Why Am I Shaky? Understanding Tremors and Their Causes

Feeling shaky can be unsettling. You might notice your hands trembling when you reach for a cup of coffee, or your legs might feel weak and unsteady. If you’ve been asking yourself, “Why Am I Shaky?”, you’re not alone. Shakiness, clinically known as tremor, is a common neurological condition characterized by involuntary trembling or shaking movements in one or more parts of the body. While hands are most frequently affected, tremors can also occur in the arms, legs, head, vocal cords, and torso. These movements can be rhythmic or sporadic, and they may arise on their own or as a symptom of an underlying health issue.

While generally not life-threatening, tremors can significantly impact your daily life. Simple tasks most people take for granted, such as writing, typing, eating, getting dressed, or even just holding things steady, can become challenging. Understanding why you might be experiencing shakiness is the first step towards managing it.

Common signs and symptoms of tremor include:

• Involuntary, rhythmic shaking in the hands, arms, head, legs, or trunk
• Trembling or shaky voice
• Difficulty with fine motor skills like writing or drawing
• Trouble holding and controlling utensils, tools, or other objects

The intensity of tremors can fluctuate. They may be aggravated by stress, strong emotions, physical exhaustion, certain postures, or specific movements. If you’re experiencing these symptoms, it’s important to understand the different types of tremors and what might be causing your shakiness.

Types of Tremors: Different Ways Your Body Can Shake

To properly address the question “Why am I shaky?”, it’s helpful to know that tremors are classified based on when and how they occur. The two primary categories are resting tremors and action tremors.

Resting Tremors: These tremors happen when your muscles are relaxed and at rest. A classic example of a resting tremor is often seen in individuals with Parkinson’s disease.

Action Tremors: As the name suggests, action tremors occur during voluntary muscle movement. There are several subcategories of action tremors, and sometimes these categories can overlap, making diagnosis nuanced.

Here’s a closer look at the different types of action tremors:

• Postural Tremors: These appear when you maintain a position against gravity. Holding your arms outstretched in front of you is a common way to observe a postural tremor. If you’re wondering “Why am I shaky when I hold my arms out?”, this could be a postural tremor.

• Kinetic Tremors: Kinetic tremors are associated with any voluntary movement. Simple actions like moving your wrists up and down or blinking your eyes can trigger this type of tremor.

  • Intention Tremors: These tremors become more pronounced as you approach a target during a purposeful movement. For instance, if you try to touch your nose with your finger and the shaking worsens as your finger gets closer, this is likely an intention tremor.

  • Task-Specific Tremors: As the name suggests, these tremors only appear when you perform specific goal-oriented tasks. Handwriting or speaking are common activities that can trigger task-specific tremors. If you only feel shaky when writing, but not during other activities, this might be a task-specific tremor.

• Isometric Tremors: These tremors occur during a voluntary muscle contraction that doesn’t involve movement. Holding a heavy book still in front of you is an example of an isometric contraction that could trigger this type of tremor.

Beyond these classifications, certain tremor syndromes are defined by their specific patterns. Let’s explore some of the most common tremor syndromes to further understand “why am I shaky”.

Essential Tremor: The Most Common Cause of Shakiness

Essential tremor (ET), sometimes previously referred to as benign essential tremor or familial tremor, is among the most prevalent movement disorders. The hallmark of ET is tremor in both hands and arms during action, without other obvious neurological signs. However, it can also affect the head, voice, or legs. While ET can start at any age, it most often appears in adolescence or middle age (between 40 and 50 years old). The severity of essential tremor is variable; it can be mild and remain stable, or it can gradually worsen over time.

The exact cause of essential tremor is still under investigation. Research suggests that ET involves mild degeneration in the cerebellum, the part of the brain responsible for coordinating movement. In a significant number of cases (50-70%), essential tremor is inherited, referred to as familial tremor. Familial forms of ET often manifest earlier in life. If you have a family history of shakiness, essential tremor might be the reason you’re asking “Why am I shaky?”.

Dystonic Tremor: Tremors Linked to Muscle Spasms

Dystonic tremor occurs in individuals with dystonia, a movement disorder where faulty brain signals cause muscles to become overactive. This overactivity leads to abnormal postures or sustained, involuntary movements. Dystonia typically emerges in young or middle-aged adults and can affect any muscle, but commonly involves the neck (cervical dystonia), vocal cords (laryngeal dystonia), or limbs (limb dystonia). Interestingly, people with dystonic tremor may find temporary relief by completely relaxing or touching the affected body part. If your shakiness is linked to muscle spasms or unusual postures, dystonic tremor could be the answer to “Why am I shaky?”.

Cerebellar Tremor: Tremors Due to Brain Damage

Cerebellar tremor is characterized by a slow, wide tremor (high amplitude) in the arms, legs, hands, or feet. It typically worsens at the end of a targeted movement, such as pushing a button. This type of tremor arises from damage to the cerebellum and its connections to other brain regions. Common causes of cerebellar damage include stroke, tumors, injury from disease or inherited disorders, or chronic alcohol abuse. If your shakiness started after a head injury, stroke, or is associated with a known neurological condition affecting the cerebellum, this might explain “why am I shaky”.

Functional Tremor: Tremors with Psychological Roots

Functional tremor, also known as psychogenic tremor, can manifest in various forms. Symptoms are often inconsistent, with sudden onsets and wide fluctuations in severity. A key characteristic of functional tremor is that it may intensify when attention is drawn to it and lessen or disappear when the person is distracted. While the exact cause is complex and not fully understood, functional tremors are considered to have psychological origins. If your shakiness seems to come and go depending on your emotional state or level of attention, functional tremor might be considered when exploring “why am I shaky?”.

Enhanced Physiologic Tremor: Common Shakiness Triggered by External Factors

Enhanced physiologic tremor is a subtle, fine tremor (small amplitude) affecting the hands and fingers during action. It’s generally not caused by a neurological disease itself but rather by the body’s reaction to certain external or internal factors. Common triggers include certain medications, alcohol withdrawal, and medical conditions like an overactive thyroid (hyperthyroidism) and low blood sugar (hypoglycemia). Importantly, enhanced physiologic tremor is often reversible once the underlying cause is addressed. If you’re asking “Why am I suddenly shaky?”, consider if you’ve recently started a new medication, are experiencing stress, or have changes in your diet or health, as these could be contributing to an enhanced physiologic tremor.

Parkinsonian Tremor: A Key Symptom of Parkinson’s Disease

Parkinsonian tremor is a frequent and often early symptom of Parkinson’s disease, although not everyone with Parkinson’s develops tremors. This type of tremor is most noticeable when the hands are at rest and has a characteristic “pill-rolling” appearance, as if the person is rolling a small object between their thumb and fingers. Parkinsonian tremors can also affect the chin, lips, face, and legs. Typically, it starts on one side of the body or in one limb and may spread to both sides as the disease progresses. Stress and strong emotions can worsen Parkinsonian tremors. If your shakiness is present at rest and accompanied by other symptoms like slowness of movement or stiffness, Parkinson’s disease and Parkinsonian tremor may be relevant to your question “Why am I shaky?”.

Orthostatic Tremor: Shakiness Upon Standing

Orthostatic tremor is a rare condition marked by rapid muscle contractions in the legs that occur specifically when a person stands up. The tremor typically ceases when sitting or walking. Standing may induce feelings of unsteadiness or imbalance, prompting the person to sit down or walk. Due to its rapid nature, orthostatic tremor may not be visible to the naked eye. It can be detected by touching the thighs or calves or by listening to muscle activity with a stethoscope. In some cases, orthostatic tremor can worsen over time. The cause of orthostatic tremor is currently unknown. If you primarily experience shakiness when standing, and it improves when you sit or walk, orthostatic tremor could be the reason “why am I shaky”.

Who is Prone to Tremors? Risk Factors and Common Causes

Tremors are most commonly observed in middle-aged and older adults, but they can occur at any age. Men and women are generally affected equally. Often, tremors arise from issues within the brain regions that control movement. While most tremor types lack a known genetic cause, some forms, like essential tremor, have a hereditary component and run in families.

Tremors can be a primary condition or a symptom of other underlying neurological disorders, including Parkinson’s disease, multiple sclerosis, and stroke. Furthermore, various other medical conditions can trigger tremors, answering “why am I shaky” in many cases. These include:

• Medications: Numerous drugs can induce tremors as a side effect. Examples include certain asthma medications, corticosteroids, chemotherapy drugs, and medications for psychiatric and neurological conditions. If you’ve recently started a new medication, review the side effects as it might be the reason “why am I shaky”.

• Heavy Metals and Neurotoxins: Exposure to heavy metals (like mercury, lead, arsenic, manganese), organic solvents, or pesticides can cause tremors. Occupational or environmental exposure to these substances could explain “why am I shaky”.

• Caffeine: Excessive caffeine intake can trigger temporary tremors or exacerbate existing tremors. High caffeine consumption might be a simple answer to “why am I shaky”.

• Thyroid Disorders: An overactive thyroid gland (hyperthyroidism) can lead to tremors. If you experience other symptoms of hyperthyroidism like weight loss, rapid heartbeat, and sweating, a thyroid issue could be the reason “why am I shaky”.

• Liver or Kidney Failure: Liver and kidney failure can cause brain damage in certain areas, resulting in tremors or jerky movements. If you have a history of liver or kidney problems, this could be relevant to “why am I shaky”.

• Diabetes: Both high and low blood sugar levels (hyperglycemia and hypoglycemia, respectively) can cause tremors and other involuntary movements. Fluctuations in blood sugar, particularly in individuals with diabetes, can be a direct cause of “why am I shaky”.

• Stress, Anxiety, and Fatigue: These common factors can also be associated with tremors. High stress levels, anxiety, or significant fatigue can trigger or worsen shakiness, providing a lifestyle-related answer to “why am I shaky”.

Diagnosing and Treating Tremors: Finding Relief from Shakiness

If you’re concerned about persistent shakiness and asking “why am I shaky?”, seeking medical evaluation is crucial for proper diagnosis and management.

Diagnosing Tremor: Identifying the Cause of Your Shakiness

To diagnose tremor, a doctor will start with a comprehensive physical exam and review your medical history. A neurological exam will assess muscle tone, strength, reflexes, balance, and speech. The doctor will also carefully evaluate the characteristics of your tremor, including:

• Whether the tremor occurs at rest or during activity
• The location of the tremor in the body (and if it affects one or both sides)
• The appearance of the tremor (frequency and amplitude/size)

To rule out underlying medical conditions, blood or urine tests may be ordered. Diagnostic imaging, such as MRI or CT scans, might be used to determine if brain damage is contributing to the tremor. An electromyogram (EMG), which measures muscle activity and nerve response, can help identify muscle or nerve problems. Additional tests may assess functional limitations, such as difficulty with handwriting or using utensils, to understand the tremor’s impact on daily life.

Treating Tremor: Managing Symptoms and Improving Quality of Life

While there is no cure for most forms of tremor, various treatments are available to help manage symptoms and improve quality of life. In mild cases, treatment may not even be necessary. Addressing any underlying health condition contributing to the tremor can sometimes resolve or reduce it.

Medications for Tremor: Reducing Shakiness with Medical Management

Several medications can help reduce tremor severity. Some commonly prescribed medications include:

• Beta-blocking drugs: These medications can be effective for essential tremor and other action tremors in some individuals.

• Anti-seizure medications: Certain anti-seizure drugs can suppress essential tremor, particularly for those who don’t respond to beta-blockers.

• Tranquilizers (Benzodiazepines): These may be prescribed for short-term relief of tremor in some people. However, they can have side effects like drowsiness, impaired concentration and coordination, and risk of dependence.

• Dopaminergic medications: These are primarily used for Parkinsonian tremors and other movement symptoms associated with Parkinson’s disease.

• Anticholinergic medications: These can be helpful for managing dystonic tremors in certain individuals.

• Botulinum toxin (Botox) injections: Botox injections can be used to treat dystonic head tremor and hand tremor. They can also be considered for essential tremor patients who don’t respond well to oral medications.

Surgical Interventions for Tremor: Advanced Options for Severe Cases

When medications are ineffective or tremor severely disrupts daily life, surgical procedures may be considered.

• Deep Brain Stimulation (DBS): DBS is the most frequently used surgical treatment for tremor. It involves surgically implanting electrodes in the thalamus, a deep brain structure involved in movement control. These electrodes deliver high-frequency electrical signals that help to regulate brain activity and reduce tremor. A pulse generator, similar to a pacemaker, is placed under the skin in the chest to control the electrical stimulation. DBS is used to treat Parkinsonian tremor, essential tremor, and dystonia.

• Radiofrequency Ablation: This procedure uses radio waves to generate heat, creating an electric current that disrupts nerve signaling and reduces tremor for six months or longer. It’s typically performed on one side of the brain to improve tremor on the opposite side of the body.

• Focused Ultrasound: This newer technique uses MRI to guide high-frequency focused ultrasound waves to create a small lesion in the thalamus, targeting the brain area thought to cause tremors. It is currently approved for essential tremor that doesn’t respond well to medications.

Lifestyle Adjustments for Managing Tremor: Self-Help Strategies

Certain lifestyle changes and techniques can provide relief for mild to moderate tremors.

• Physical, Speech, and Occupational Therapy: These therapies can help improve tremor control and teach adaptive strategies for daily tasks affected by tremor.

• Eliminating or Reducing Caffeine: Reducing caffeine intake can lessen tremor symptoms in some individuals.

• Assistive Devices: Using specialized tools like weighted utensils, plates with rims, and adaptive clothing can make daily activities like eating and dressing easier.

• Medication Management: Taking prescribed medications consistently and discussing any tremor-aggravating medications with your doctor is important.

• Stress Reduction: Managing stress and avoiding stressful situations can help lessen tremor severity.

• Adequate Sleep: Getting enough sleep is crucial, as fatigue can worsen tremors. Regular physical activity and exercise can help improve sleep and reduce fatigue.

Latest Research on Tremor: Advancing Understanding and Treatment

The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health (NIH), is a leading supporter of research into tremor and other neurological disorders. Ongoing research is focused on several key areas to better understand and treat tremors.

Understanding Brain Function and Disease Markers

NINDS researchers are utilizing advanced neuroimaging techniques to identify structural and functional changes in the brain associated with tremors. The goal is to develop sensitive markers for movement disorders like Parkinson’s disease and essential tremor to track disease progression. Functional MRI technology is also being used to gain deeper insights into brain circuit functions related to motor control. Scientists are also working on digital tools for real-time tremor monitoring outside of clinical settings, which could optimize treatment strategies. Studies of donated brain tissue are helping to identify specific brain changes linked to tremor, potentially uncovering new treatment targets.

Genetic Discoveries: Unraveling the Hereditary Links to Tremor

Essential tremor has a strong genetic component. NINDS researchers are building upon previous genetic studies to identify specific genes that increase susceptibility to familial early-onset essential tremor. Research is focusing on families with multiple generations affected by early-onset tremor to enhance gene discovery. Additionally, the impact of genetic variations on the development of essential tremor is being actively investigated.

Medications and Novel Treatments: Improving Therapeutic Options

Medications are effective for approximately half of individuals with tremor. Researchers are actively exploring strategies to minimize or suppress tremor while preserving voluntary movements, with the aim of developing improved assistive and rehabilitative devices.

The effects of ethanol (alcohol) on tremor are also being studied, as many people with essential tremor experience symptom relief with alcohol consumption. NINDS researchers are investigating the optimal dosage of ethanol, its physiological effects on the brain, and whether medications mimicking these effects but without the downsides of alcohol could be developed.

Other NIH-supported research aims to pinpoint the precise origins of essential tremor, study the effects of existing tremor-suppressing drugs on the brain, and develop more targeted and effective therapies for all types of tremors, offering hope for more effective answers to “why am I shaky” and better treatment options in the future.

Participating in Clinical Trials: How You Can Help

Clinical trials are vital for advancing our understanding of tremor and developing better treatments. By participating in clinical research, you can contribute to improving care for yourself and others affected by tremor.

Clinical trials need volunteers of all types – healthy individuals and those with illnesses, representing diverse ages, sexes, races, and ethnicities. This ensures that research findings are applicable to a wide population and that treatments are safe and effective for everyone.

To learn more about participating in clinical research, visit NIH Clinical Research Trials and You. For information on clinical trials specifically seeking participants with tremor, visit Clinicaltrials.gov.

Resources for More Information About Tremor

For further information and support regarding tremor, these resources may be helpful:

• Diann Shaddox Foundation for Essential Tremor

  • https://diannshaddoxfoundation.org
  • Email: [email protected]
  • Phone: 803-761-2860

• HopeNET

  • https://thehopenet.org/blog2/
  • Phone: 804-754-4455

• International Essential Tremor Foundation

  • https://www.essentialtremor.org
  • Phone: 913-341-3880 or 888-367-3667

• MedlinePlus

  • https://medlineplus.gov/tremor.html

This information is intended for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.