A pill-rolling tremor is a tremor named for the way it looks. A person with this tremor may appear to be rolling a pill or small object between their thumb and index finger. This kind of tremor is usually one of the earliest symptoms of Parkinson’s disease.

A pill-rolling tremor can be an indicator of various conditions, but it has the closest association with Parkinson’s disease. Up to 75% of people with Parkinson’s disease experience resting tremors at some point. It is a resting tremor, meaning a person is more likely to experience it while relaxed.

This article explores the symptoms of pill-rolling tremors and their causes, risk factors, and treatment.

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Tremors are a common symptom of Parkinson’s disease. They may become noticeable if a person:

  • experiences a rhythmic shaking in their head, legs, arms, or torso
  • has issues holding and controlling utensils, such as forks or spoons
  • has a shaky voice
  • has difficulty writing or drawing

A person may also experience other early symptoms of Parkinson’s disease, including:

  • stooped posture
  • balancing issues
  • slowed movement, known as bradykinesia
  • changes in speech, such as becoming monotone, slurring words, or speaking more quickly and softly than usual
  • feelings of unsteadiness and difficulty walking
  • stiff muscles

A tremor is usually due to an issue in the deep parts of the brain that control movement, called the basal ganglia — it is a group of structures located in the thalamus. There is no known cause for most types of tremors.

A tremor can occur on its own, or as a symptom of various neurological disorders, including:

Other known causes include:

Tremors and Parkinson’s disease

Tremors are a major symptom of Parkinson’s disease, presenting in about 75% of cases.

When a person has the disease, nerve cells in the basal ganglia begin to die, producing less dopamine.

The basal ganglia need dopamine to form connections between neurons. A reduction in this hormone leads to fewer connections and interrupted communication within the brain, meaning movements do not occur as smoothly in the body. Additionally, tremors and other movement symptoms, such as jerking, can develop.

While pill-rolling tremors may sometimes be a symptom of other neurological conditions, such as multiple sclerosis, they are almost always an indicator of Parkinson’s disease.

As pill-rolling tremors are most commonly a symptom of Parkinson’s disease, the most common risk factors for this type of tremor are the same as those for the disease. These include:

  • Genetics: A genetic predisposition is likely in at least some cases of Parkinson’s disease. About 15–25% of people with the disease have a relative with Parkinson’s disease.
  • Age: The average age of the onset of Parkinson’s disease is close to 60 years of age.
  • Environmental factors: Researchers have identified various environmental factors associated with Parkinson’s disease, including pesticide exposure and traumatic brain injury.
  • Gender: The risk of developing Parkinson’s disease is twice as high for males compared to females. However, females experience a faster progression of the disease and have a higher mortality rate.

There is no known cure for most types of tremors, although treatment options are available to help people manage the symptoms. If a tremor is due to a treatable underlying health issue, such as hyperthyroidism, or a certain type of medication, treating the cause may reduce or stop tremors entirely.

Treatment options include the below.


Doctors prescribe various medications to treat pill-rolling tremors and Parkinson’s disease. These may include:

  • Parkinson’s disease medication: Doctors prescribe medications, such as carbidopa and levodopa, to treat the tremors associated with the disease.
  • Benzodiazepines or tranquilizers: These can include clonazepam or alprazolam, which may temporarily alleviate tremors. Healthcare professionals usually prescribe these for limited use because they may cause unwanted side effects, such as sleepiness and poor concentration, and affect a person’s ability to perform daily activities. They may also cause individuals to become dependent on these medications.
  • Beta-blockers: Doctors usually prescribe certain drugs, such as propranolol, for high blood pressure, but they may also help treat tremors.
  • Anti-seizure medication: A doctor may prescribe medications, such as primidone, when beta-blockers are not effective in reducing tremors. However, some anti-seizure medications may actually cause tremors.
  • Botulinum toxin, or Botox: A healthcare professional may administer these medications in the form of an injection to treat almost all types of tremors. Although they can improve tremors for about 3 months at a time, they may also lead to muscle weakness.
  • Dopamine agonists: Another type of medication for treating Parkinson’s disease.


If a person does not respond to medications, or they have a severe tremor that negatively affects their life significantly, a doctor may recommend surgical interventions.

These may include the below.

Deep brain stimulation (DBS)

This is the most common type of surgery for treating tremors. It is effective, low risk, and treats a broad range of symptoms.

The technique uses surgically implanted electrodes to send high-frequency electrical signals to the thalamus, a deep structure of the brain that controls some involuntary movements.

During the procedure, doctors place a small device under the skin on the chest, which generates pulses, sending electrical stimuli to the brain. This temporarily disables the tremors.

Learn more about deep brain stimulation here.


According to the Parkinson’s Foundation, this surgery is a much rarer procedure than DBS — it involves the precise, permanent destruction of the thalamus.

Here, doctors use radio waves to create an electric current to heat a nerve and disrupt its ability to send signals. A person undergoes this surgery on one side of the body to treat tremors on the opposite side.

Repeating the process on the other side of an individual’s brain may increase the risk of cognitive and speech problems.

Additionally, doctors can use focused ultrasound, another type of thalamotomy.

Lifestyle changes

Changes in lifestyle habits can also help reduce tremors. They include:

Occupational, relaxation, and physical therapy

A physical therapist may help people with tremors improve their strength and muscle control with balancing, coordination, and other exercises. Additionally, some therapists may recommend adaptive equipment, such as weights and splints, to help improve tremors.

Reducing or eliminating triggers

These triggers may include stimulant medications and caffeine. Additionally, the after-effects of alcohol can also result in tremors.

Pill-rolling tremors are resting tremors that appear as if a person is rolling a pill or other small object between their thumb and index finger. This type of tremor has strong links with Parkinson’s disease — about 75% of people experience this as a symptom.

Treatment for pill-rolling tremors may involve medication or surgery. Lifestyle changes, such as avoiding trigger substances, together with occupational, physical, and relaxation therapies, may also help ease symptoms.