You wake up after a night of drinking alcohol with a familiar and unsettling feeling. Your head is pounding and you feel nauseated. You forgot to take your hangover prevention pills. You don’t remember much from the night before, but you feel an overwhelming sense of anxiety and your hands shake. You have a hangover. But what is the cause of the shakes and tremors you experience after a night out?
In the past, dehydration was thought to be the main cause of hangover symptoms [1]. But now, scientists believe that alcohol withdrawal, and chemicals formed in the body when our livers break down alcohol, are the main contributors to those dreaded mental and physical symptoms.
Truth be told, the hangover may well be one of the least-documented alcohol-related subjects. Based on the research to date, it is now possible to group the causes and effects of alcohol hangover into two main categories: indirect and direct.
Indirect causes are the dehydration, low blood sugar levels, and sleep disturbance resulting from excessive drinking. The direct causes are related to the byproducts of alcohol metabolism, namely acetaldehyde.
Some people report experiencing hangover symptoms after consuming only two or three drinks, while some heavy drinkers never experience hangover symptoms at all. But for most people, the greater the amount of alcohol consumed and the longer the duration of alcohol consumption, the more severe the hangover symptoms, including tremors and shakes.
Drinking interferes with brain activity during sleep, scrambles the hormones that regulate our biological clocks, and also trigger migraines, which explains the classic symptoms of fatigue, hangover headache, and nausea. But what about the shaking?
SHORT-TERM ALCOHOL WITHDRAWAL
The first symptom of a hangover is actually the feeling of alcohol withdrawal. When we first wake up in the morning, this can be a pretty severe experience, especially if that comes with waking up before we really should – the so-called “rebound effect” that disturbs our sleep patterns. But that’s not the only symptom of alcohol withdrawal.
Many of us also feel our hands shake for no reason. These shakes are body tremors someone can experience when they suddenly reduce the amount of alcohol they drink if they have previously been drinking excessively through the night. Shakes from alcohol can be very light and only barely noticeable, or it can be strongly pronounced in some cases.
In other words, tremors (or shakes) and sweating – both common features of hangovers – are due to alcohol withdrawal [2][3]. The brain adapts even in the course of one evening of drinking and is then left in a withdrawal state for the next 24 hours.
So now you know. Next time you experience shaking following too much alcohol, that actually means your body is having withdrawal symptoms from all the booze you've plied it with. It's basically a mild version of the withdrawal symptoms a drug addict would experience.
That helps explain why some people swear by the “hair of the dog” – another alcoholic drink – to cure their hangover.
DOES THE “HAIR OF THE DOG” HELP?
A hangover develops as your body breaks down alcohol. Symptoms appear to be worst when blood alcohol levels (BAC) return to zero [4].
The theory behind the “hair of the dog” hangover remedy is that if you drink more alcohol, your blood alcohol levels will rise and you will no longer experience hangover symptoms. The “hair of the dog” can temporarily make you feel better by boosting endorphins and slowing the creation of toxic compounds.
Unfortunately, at some point, your body is going to have to metabolize that alcohol, which means there will come a time when you are going to need to deal with the impact your decisions have caused. Some people seem to think continuing to drink lightly throughout the day allows most of that pain to disappear, but that is debatable. What they are doing is mitigating the short-term alcohol withdrawal in exchange for dealing with the pain later.
Drinking more alcohol to cure a hangover may lead to an even worse hangover when you stop [5].
Explaining the mechanism of shakes and tremors
Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter that functions as a regulator for the nerve cells in the body; this means that everything related to bodily coordination is controlled by this system. Alcoholic beverages have a depressant effect, and this inhibits the functions of the neurotransmitter which partially numbs the body, leading to that feeling of intoxication. When you drink, this becomes a problem as the brain adapts to the constant presence of ethanol in the body to maintain fairly constant homeostasis.
The complete inhibition of GABA due to excessive drinking (even in a short period of time) becomes close to normal for the brain nerves; hence, the sudden deficiency of ethanol in the body due to withdrawal means that the brain has to begin to reintroduce the production of GABA [6]. The increase in GABA activity result in alcohol withdrawal shakes and other symptoms (like sweating) which can begin after 6-10 hours after the last drink.
Facts about hangover shakes:
The shaking due to alcohol withdrawal can occur in any body part, but most often occurs in the hands [7].
Someone can develop hangover shakes as soon as 6 hours after their last drink
The likelihood and severity of alcoholic tremors are increased in people who drink more frequently and in higher amounts
Bottom line
The only guaranteed way to avoid hangover symptoms is to not drink or drink in moderation. Keeping your blood alcohol level below 0.1% can reduce the likelihood of feeling hungover the next day.
Drinking more alcohol to reduce a hangover is not generally recommended, as it may lead to an even worse hangover and increase your risk of alcohol abuse and addiction.
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