Have you noticed your hands shaking while holding a coffee cup or tying your shoes? While hand tremors can be a normal part of aging, they may also be a symptom of an underlying medical condition. Before you jump to any conclusions, know that there are several factors that can trigger shaking, including caffeine overload. If your hands are shaking because of an underlying medical condition, there are treatments available.

Common Tremor Types and Causes

Understanding the different types of tremors and their causes can help you have a more informed discussion with your physician.

Essential Tremor: A neurologic disorder affecting more than 10 million Americans, essential tremor is the most common cause of shaky hands. These tremors typically occur during everyday actions, like picking up your car keys or holding a glass of water.

“Though it is often confused with Parkinson's disease, essential tremor is not tied to any other condition and is more common in adults over the age of 65,” say Sachin S. Kapur, MD, a movement disorders neurologist at Northwestern Medicine.

The condition can also be hereditary. About half of all people diagnosed with essential tremor have a parent with it. In addition to the hands, essential tremor can also cause tremors in your legs and jaw.

Enhanced Physiologic Tremor: Everyone experiences physiologic tremor, a natural tremor that goes unnoticed and happens at rest and during activity. However, physiologic tremor can be enhanced by:

• Stress
• Caffeine
• Smoking tobacco products
• Alcohol withdrawal
• Certain medications, such as amphetamines and some antidepressants
• Medical conditions like overactive thyroid (hyperthyroidism) and low blood sugar (hypoglycemia).

Any of these triggers can make the tremor visible. Enhanced physiologic tremor lessens or goes away if you are able to avoid or manage your trigger, such as coffee, cigarettes, alcohol or stress.

Parkinson’s Disease: Shaking hands are often associated with Parkinson’s disease, as it is often one of the first signs of the neurological condition. Not to be confused with essential tremor or enhanced physiologic tremor, which both occur more when you are using your hands, this type of shaking usually occurs when hands are at rest. About 90,000 people in the U.S. are diagnosed with Parkinson's disease every year. Early signs vary but, in addition to tremor, they may also include:

• Loss of smell
• Trouble moving or walking
• Small handwriting
• Development of a lower or softer voice
• Constipation

Tremor Treatment Options

The treatment for hand tremor depends on the underlying cause. Some possible options include:

• Medication: Your physician may recommend prescription medications to help manage shaking from essential tremor or Parkinson’s disease.
• Lifestyle changes: Stress management techniques, such as breathing exercises and yoga, as well as eliminating stimulants like caffeine and nicotine can help alleviate enhanced physiologic tremor.
• Magnetic resonance-guided focused ultrasound (MRgFUS): This relatively new, minimally invasive (no incisions) procedure uses focused sound waves to treat essential tremor or Parkinson’s if tremor is the dominant symptom. For most patients, it can improve or eliminate the shaking. “Because the procedure is minimally invasive and performed while the patient is awake with no anesthesia, they can go home the same day,” says Joshua M. Rosenow, MD, director of Functional Neurosurgery at Northwestern Medicine. Northwestern Medicine is one of few health systems in the Midwest offering this treatment option.
• Deep brain stimulation: In this surgical procedure, electrodes are implanted in the brain to deliver electrical stimulation to block the signals in the brain causing the tremor. A pacemaker-like device is also implanted under the skin in your chest, which controls the electrical stimulation. Deep brain stimulation is used to treat essential tremor and tremor from Parkinson’s disease.

“Deep brain stimulation should be considered when symptoms are progressing and becoming more difficult to manage, and when medications are not working to control your symptoms or causing side effects,” says Dr. Rosenow.

While shaking hands could be worrisome, there is no reason to immediately suspect essential tremor or Parkinson’s disease. Consult your care team if you have had shaking hands for a prolonged period of time. Together, you can determine the underlying cause and find the appropriate treatment, if needed.

Learn more about procedures that can modify the functioning of the nervous system.