A slight shake in your hands is normal. The NHS and HSE both say that if you hold your hands out in front of you, they will not be completely still. That shake often becomes more noticeable when you are stressed, anxious, tired or angry. It also shows up after caffeine, alcohol or smoking, if you are very hot or cold, and as you get older.
When a tremor is new or getting worse, the cause can often be found and treated. Examples are a medicine, an overactive thyroid or low blood sugar. A tremor that lasts is often essential tremor, one of the most common movement disorders. Parkinson's disease is a possible cause, but a shake on its own does not mean Parkinson's.
This guide covers the usual causes, the warning signs, and what your GP will do.
Call 112 or 999 (Ireland), 999 (UK) or 911 (US) if shaking comes with:
Contact a doctor straight away (in the UK you can call 111) if you take sodium valproate and develop new shakes or unusual eye movements.
See a GP (not urgent) if:
A tremor is shaking or trembling in part of your body that you cannot control. It usually affects the hands. It can also affect the head, legs or voice.
Doctors sort tremors by when they happen.
Neither type tells you the cause on its own.
Everyone has a slight tremor. When it becomes stronger, doctors may call it "enhanced physiologic tremor". The US National Institute of Neurological Disorders and Stroke (NINDS) describes it as a small tremor of both hands and fingers during action. It is generally not caused by a disease of the nervous system. Causes include certain drugs, alcohol withdrawal, an overactive thyroid and low blood sugar. NINDS says this tremor can go away once the cause is corrected.
The NHS and HSE both list stress, anxiety, tiredness and anger as things that make a tremor more noticeable. Trembling and shaky limbs are also on the NHS list of panic attack symptoms. Other symptoms include a racing heart, sweating and shortness of breath.
If shaking comes with frequent worry or panic, the anxiety is worth getting help for in its own right. Our guide to panic attacks versus panic disorder explains the difference and what helps.
Drinks with caffeine, such as tea, coffee and cola, can make a tremor more noticeable. So can smoking. NINDS says excessive caffeine may cause a temporary tremor or make an existing one worse. The HSE suggests drinking less caffeine if it seems to trigger your tremor.
Alcohol works in two directions. NINDS notes that many people with essential tremor find alcohol eases it, but that is not a treatment. Shaking is also a common symptom of alcohol withdrawal. The HSE says withdrawal symptoms start about 8 hours after the last drink and may get worse over the next 24 to 48 hours. It lists shaking hands among the signs of physical dependence. Talk to your GP before stopping heavy drinking, because you may need medicine to stop safely. In Ireland, the HSE drugs and alcohol helpline is free on 1800 459 459.
Many medicines can cause a tremor. NINDS lists certain asthma medicines, corticosteroids (steroids), chemotherapy, and some drugs for psychiatric and neurological conditions. Examples from NHS medicine guides:
Do not stop a prescribed medicine suddenly because of a tremor. The HSE says stopping suddenly could be harmful. Speak to your GP or pharmacist first.
Shaking, sweating, hunger, dizziness and feeling anxious or irritable are all symptoms of low blood sugar (hypoglycaemia). It mostly affects people with diabetes who take insulin or certain other diabetes medicines. The NHS says it is rare in people without diabetes.
If you have diabetes, check your blood sugar when these symptoms come on and follow your treatment plan. If you do not have diabetes and get episodes like this, see a GP.
An overactive thyroid can cause twitching or trembling. It often comes with other signs, such as a fast or irregular heartbeat, sweating, weight loss despite a good appetite, anxiety and difficulty sleeping. A blood test can often show whether the thyroid is the cause. Our article on the thyroid and the brain explains more.
The key feature of essential tremor is a shake in both hands and arms during action, with no other neurological signs. It can also affect the head, voice or legs. NINDS says it most often starts in adolescence or between 40 and 50. It runs in families in 50 to 70% of cases.
A 2021 review pooled 42 population studies from 23 countries. About 1.3% of people of all ages had essential tremor. Among people aged 65 and over, the figure was about 5.8%. The studies varied a lot, so these are rough figures.
Mild essential tremor does not always need treatment. If it gets in the way of life, medicines can help, and surgery is an option for a few people with severe tremor.
In Parkinson's, the tremor usually starts in one hand or arm. It is more likely when the limb is relaxed and resting. NINDS describes it as looking like rolling a pill between the thumb and a finger. It may start on one side and spread to both sides later.
Not everyone with Parkinson's has a tremor. The NHS says the main symptoms are tremor, slow movement and stiff muscles. Most people develop symptoms over the age of 50.
Our article on essential tremor or Parkinson's goes into how doctors tell the two apart. Our guide to Parkinson's disease treatment covers what treatment can and cannot do.
The NHS and HSE say your GP will examine you and ask about:
Before your appointment, note when the shaking happens and what makes it better or worse. A short phone video helps if it comes and goes.
NINDS says a doctor will usually check muscle tone, strength, reflexes, balance and speech. They will see whether it happens at rest or in action, on one side or both, and how large it is. You may be asked to write or to hold a cup.
Blood tests may look for causes such as thyroid or blood sugar problems. A mild tremor with no underlying cause does not usually need treatment, and your GP may simply monitor it. If it could be Parkinson's or multiple sclerosis, they may refer you to a specialist. NICE guidance in England says people with suspected Parkinson's should be referred quickly, and untreated, to a specialist. The NHS says this is usually a neurologist or a geriatrician (a doctor who specialises in older people). Our guide to getting referred to a neurologist in Ireland explains the routes.
There is no single test for Parkinson's. The NHS says the diagnosis is based on symptoms, history and a detailed examination. A special brain scan is sometimes used to help rule out other causes.
The NHS, HSE and NINDS suggest:
Yes. The NHS and HSE say a slight tremor is normal. See a GP if it is getting worse or affecting daily life.
Yes. Stress and anxiety make tremors more noticeable, and trembling is a symptom of panic attacks. If it happens a lot, it is worth getting the anxiety itself assessed. Your GP can also check other causes, such as thyroid problems or medicines.
Not on its own. Tremor has many causes. A Parkinson's tremor tends to start on one side and happen at rest. It usually comes with slowness or stiffness. A shake in both hands when you use them is more typical of essential tremor or an enhanced normal tremor. Only a doctor's examination can tell.
There are several possible reasons, including caffeine, anxiety, tiredness and low blood sugar. Shaking that starts some hours after your last drink can be a sign of alcohol withdrawal. Talk to your GP about it. The HSE says some people need medicine to stop drinking safely.
This article is general information, not medical advice. It cannot tell you the cause of your symptoms. If your tremor is getting worse or affecting your daily life, see your GP.
Reviewed by: Proco Team
Last updated: November 2026