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When you see your thumb twitching or fingers moving, you may wonder, “Why are my hands shaking for no reason?” Though these movements happen involuntarily, hand tremors usually happen for a reason. Most of the time, the cause isn’t something serious — maybe it’s too much coffee or stress, for instance.

In some cases, however, the cause is a medical problem. Though handshaking isn’t a problem in itself, it can make certain tasks difficult. Treating the cause of hand tremors can help stop or reduce it.

Hand Tremor Causes

Most of the time, shaking hands involves diet, lifestyle, or medication changes. Hand tremors can happen because of:

• A lack of sleep.
• Nutritional deficiency — A lack of vitamin B12, calcium, or magnesium can cause shaking hands.
• Medication — Some antidepressants, asthma inhalers, certain heart treatments, steroids, and other medications can cause hand tremors as a side effect.
• Skipping meals — Low levels of sugar or sodium in the blood can cause handshaking.
• Stress.
• Too much caffeine.
• Withdrawing from certain drugs or substances — Quitting alcohol or benzodiazepines can cause handshaking for days to months.

In some cases, a medical disorder can cause hand tremors. These include:

• Essential tremor.
• Liver or kidney problems.
• Multiple sclerosis (MS).
• Overactive thyroid.
• Parkinson’s disease.
• Previous stroke (people can have a stroke without realizing it).

Talk to your doctor if your hand tremors last more than two weeks or come with other symptoms that concern you.

How Doctors Diagnose Hand Tremors

Your doctor will ask you when your hand tremors started, how often your hands shake, and when your hands are most likely to shake. For instance, some types of hand tremors happen when the hands are at rest. Others occur when you outstretch your arms in front of you or try to do something with your hands.

How and when your tumor occurs will help your doctor narrow down the cause.

Tests to diagnose the cause of hand tremors include:

• Blood tests — To look for signs of thyroid problems, a lack of certain nutrients, or issues with the liver or kidney.
• Electromyography — To measure how your nerves and muscles respond to electrical signals.
• A neurological exam — To check overall brain and nervous system functioning.
• Imaging tests — A doctor may order a CT scan or MRI to look for signs of damage to the brain from a stroke.

The type of test your doctor suggests will depend on what they think is the most likely cause of your tremors.

Common Types of Hand Tremors

How often and when your hand tremors happen and what they look like provide clues to their cause.

Enhanced physiologic tremor

This is the most common type of hand tremor. An enhanced physiologic tremor may happen due to stress, poor diet, lack of sleep, an overactive thyroid, or medication. In other words, its cause is reversible.

Most people notice enhanced physiologic tremors when they hold their arms out in front of them.

Their hands may shake with their arms outstretched but not at rest. These tremors are also more likely when people perform precise tasks with their hands, such as threading a needle.

Essential tremor

Some people with essential tremor notice the tremor only in their hands, at least at first. However, this condition can also cause tremors in the arms, legs, head, and vocal cords (leading to speech problems).

Essential tremors can occur when the hands are moving or at rest. They can get worse over time. In 50% of cases, families pass down essential tremors because they’re genetic.

Though essential tremor can happen at any age, it’s more common in people over 40. There are no tests to confirm essential tremor. Doctors diagnose people with essential tremors when they have essential tremor symptoms and tests don’t show any other cause.

Parkinson’s disorder tremor

The hand tremor of Parkinson’s disease looks different from other types of tremors. The tremor seems like the person is rolling a pill between their thumb and pointer finger.

Unlike physiologic tremor, this type occurs when the person is at rest. It goes away when they’re moving.

Though hand tremors can present as the first sign of Parkinson’s disease, the disease eventually affects the whole body. Parkinson’s disease symptoms also include uncontrollable movements in other parts of the body, including the arms and head. Early symptoms can also include stiff muscles, slow movements, poor balance, and trouble walking.

Intention tremor (cerebellar tremor)

Damage to the cerebellum in the back of the brain causes this tremor. This damage can happen from a stroke, MS, or brain trauma.

People tend to notice this tremor when they reach for something, like a doorknob or button. That’s why some also call it an intention tremor — it happens when the person who has it intends to perform a task. The tremor tends to get worse as they get closer to the object.

This type of tremor doesn’t occur when someone is at rest.

How Do Doctors Treat Hand Tremors?

How doctors treat hand tremors depends on the cause. If your hand tremor is due to an overactive thyroid, your doctor will prescribe medication to block the thyroid from making too much hormone. If your handshaking is from a new medication, your doctor may reduce your dose or switch you to another treatment.

If your tremors result from more serious conditions, like MS or Parkinson’s, medications that treat these diseases will also reduce your tremor. If tremors are due to a stroke, physical or occupational therapy can help.

With essential tremor, doctors treat the tremor itself rather than an underlying disease. Treatments for essential tremors can include anti-seizure drugs, Botox injections, and beta-blockers.

Surgery can also help when tremors caused by Parkinson’s disease, MS, and essential tremors remain severe, even with medication. Deep brain stimulation involves placing electrodes in the brain to regulate the signals that cause tremors.

Though handshaking can cause people to think they have a serious disease, the cause is usually not serious. Handshaking usually improves with simple lifestyle adjustments, like getting enough sleep, eating well, reducing stress, and limiting caffeine.