The short answer: Everyone has a slight hand tremor, and stress, fatigue, and caffeine make it easier to see. MedlinePlus lists those triggers, along with certain medicines, an overactive thyroid, and alcohol withdrawal, among the causes of shaking. Essential tremor is the most common tremor disorder. It shakes the hands during movement. Parkinson's disease usually shakes a hand at rest. See a doctor for a tremor that is new, lasts, or comes with other symptoms.

Is it normal for hands to shake a little?

Yes. MedlinePlus says everyone has some tremor at times, but the movements are usually too small to see. Doctors call this physiologic tremor.

Some things make that normal tremor bigger. Doctors then call it enhanced physiologic tremor. The National Institute of Neurological Disorders and Stroke (NINDS) describes it as a fine, small action tremor in both hands and the fingers. NINDS says a neurological disease does not usually cause it. It is a reaction to certain drugs, alcohol withdrawal, or conditions such as an overactive thyroid and low blood sugar.

NINDS adds an important point: this tremor can go away once the cause is corrected.

The International Parkinson and Movement Disorder Society defines tremor in its 2018 consensus statement as an involuntary, rhythmic, oscillatory movement of a body part.

Which everyday triggers make hands shake?

MedlinePlus says stress, fatigue, anger, fear, caffeine, and smoking may make the normal hand tremor worse.

  • Caffeine. NINDS says too much caffeine may cause a temporary tremor or make an existing tremor worse.
  • Stress and anxiety. MedlinePlus lists anxiety or panic as a cause of tremor. If worry or panic is a regular problem, our sibling site anxiety.md covers what helps. Shaking with a pounding heart at night is the subject of our article on waking up with your heart racing.
  • Fatigue and poor sleep. NINDS says some tremors get worse when a person is tired.
  • Low blood sugar. MedlinePlus counts blood sugar below 70 mg/dL as low. Shaking or trembling is one of the symptoms, along with sweating, hunger, and a fast or pounding heartbeat. It happens most often in people who take insulin or certain other diabetes medicines.
  • Nicotine. MedlinePlus lists smoking and smokeless tobacco among the things to check for.

Which medicines cause hand tremor?

Many do. A 2022 review in the Journal of the Neurological Sciences names the drugs most often linked to tremor. The list includes amiodarone, SSRI and SNRI antidepressants, amitriptyline, lithium, valproate, and beta-agonist asthma medicines. MedlinePlus adds these groups:

  • Asthma medicines such as theophylline and albuterol
  • Immune-suppressing medicines such as steroids, cyclosporine, and tacrolimus
  • Stimulants such as caffeine and amphetamines
  • Too much thyroid medicine (levothyroxine)
  • Certain antibiotics, antivirals, and blood pressure medicines

The 2022 review says the risk is higher with high doses, older age, and the use of many medicines at once. It also says the tremor usually stops after the medicine is stopped, although it persists in some cases.

Do not stop a medicine on your own. MedlinePlus says to talk to your provider first. The provider can lower the dose or switch you to a different medicine.

Can a thyroid problem or alcohol withdrawal cause shaky hands?

Overactive thyroid. MedlinePlus lists hand tremor as a common symptom of hyperthyroidism. Other common symptoms are nervousness, heat intolerance, increased sweating, a pounding or racing heartbeat, and weight loss. A blood test for thyroid hormones and TSH checks for it. Our sibling site thyroid.md explains those tests. Our article on unintentional weight loss covers that symptom.

Alcohol withdrawal. This occurs when a person who drinks heavily and regularly stops suddenly. MedlinePlus says symptoms tend to start within 8 hours after the last drink and tend to peak by 24 to 72 hours. Shakiness and tremor of the hands are typical. So are anxiety, sweating, nausea, and a rapid heart rate.

MedlinePlus calls alcohol withdrawal a serious condition that may quickly become life-threatening. Its severe form, delirium tremens, can cause sudden confusion, fever, hallucinations, and seizures.

What is essential tremor, and how common is it?

Essential tremor is the most common type of tremor disorder, according to MedlinePlus. Its exact cause is unknown. NINDS describes its key feature as a tremor in both hands and arms during action, without other neurological signs. It can also affect the head and the voice.

MedlinePlus describes small, rapid movements that occur 4 to 12 times a second. People notice them when they write, drink from a cup, or use tools. Stress, caffeine, lack of sleep, and certain medicines make the tremor worse.

It often runs in families. NINDS says essential tremor is inherited in 50 to 70% of cases.

Prevalence estimates differ by method, but all of them rise sharply with age:

MedlinePlus says essential tremor is not a dangerous problem. Treatment may not be needed unless the tremor interferes with daily activities or causes embarrassment. NINDS notes that it can stay mild or slowly get worse over time.

How is a Parkinson's tremor different?

The main difference is when the shaking occurs. A 2019 review in Continuum says doctors first establish whether a tremor is an action tremor or a resting tremor. It names essential tremor, enhanced physiologic tremor, and drug-induced tremor among the most common action tremors. It calls Parkinson's disease the most common disorder of resting tremor.

  • Timing. NINDS says a Parkinson's tremor is most obvious when the hand is at rest and may improve when the person moves on purpose. Essential tremor shows during action.
  • Appearance. The thumb and forefinger often rub together. NINDS says this may look like "pill rolling."
  • Sides. NINDS says a Parkinson's tremor may first appear in one limb or on one side of the body. Essential tremor affects both hands, although MedlinePlus notes the two sides can differ.
  • Other signs. Parkinson's disease also causes muscle stiffness, slow movement, and balance problems. Essential tremor occurs without other neurological signs.

These rules have exceptions. A 2022 review of essential tremor says it can be hard to tell these tremors apart from the examination alone. NINDS also notes that some people with Parkinson's disease never develop a tremor.

When should you see a doctor about shaky hands?

MedlinePlus says to contact your provider if you have a new tremor. It also says a tremor that does not go away over time should be checked. MedlinePlus lists these reasons to call:

  • The tremor is worse at rest and gets better when you move, such as when you reach for something.
  • The tremor is prolonged or severe, or it interferes with your life.
  • The tremor occurs with other symptoms, such as headache, weakness, abnormal tongue movements, muscle tightening, or other movements you cannot control.

Also call if a tremor starts while you take a medicine and it interferes with your activity, as MedlinePlus advises.

Some situations need emergency care:

  • Possible alcohol withdrawal. MedlinePlus says to contact your provider right away or go to the emergency room. Call 911 for seizures, fever, severe confusion, hallucinations, or an irregular heartbeat.
  • Low blood sugar with confusion, fainting, or a seizure. MedlinePlus says unclear thinking and seizures occur at lower blood sugar levels, below 54 mg/dL.

At the visit, expect a neurological examination. MedlinePlus says the provider may order thyroid function tests and a glucose test. Our guide to warning signs that need a doctor covers other symptoms.

The bottom line

Most shaky hands come from a normal tremor that stress, fatigue, caffeine, or a medicine has made bigger. That kind often improves when the cause is corrected. Essential tremor is the most common tremor disorder, and it shows when you use your hands. A tremor at rest, a tremor on one side, or a tremor with stiffness or slow movement needs a medical examination. Possible alcohol withdrawal needs care right away.

Last updated: October 2026. This article is for informational purposes only and does not constitute medical advice. See a health care provider about a new or lasting tremor, and do not stop or change a prescribed medicine without medical guidance.