treatments. 

Other types of tremor

Tremor is not always a sign of Parkinson’s. It can be caused by other conditions, getting older or by everyday things like:

• stress or tiredness
• caffeine, alcohol and smoking
• being too hot or cold. 

Essential tremor

Essential tremor is different from a Parkinson’s tremor. It usually affects your hands and arms but can also affect other parts of your body such as your legs, jaw or head. It’s usually an action tremor, so it appears when you move. Essential tremor can get worse over time.

For some people, essential tremor is mild. For more severe cases, your doctor may recommend drug treatments or deep brain stimulation (DBS) surgery. 

You can have an essential tremor and Parkinson’s tremor at the same time. Your doctor will explain the difference and support you to manage both. 

Dystonia

Dystonia can cause involuntary muscle spasms, pain and tremors. 

Dystonia can be unrelated to Parkinson's. But it can also be a Parkinson’s symptom or side effect of levodopa. Dystonia is more common in younger people who are diagnosed with Parkinson’s.

This type of tremor is sometimes called dystonic tremor. Dystonic tremors are jerky and don’t follow a pattern or rhythm. They can happen anywhere on your body where you have dystonia, such as your hands, head or neck. Dystonic tremors can start as you begin an action, such as standing up to get out of bed. They can be painful or uncomfortable.  

Read more about muscle cramps and dystonia.

Our helpline and other useful contacts

Our helpline

Call our helpline free on 0808 800 0303 for advice on tremor or any aspect of living with Parkinson's.

More information and support

The National Tremor Foundation provides information and support to people with any form of tremor. Visit the National Tremor Foundation website.