Why Do My Hands Shake? Causes, Treatments and Science-Backed Solutions
Occasional hand shaking is common and is often harmless. It may occur after drinking too much coffee, during periods of stress, after strenuous exercise, or when blood sugar levels fall.
However, persistent or worsening hand tremors may indicate an underlying medical condition such as essential tremor, thyroid disease, medication side effects, vitamin deficiencies, Parkinson’s disease, or neurological disorders.
Understanding the cause of your hand tremor is important because treatment depends on the underlying condition.
Common Symptoms
Hand tremors may appear as:
- Shaking while holding a cup
- Difficulty writing
- Trouble using utensils
- Difficulty buttoning clothes
- Shaky handwriting
- Trembling when reaching for objects
- Tremor affecting one or both hands
- Tremor that worsens with stress
What Is a Tremor?
A tremor is an involuntary, rhythmic movement caused by alternating muscle contractions.
Several types of tremors exist, and identifying when the shaking occurs helps determine the cause.
Examples include:
- Tremor while using the hands (action tremor)
- Tremor while holding a position (postural tremor)
- Tremor while the hands are resting (resting tremor)
Why Do My Hands Shake?
Essential Tremor (Most Common Cause)
Essential tremor is the most common movement disorder.
It usually affects both hands and often becomes more noticeable during activities such as:
- Writing
- Drinking from a cup
- Eating
- Using tools
Unlike Parkinson’s disease, essential tremor usually occurs during movement rather than at rest.
It often runs in families and may gradually worsen with age.
Anxiety and Stress
Stress activates the body’s “fight-or-flight” response, releasing adrenaline.
This may cause:
- Trembling hands
- Sweating
- Rapid heartbeat
- Feeling shaky
Many people notice hand tremors before:
- Public speaking
- Examinations
- Interviews
- Emotional events
Too Much Caffeine
Large amounts of caffeine stimulate the nervous system.
Common sources include:
- Coffee
- Energy drinks
- Strong tea
- Pre-workout supplements
Reducing caffeine intake often improves symptoms.
Low Blood Sugar (Hypoglycemia)
When blood sugar falls too low, the body releases adrenaline.
Symptoms include:
- Trembling
- Sweating
- Hunger
- Dizziness
- Palpitations
- Confusion
People with diabetes taking insulin or sulfonylureas are at higher risk.
Hyperthyroidism (Overactive Thyroid)
An overactive thyroid speeds up metabolism and commonly causes:
- Fine hand tremor
- Weight loss
- Anxiety
- Sweating
- Fast heartbeat
- Heat intolerance
Certain Medications
Many commonly used medications may cause hand tremors.
Examples include:
Asthma Inhalers
- Salbutamol (Albuterol)
- Terbutaline
Antidepressants
Some SSRIs and SNRIs may cause tremor in susceptible individuals.
Examples include:
- Sertraline
- Fluoxetine
- Venlafaxine
Lithium
Lithium commonly causes a fine hand tremor, particularly at higher blood concentrations.
Valproate
Used to treat epilepsy and bipolar disorder.
May produce dose-related tremor.
Corticosteroids
Examples:
- Prednisone
- Dexamethasone
Tacrolimus and Cyclosporine
These immunosuppressants commonly cause tremor.
Excess Thyroid Hormone
Taking more levothyroxine than needed may produce symptoms similar to hyperthyroidism.
Parkinson’s Disease
Parkinson’s disease usually causes a resting tremor.
Typical features include:
- Tremor when the hand is relaxed
- Tremor affecting one side first
- Slowness of movement
- Muscle stiffness
- Reduced arm swing while walking
Not every hand tremor indicates Parkinson’s disease.
Vitamin Deficiencies
Several nutrient deficiencies may contribute to neurological symptoms, although they are less common causes of tremor than essential tremor, medications, or thyroid disease.
Vitamin B12 Deficiency
Low vitamin B12 may cause:
- Numbness
- Tingling
- Balance problems
- Weakness
- Tremor in some individuals
Magnesium Deficiency
Severe magnesium deficiency may contribute to:
- Muscle twitching
- Tremors
- Muscle cramps
- Weakness
Mild deficiency is more likely to cause muscle cramps than persistent hand tremors.
Vitamin B6 Deficiency
Vitamin B6 is important for normal nerve function.
Deficiency is uncommon but may contribute to neurological symptoms.
Alcohol
Small amounts of alcohol temporarily improve essential tremor in some individuals.
However, alcohol is not a treatment.
Heavy alcohol use and alcohol withdrawal can both worsen tremors.
Rare Causes
Less common causes include:
- Multiple sclerosis
- Wilson’s disease
- Cerebellar disorders
- Stroke
- Heavy metal poisoning
- Liver failure
- Kidney failure
How Is Hand Tremor Diagnosed?
Your healthcare provider may recommend:
- Medical history
- Neurological examination
- Medication review
- Blood tests
Possible blood tests include:
- Thyroid function (TSH, Free T4)
- Blood glucose
- HbA1c
- Vitamin B12
- CBC
- Electrolytes
- Magnesium (when appropriate)
Some individuals may require brain imaging or referral to a neurologist.
How Can I Reduce Hand Tremors?
Reduce Caffeine
Gradually reducing caffeine intake may improve tremors caused by excessive stimulation.
Manage Stress
Helpful approaches include:
- Regular exercise
- Mindfulness
- Yoga
- Good sleep habits
- Breathing exercises
Eat Regular Meals
Preventing low blood sugar may reduce shaking in susceptible individuals.
Review Medications
Never stop prescribed medication yourself, but ask your healthcare provider whether a medication could be contributing to your symptoms.
Treat Underlying Conditions
Managing thyroid disease, diabetes, or vitamin deficiencies often improves symptoms.
Supplements That May Support Nervous System Health
Vitamin B12
Supplementation is appropriate for confirmed deficiency or individuals at increased risk, such as vegans, older adults, and people taking long-term metformin or proton pump inhibitors.
Magnesium
Magnesium may support normal muscle and nerve function in people with inadequate intake or deficiency.
It is not an established treatment for essential tremor or Parkinson’s disease.
Omega-3 Fatty Acids
Omega-3 fatty acids support overall brain and nervous system health, although they have not been shown to treat hand tremors directly.
Coenzyme Q10 (CoQ10)
CoQ10 has been studied for several neurological conditions because of its role in mitochondrial energy production.
Current evidence does not support CoQ10 as a standard treatment for essential tremor, but maintaining adequate levels is important for overall cellular health.
Amazon Recommendations
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Why do my hands shake when I hold something?
This is often called an action tremor or postural tremor and is commonly associated with essential tremor, anxiety, caffeine, or certain medications.
Is hand shaking always Parkinson’s disease?
No.
Essential tremor is considerably more common than Parkinson’s disease. Parkinson’s tremor typically occurs when the hand is at rest and is often accompanied by stiffness and slowed movements.
Can anxiety make your hands shake?
Yes.
Stress and anxiety commonly trigger temporary hand tremors through the release of adrenaline.
Which vitamin deficiency causes hand tremors?
Vitamin B12 deficiency can contribute to neurological symptoms, including tremor in some individuals. Severe magnesium or vitamin B6 deficiency may also affect nerve and muscle function, but these are less common causes.
Can thyroid problems cause shaky hands?
Yes.
Hyperthyroidism commonly causes a fine hand tremor along with weight loss, rapid heartbeat, heat intolerance, and anxiety.
Which medications commonly cause tremors?
Several medications may contribute, including asthma inhalers, lithium, valproate, some antidepressants, corticosteroids, tacrolimus, cyclosporine, and excessive thyroid hormone replacement.
When should I see a doctor?
Medical evaluation is recommended if hand tremors:
- Persist or worsen
- Interfere with daily activities
- Begin suddenly
- Are associated with weakness, numbness, or difficulty walking
- Occur with changes in speech or vision
- Are accompanied by weight loss or symptoms of thyroid disease
Clinical Considerations
Most hand tremors are caused by essential tremor, anxiety, medications, caffeine, or thyroid disorders rather than serious neurological disease. A careful history, medication review, physical examination, and selected laboratory tests can often identify the underlying cause.
Persistent, progressive, or disabling tremors should be evaluated by a healthcare professional, particularly when accompanied by neurological symptoms.
When should I see a doctor?
Medical evaluation is recommended if hand tremors:
- Persist or worsen
- Interfere with daily activities
- Begin suddenly
- Are associated with weakness, numbness, or difficulty walking
- Occur with changes in speech or vision
- Are accompanied by weight loss or symptoms of thyroid disease
Clinical Considerations
Most hand tremors are caused by essential tremor, anxiety, medications, caffeine, or thyroid disorders rather than serious neurological disease. A careful history, medication review, physical examination, and selected laboratory tests can often identify the underlying cause.
Persistent, progressive, or disabling tremors should be evaluated by a healthcare professional, particularly when accompanied by neurological symptoms.
Related Guides
- Why Do My Hands Go Numb at Night?
- Why Is My Neck Stiff and Painful?
- Why Am I So Forgetful Lately?
- Vitamin B12 Deficiency: Symptoms, Causes and Treatment
- Magnesium: Benefits, Types and Dosage
- Coenzyme Q10: Benefits, Dosage and Side Effects
- Best Supplements for Energy
- Why Am I Always Tired?
- Why Are My Legs Cramping at Night? Causes, Deficiencies and Solutions
References
- National Institute of Neurological Disorders and Stroke (NINDS). Essential Tremor Information Page.
- American Academy of Neurology (AAN). Practice Guideline: Essential Tremor.
- International Parkinson and Movement Disorder Society. Diagnostic Criteria for Parkinson’s Disease.
- National Institutes of Health (NIH). Office of Dietary Supplements – Vitamin B12 Fact Sheet.
- American Thyroid Association. Hyperthyroidism Guidelines.
- American Diabetes Association. Standards of Care in Diabetes.
- Mayo Clinic. Essential Tremor.
- Cleveland Clinic. Hand Tremors: Causes and Treatment.
- PubMed. Reviews on Essential Tremor and Movement Disorders.
