Feeling your hands start to quiver during a first date or while speaking in public is quite normal, but what if this happens without any reason?
Tremors – involuntary muscle contractions that lead to shaking movements in the body – occur mostly in middle-aged or older adults, and with the hands.
But they can happen at any time and can be occasional or constant.
There are two main types: “resting tremor” which happens when the person is relaxed, and “action tremor”, when someone is moving their muscles.
So what’s causing yours?
Overactive thyroid
“An overactive thyroid causes the whole system to speed up, feeling like the body is on a high,” says Dr Ruth Handford, GP at digital healthcare provider Livi.
“As a result, the nervous stimuli become excessive, commonly resulting in a hand tremor. This can vary from barely noticeable to very exaggerated, where it’s impossible to carry a cup without spilling the contents.”
If you notice this or other symptoms, for example, unexplained weight loss, a rapid heartbeat, sweating, insomnia or anxiety, see your GP. They may prescribe daily hormone replacement tablets.
Too much caffeine
Caffeine can overstimulate the nervous system and cause our hands to shake.
“While we all have what’s known as physiologic tremor, an imperceptible shake of the extremities, when the nervous system is overstimulated it can enhance this making the shaking more noticeable. However, this type of shaking is intermittent and doesn’t last for long,” says Abbas Kanani, a pharmacist at Chemist Click.
If you notice a tremor after drinking tea or coffee, try cutting down or eliminating it from your diet.
Stress
“Stress in the form of anxiety can cause you to shake,” says Abbas.
“When stress hormones are released, your blood pressure is raised and your heart beats faster. In turn your muscles become primed to act, causing shaking and tremors. These tremors are temporary and breathing techniques can help.
“Try holding your breath for a few seconds, exhaling slowly. If you’re struggling, speak to your doctor as medication such as propranolol can help reduce tremors associated with anxiety.”
Sleep
“Extreme sleep deprivation over a prolonged period of time affects our neurological reflexes,” explains Abbas.
“However these types of shakes are temporary and will resolve once you’ve had a good rest.”
Ensure you adopt good sleep hygiene habits, such as getting into a regular routine and avoiding the use of electronic devices before bedtime.
Make sure your bedroom is dark, quiet and at a comfortable temperature too.
Multiple sclerosis
“MS tremors are usually caused by damage to the cerebellum in the brain and the nerves leading to and from it,” explains Dr Handford.
“This part of the brain controls coordination and balance. An MS tremor can also be the result of a loss of myelin, known as demyelination, in some other areas of the brain that control movement. If your MS tremor is impacting your life, speak to your GP who may recommend talking therapy. This can be particularly useful if anxiety is making your tremor worse.”
Alcohol withdrawal
“Alcohol has a depressive effect on the central nervous system, slowing down brain activity and reducing energy levels,” explains Abbas.
“Over time the body adapts to this by releasing more excitatory neurotransmitters than normal, which increases activity of the nerves, keeping the body alert.
“When alcohol is withdrawn, nerve activity is higher than usual as the brain has adapted and is still working as if alcohol is present, and this can cause tremors. This is temporary, and usually improves
with time.”
If you’re going through withdrawal, make sure you’re monitored by a medical professional who can advise you how to do this safely.
Stroke
Tremors are common after stroke, most often in the hands and arms.
“This is due to small vessel disease of the brain in the areas responsible for voluntary muscle contraction,” says Dr Handford.
“Often, tremors as a result of a stroke will resolve on their own within six months but if you’re struggling to cope with them, see your GP who may recommend physical therapy or medication.”
Parkinson’s disease
Around 80% of people with Parkinson’s have a tremor and sometimes it can be the first symptom of the disease.
“It can appear as a resting tremor or an action tremor,” says Dr Handford. “Your doctor might prescribe medication and supportive treatments, such as physiotherapy. “In some cases, deep-brain stimulation (DBS), where a small current is passed with high frequency through areas of the brain believed to block motor function, can help. It has around a 90% success rate in decreasing or eliminating a Parkinson’s tremor.”
Brain tumour
Although brain tumours are rare, one symptom is a partial seizure that can lead to muscle twitching.
“This can spread from the hand or foot and affect up to half of your body,” says Dr David Jenkinson, CEO and Chief Scientific Officer at The Brain Tumour Charity.
“These focal seizures are very different to a convulsive seizure, where someone may lose consciousness.”
If you’ve had a seizure, seek help immediately.
How to deal with tremors
For non-medical tremors, doctors advise managing stress, avoiding caffeine, stimulants and alcohol, and maintaining a healthy lifestyle.
Physiotherapy can also help build strength, coordination and aid muscle control, which can be useful when managing the condition.
Tremors caused by medical conditions, for example an overactive thyroid, can be treated with the appropriate medication.
Otherwise your doctor may prescribe medication such as beta-blockers, anti-seizure medication, tranquillisers or even Botox injections.
In severe cases, ultrasound treatment or brain surgery might be advised.
