Cause | Features* | Diagnostic Approach† |
---|---|---|
Postural tremors (tremor when a limb is held outstretched) | ||
Alcohol or another sedating substance (such as a benzodiazepine Misuse of Antianxiety Medications and Sedatives Antianxiety and sedative medications are prescription drugs used to relieve anxiety and/or help with sleep, but their use can result in dependency and a substance use disorder. Using prescription... read more ) when use is stopped | Agitation and a fine tremor starting 24–72 hours after the last use of alcohol or a another substance Sometimes high blood pressure, a rapid heart rate, or fever, especially in people who are hospitalized | A doctor's examination |
Medication or other substances, such as
| History of medication or substance use | Stopping the medication of substance to see whether the tremor goes away |
Hormonal, metabolic, and toxic abnormalities that affect the brain:
| A tremor plus one or more of the following:
For hyperthyroidism: Difficulty tolerating heat, excessive sweating, an increased appetite, weight loss, bulging eyes, and frequent bowel movements | Tests to help identify the cause, such as blood tests
|
Essential tremor | A persistent tremor that
No other symptoms of nervous system malfunction | A doctor's examination |
Physiologic tremor | A fine, rapid tremor that
| A doctor's examination |
Resting tremor | ||
Parkinsonism Parkinsonism Parkinsonism refers to symptoms of Parkinson disease (such as slow movements and tremors) that are caused by another condition. Parkinsonism is caused by brain disorders, brain injuries, or... read more triggered by a drug, such as certain antipsychotic medications and medications used to relieve nausea | A history of medication or substance use | Stopping the medication or substance to see whether the tremor goes away |
A slow alternating tremor that
Often no family history of tremor and no lessening of tremor after drinking alcohol | A doctor's examination Use of the medication levodopa to see whether improvement occurs | |
A sometimes coarse or jerky tremor that is often inconspicuous In older adults who have difficulty looking down and eventually looking up, muscle stiffness, difficulty moving, early falls, and dementia | A doctor's examination | |
Intention tremor | ||
Cerebellar disorders Coordination Disorders Coordination disorders often result from malfunction of the cerebellum, the part of the brain that coordinates voluntary movements and controls balance. The cerebellum malfunctions, causing... read more :
| A slow tremor that
In some people, a family history of the disorder (as for Friedreich ataxia or spinocerebellar ataxias) | MRI of the brain |
Medications or other substances, such as
| A history of use of a medication or other substance | Stopping the medication or substance to see whether the tremor goes away |
Complex tremors | ||
Disorders that affect many of the nerves outside the brain and spinal cord ( polyneuropathies Polyneuropathy Polyneuropathy is the simultaneous malfunction of many peripheral nerves throughout the body. Infections, toxins, medications, cancers, nutritional deficiencies, diabetes, autoimmune disorders... read more ): | A tremor that
| Electromyography (stimulating muscles and recording their electrical activity) Other tests to identify the cause |
Functional (psychogenic) tremor (due to psychologic factors) | A tremor that
| A doctor's examination |
* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. | ||
† Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing | ||
MRI = magnetic resonance imaging; SSRIs = selective serotonin reuptake inhibitors (a type of antidepressant). |