Migraine headaches and tremors are distinct neurological phenomena, yet many people who experience migraines also report episodes of involuntary shaking. Migraines involve intense, throbbing head pain, often accompanied by sensitivity to light and sound. A tremor is a rhythmic, involuntary muscle contraction that causes shaking in one or more body parts. The relationship is complex: while a migraine itself can directly cause a tremor in rare cases, the shaking is more frequently a result of co-existing conditions or medication side effects. Understanding the underlying cause is the first step toward effective management.
Understanding the Neurological Link
In a small number of cases, the migraine attack itself can directly trigger a movement disorder like a tremor as part of the neurological disturbance. This occurs most notably in rare migraine subtypes, such as hemiplegic migraine, where the aura phase includes temporary motor weakness, or hemiparesis. This weakness affects one side of the body and, while not typically a rhythmic tremor, the resulting motor dysfunction and instability can be perceived as shaking or clumsiness.
Hemiplegic migraine is defined by this episodic, reversible motor weakness, which usually lasts less than 24 hours and often precedes the headache phase. These symptoms are thought to be related to temporary electrical and chemical signaling dysfunction in the brain. In extremely rare instances of complicated aura, a tremor or other involuntary movement may manifest as a result of cortical spreading depression, a temporary neurological event that alters brain activity and affects motor pathways.
Common Co-occurring Factors
The most common reasons for experiencing a tremor with migraines are co-occurring medical conditions or side effects of treatment. Many medications prescribed to prevent or treat migraines are known to cause tremor as a side effect. For instance, the anticonvulsant divalproex sodium, often used as a migraine prophylactic, can induce a postural tremor in a significant percentage of patients.
Other preventive treatments, including certain tricyclic antidepressants like amitriptyline, are also known to enhance physiological tremor, making a slight natural shake more pronounced. Even medications used for acute migraine attacks, such as the anti-nausea drug metoclopramide, can occasionally lead to involuntary movements. When a tremor is persistent and not strictly linked to the acute migraine attack, a medication-induced cause is a common differential diagnosis.
Beyond medication effects, a significant number of migraine sufferers also have a separate, co-existing neurological condition called Essential Tremor (ET). Essential Tremor is one of the most common movement disorders. Studies suggest that individuals with migraines have an approximately 1.83-fold increased risk of subsequently developing ET compared to those without migraines. This bidirectional connection suggests a shared underlying pathophysiology, possibly involving the cerebellum, the brain region responsible for motor control and coordination.
Acute psychological stress and intense pain can also trigger a temporary, non-pathological shaking, known as a physiological tremor. The intense pain and associated anxiety during a severe migraine attack can cause a surge of adrenaline, which naturally amplifies this physiological tremor. This type of shaking is usually mild and resolves shortly after the pain and anxiety subside, representing a temporary response to the body’s acute stress reaction.
When to Consult a Healthcare Provider
Consult a healthcare provider for any new or worsening tremor, particularly if the shaking is persistent or occurs outside the acute migraine phase. Immediate medical attention is necessary if a tremor is accompanied by red-flag symptoms. These symptoms include sudden, severe weakness or paralysis on one side of the body, difficulty speaking, slurred speech, or profound confusion.
Any tremor that is unilateral should be promptly evaluated to rule out conditions like stroke or other focal neurological issues. A consultation is also warranted if the tremor is progressive or significantly interferes with daily activities like eating or writing. It is helpful to track the tremor’s timing, noting whether it occurs before, during, or after the headache, and whether it is present when taking specific medications.