Neurology
Tremor
A tremor is a rhythmic shaking or trembling, most often of the hands, which can have many causes ranging from harmless to ones that need treatment.
Education and reference only. This explains the common causes of tremor and the warning signs that need urgent help, in plain language — it is not a diagnosis or a substitute for advice from a clinician. If you feel very unwell or are worried, seek medical help.
Quick answer
What is tremor?
A tremor is an involuntary, rhythmic movement, usually noticed in the hands but sometimes affecting the head, voice or legs. Mild shaking is normal and can be brought on by tiredness, caffeine, stress, cold or strong emotion.
- Get urgent help: A sudden tremor with weakness, slurred speech, or loss of balance — this can be a stroke; call 999. Tremor with confusion, sweating and a racing heart — this can be alcohol withdrawal or low blood sugar and needs urgent help.
- Self-care: If your tremor is mild and brought on by everyday triggers, it often helps to cut back on caffeine, get enough sleep, and find ways to lower stress, as tiredness and tension make shaking worse.
About tremor
A tremor is an involuntary, rhythmic movement, usually noticed in the hands but sometimes affecting the head, voice or legs. Mild shaking is normal and can be brought on by tiredness, caffeine, stress, cold or strong emotion. A more noticeable tremor may run in families, appear with movement such as holding a cup, or occur at rest. While many tremors are not dangerous, some point to conditions such as an overactive thyroid or a neurological condition, and a few signal something urgent. Working out when the tremor happens — at rest, while holding a position, or during movement — helps point to the cause.
When to get help
Call 999 or go to A&E if tremor comes with any of these warning signs:
- A sudden tremor with weakness, slurred speech, or loss of balance — this can be a stroke; call 999.
- Tremor with confusion, sweating and a racing heart — this can be alcohol withdrawal or low blood sugar and needs urgent help.
- A tremor that comes on quickly and affects daily life — get prompt assessment.
When to see a doctor
See a doctor if a tremor is new, getting worse, affecting your daily tasks, or making you self-conscious. It is also worth being seen if the shaking comes with stiffness or slowness of movement, weight loss, a racing heartbeat, or if you think it may be linked to your drinking. Many tremors can be helped once the cause is found, so getting assessed is worthwhile rather than putting up with it.
Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.
What can cause it
Common causes of tremor
Tremor has many possible causes. Each links to a full, plain-language guide to that condition — what it is, how it's treated and when to seek help.
What helps
Self-care and what you can do
If your tremor is mild and brought on by everyday triggers, it often helps to cut back on caffeine, get enough sleep, and find ways to lower stress, as tiredness and tension make shaking worse. Keep warm, since cold can increase trembling, and use both hands or rest your arm on a surface for steady tasks. Limiting alcohol is sensible, as drinking can mask a tremor briefly but make it worse overall. Keeping a note of when the tremor happens and what makes it better or worse is useful information to share when you seek advice.
Answers
Tremor: frequently asked questions
Is a shaky hand always serious?
No. Mild shaking is common and is often caused by tiredness, caffeine, stress or cold. A tremor that is new, getting worse, or affecting daily life is worth getting checked, as is one that comes with stiffness or slowness.
What is the difference between essential tremor and Parkinson's?
Essential tremor usually appears during movement, such as holding a cup, and often runs in families. The tremor of Parkinson's tends to happen at rest and comes with stiffness and slowness. A doctor can help tell them apart.
Can anxiety cause trembling?
Yes. Stress and anxiety release adrenaline, which can make the hands shake, especially in tense situations. This kind of tremor usually settles as the anxiety eases.
Does caffeine make tremor worse?
It can. Caffeine and other stimulants can increase a fine tremor of the hands. Cutting back often reduces shaking, and is a simple first step worth trying.
Sources
Where this is drawn from
- NICE CKS: Tremor.
- Parkinson's UK (charity)
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