Temporary changes to neurotransmitter activity are part of the reason some people experience hangover shakes. Low blood sugar may also contribute to shakiness.

Alcohol is a depressant that changes the way the nervous system functions. When a person stops drinking alcohol, they may experience nervous system effects such as tremors.

This article discusses hangover shakes, what causes them, how to treat them, and when to see a doctor.

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Hangover shakes are tremors that some people experience after they stop drinking alcohol.

Tremors due to alcohol withdrawal most often occur in the hands and fingers. However, tremors due to alcohol use disorder may also happen in the:

  • arms
  • legs
  • torso
  • vocal cords
  • head

Hangover shakes can make certain fine motor tasks, such as eating, typing, or dressing, more challenging. A person might speak with a shaky voice or have trouble holding items like utensils.

There are several reasons a person might experience tremors with a hangover.

Nervous system changes

These depressant actions wear off after a person stops drinking alcohol, and the nervous system becomes overexcited. This leads to alcohol withdrawal symptoms such as hangover shakes.

Blood sugar changes

Hand tremor is also a sign of low blood sugar.

When a person drinks alcohol, the liver prioritizes processing that alcohol and may temporarily pause other liver functions, such as gluconeogenesis, the production of glucose for transport into the bloodstream.

This can cause symptoms of low blood sugar.

Alcohol-related brain damage

A cerebellar tremor is a type of shaking that occurs at the end of a purposeful movement. These tremors are usually felt in the arms, hands, legs, or feet.

Cerebellar tremors result from damage to the brain area known as the cerebellum, and its connections to other brain areas. Chronic alcohol use can cause this type of damage.

A person who frequently uses alcohol may experience this kind of tremor.

The duration of hangover symptoms, such as the shakes, depends on how much alcohol a person has consumed.

To recover from a hangover, the body must:

  • finish clearing alcohol metabolism toxic byproducts
  • heal irritated tissue
  • rehydrate
  • restore brain and immune activity

The liver metabolizes alcohol at a rate of approximately one drink per hour, and any remaining alcohol continues to circulate in the bloodstream. There is no way to speed up metabolism or shorten hangover recovery time.

It may not be possible to speed up a person’s recovery from alcohol use. However, the following strategies may help provide symptom relief:

  • Rest: Alcohol can disrupt sleep, so resting during a hangover may ease symptoms.
  • Hydrate: Alcohol is a diuretic, which means it promotes fluid loss. Replenishing fluid lost from alcohol use may reduce hangover symptoms such as tremors.
  • Consume carbohydrates: A nutrient-dense meal that contains carbohydrates can help to stabilize blood sugar and ease hangover shakes.
  • Magnesium: This mineral may ease symptoms of alcohol withdrawal. Magnesium helps to reduce neurotransmitter release and prevent nervous system overexcitability that can occur after alcohol use stops. More research is needed on this topic.
  • Thiamine: Chronic use of alcohol can put a person at risk for a thiamine (vitamin B1) deficiency. Insufficient thiamine can cause a neurological condition called Wernicke encephalopathy (WE). One of the symptoms of WE is ataxia, or loss of coordination.
  • Medication: In severe cases of alcohol withdrawal, where there may be a risk of serious complications, doctors can prescribe medications. Benzodiazepines are the first-line treatment for alcohol withdrawal. They mimic the effects of ethanol to ease withdrawal symptoms.

The most effective way to prevent hangover shakes is to avoid alcohol use.

A person can reduce their chance of hangover shakes by drinking less alcohol. It may also help to maintain hydration and stable blood sugar by consuming nonalcoholic drinks and food containing carbohydrates.

Hangover shakes can be a warning of more severe alcohol withdrawal symptoms to come.

A person who regularly uses alcohol and then stops is at risk of severe alcohol withdrawal symptoms, including delirium tremens (DT).

Without treatment, DT can lead to death in 37% of cases. However, early diagnosis and treatment decrease the mortality rate to less than 5%.

DT can begin as early as 48 hours from a person’s last drink and can last as long as 5 days.

Symptoms can include:

  • severe confusion
  • visual hallucinations
  • rapid heart rate
  • perspiration
  • hypertension
  • agitation
  • hyperthermia

DT complications include:

  • seizures
  • hypertension
  • hyperthermia
  • arrhythmias
  • disorientation
  • confusion
  • altered mental status
  • pneumonia
  • respiratory failure
  • death

It may be possible to independently manage mild alcohol withdrawal. However, it is best to contact a healthcare professional for help with severe symptoms or if there is a chance DT can occur.

Since there is an overlap of possible signs and symptoms, individuals may choose to contact a healthcare professional if they experience any of the above symptoms.

Some of the adverse outcomes from chronic and heavy alcohol use can include:

A person who often gets hangover shakes might want to discuss AUD treatment with their doctor.

The following are answers to two frequently asked questions about hangover shakes.

Are hangover shakes dangerous?

Hangover shakes can be a warning that DT may occur.

Not everyone who experiences post-drinking tremors will develop DT. However, untreated DT can be dangerous, so a person at risk for DT should see a doctor if they get hangover shakes.

Is it normal to shake when hungover?

Hangover shakes are typically considered a minor symptom of alcohol withdrawal. However, they can also be a sign of alcohol use disorder and other conditions.

If someone believes they may be experiencing alcohol use disorder or are experiencing tremors regularly, they should speak with a healthcare professional.

Hangover shakes are a symptom of alcohol withdrawal. They occur more often in people who use alcohol regularly, which may be due to brain damage from excessive alcohol use.

The causes include nervous system changes, low blood sugar, and brain damage.

Sometimes, hangover shakes can be a warning that more serious effects like DT might follow. People living with AUD may be at higher risk of severe complications if they abruptly stop drinking. They should see a healthcare professional if they experience post-drinking tremors.

The only way to ensure the prevention of hangover shakes is to avoid alcohol use.