Hand tremors can be caused by anxiety, caffeine, essential tremor, low blood sugar, or medicines. See a doctor if they persist.
Causes
- Anxiety, stress and fatigue.
- Caffeine and stimulants.
- Essential tremor, the most common movement disorder (affects about 7 million Americans).
- Low blood sugar.
- Medicines (asthma inhalers, antidepressants, lithium).
- Alcohol withdrawal.
- Overactive thyroid.
- Parkinson’s disease (resting tremor).
What helps
Cut caffeine, sleep, manage stress and avoid triggers.
See a doctor if
The tremor persists, worsens, affects daily tasks or comes with other symptoms like stiffness or weakness.
Emergency
Tremor with confusion, weakness or speech trouble needs 911.
Treatment
Propranolol and primidone for essential tremor.
Types of tremor
- Resting tremor: happens when the muscle is relaxed, as seen in Parkinson’s disease.
- Action tremor: occurs during movement. It includes postural tremor (holding arms out) and kinetic tremor (reaching for an object).
- Essential tremor: the most common movement disorder, affecting an estimated 7 million Americans, according to the International Essential Tremor Foundation. It often runs in families.
Physiologic tremor
Everyone has a very slight tremor, which becomes visible with caffeine, stress, fatigue, low blood sugar, strong exercise or some medications.
Medicines that cause tremor
Asthma inhalers (albuterol), stimulants, antidepressants such as SSRIs, lithium, valproate, steroids and thyroid hormone excess. Do not stop a prescribed medicine without talking to the prescriber.
Medical conditions
- Overactive thyroid (hyperthyroidism).
- Low blood sugar.
- Alcohol withdrawal.
- Parkinson’s disease.
- Multiple sclerosis.
- Stroke or brain injury.
- Liver or kidney failure.
- Anxiety and panic attacks.
Practical steps
- Reduce caffeine and nicotine.
- Get enough sleep and manage stress.
- Avoid alcohol, which temporarily helps some essential tremor but can worsen it later.
- Try wrist weights, heavier utensils or adaptive devices.
Treatment of essential tremor
First line drugs include propranolol and primidone. Botulinum toxin, focused ultrasound and deep brain stimulation are options in severe cases.
Tests
A doctor does a neurological exam and may order blood tests for thyroid function, glucose, electrolytes and others, plus imaging if needed.
Get help quickly if
A tremor starts suddenly along with weakness, speech trouble, confusion or facial droop. Call 911.
Types of tremor
Physiologic tremor is a fine shaking present in everyone, and it can be heightened by caffeine, stress, fatigue, alcohol withdrawal, hyperthyroidism and medicines such as albuterol, lithium, valproate and some antidepressants. Essential tremor is the most common movement disorder, affecting an estimated 7 million Americans, and it shows as action tremor in the hands during writing or drinking, often with family history. Parkinson disease causes a resting tremor of 4 to 6 hertz, often like pill rolling in one hand, along with slowness and stiffness. Tremor with weight loss, heat intolerance and a fast pulse suggests overactive thyroid.
Evaluation and treatment
A doctor will review medications and may order thyroid tests, blood glucose, electrolytes and sometimes imaging. For essential tremor, propranolol and primidone are first line drugs, and procedures include deep brain stimulation and MRI guided focused ultrasound, which the FDA approved in 2016. Reducing caffeine, getting enough sleep, using weighted utensils and managing stress help. See a doctor if tremor interferes with daily tasks, begins suddenly, affects one side, or comes with weakness, speech trouble or stiffness. Sudden tremor with confusion or fever can be an emergency.
Based on data from the NINDS and the International Essential Tremor Foundation
