Tingling: Causes and When to Worry

What tingling is

Sensory nerves carry signals from the skin to the brain. When a nerve is squeezed, starved of blood, irritated or damaged, it can fire abnormally and produce sensations without a real stimulus. This is paresthesia. It may come with numbness (reduced feeling), burning, or extra sensitivity to touch (dysesthesia).

• Transient paresthesia: brief, from pressure or hyperventilation.
• Chronic paresthesia: lasting or recurring, usually from nerve damage or compression.

Common causes of tingling

Pressure on nerves

• Limb "falling asleep": pressure on a nerve and its blood supply, relieved within minutes by moving.
• Carpal tunnel syndrome: tingling in the thumb, index, middle and half of the ring finger, often waking you at night.
• Cubital tunnel syndrome: tingling in the ring and little fingers, worse with the elbow bent.
• Pinched nerve in the neck or back: cervical radiculopathy causes arm tingling; sciatica causes leg and foot tingling, usually with pain.

Nerve damage (peripheral neuropathy)

Peripheral neuropathy typically begins as tingling and burning in both feet, later the hands. Causes include:

• diabetes and prediabetes
• vitamin B12 deficiency (also B1 and B6 deficiency, or B6 excess from supplements)
• alcohol overuse
• chemotherapy and some antibiotics and HIV medicines
• kidney disease and underactive thyroid
• autoimmune diseases and Guillain-Barré syndrome

Anxiety, panic and hyperventilation

During a panic attack, fast breathing lowers carbon dioxide in the blood, which makes nerves irritable. This causes tingling in the hands, feet and around the mouth, often on both sides, with a racing heart, chest tightness, dizziness and a sense of dread. It usually peaks within 10 minutes.

Brain and spinal cord causes

• Stroke and TIA: sudden tingling or numbness on one side, often with weakness.
• Multiple sclerosis: tingling or numbness lasting days to weeks, sometimes an electric-shock feeling down the spine when bending the neck.
• Migraine aura: tingling spreading slowly up one arm to the face over several minutes, followed by headache.
• Seizures affecting the sensory part of the brain.

Other causes

• Low calcium (hypocalcemia): tingling around the mouth and in the fingers, with muscle cramps.
• Raynaud's phenomenon: fingers turn white then blue in the cold, with tingling as they warm.
• Shingles: tingling or burning in a band on one side, days before the rash.
• Allergic reactions: tingling of the lips and mouth.
• Medicines and supplements: for example, the tingling flush of niacin and the skin tingling of beta-alanine.

Sudden tingling with feeling hot, sweating and flushing

A sudden wave of heat, sweating, red flushing of the face and chest, and tingling has several possible explanations:

• Panic attack: with racing heart, fast breathing and fear, usually settling within 20 to 30 minutes.
• Hot flash in perimenopause or menopause: heat spreading over the chest and face, sweating, sometimes tingling and palpitations, lasting a few minutes. See hot flashes.
• Allergic reaction: flushing with itching, hives or swelling, which can progress to anaphylaxis.
• Low blood sugar in people with diabetes: sweating, shakiness, tingling lips and confusion.
• Alcohol flush reaction, niacin or other medicines.
• Rarely, hormone-producing tumors such as carcinoid syndrome or pheochromocytoma.

If it comes with swelling, breathing trouble, chest pain or confusion, call 911 or your local emergency number.

Tingling with chest tightness and jaw tightness

Slight chest tightness, feeling short of breath, tingling in the hands and feet and a tight jaw are typical of anxiety and hyperventilation. However, chest tightness with tingling in the arms or jaw can also be a heart attack, particularly in women, older adults and people with diabetes, whose symptoms are often milder. Do not assume it is anxiety. Call 911 or your local emergency number if symptoms are new, last more than a few minutes, or come with sweating, nausea or pain spreading to the arm, back, neck or jaw.

How doctors find the cause

The doctor will ask where the tingling is, whether it is one-sided or both sides, when it happens and what makes it worse, and about diabetes, alcohol, diet, medicines and other symptoms. They will test sensation, strength and reflexes. Tests may include:

• blood sugar and HbA1c, vitamin B12, folate, thyroid, kidney function, calcium and magnesium
• nerve conduction studies and electromyography
• MRI of the brain or spine if a central cause is suspected
• ECG if heart symptoms are present

Treatment

• Compression: wrist splints at night for carpal tunnel, avoiding leaning on elbows, physical therapy, injections or surgery.
• Neuropathy: control blood sugar, replace vitamins, reduce alcohol, review medicines; prescription medicines can relieve nerve pain.
• Panic and hyperventilation: slow breathing (in for 4 seconds, out for 6), and treatment for anxiety such as CBT.
• Low calcium: calcium and vitamin D replacement under medical supervision.
• Stroke, MS and other neurological causes: specialist treatment.

Frequently asked questions

What is the medical term for tingling?

The medical term is paresthesia. It describes abnormal skin sensations such as tingling, prickling, buzzing or "pins and needles" without an outside cause. Paresthesia can be brief, as when a limb falls asleep, or chronic, as in nerve damage from diabetes.

Why do I suddenly feel hot, flushed and tingly?

Common causes include a panic attack, a menopausal hot flash, an allergic reaction, low blood sugar or an alcohol or medicine flush. If it comes with swelling, wheezing, chest pain or confusion, call 911. If it keeps happening, see your doctor to identify the trigger.

Can anxiety cause tingling in hands and feet?

Yes. Anxiety and panic often cause fast breathing, which lowers carbon dioxide and makes nerves fire, causing tingling in the hands, feet and lips. Slow breathing usually eases it within minutes. New tingling with chest pain or one-sided symptoms should be checked urgently.

When should I worry about tingling?

Seek emergency care for sudden tingling on one side of the body, tingling with chest pain or breathlessness, rapidly spreading tingling with weakness, or tingling with bladder problems. See a doctor for tingling that keeps returning or lasts more than a few days.

Can vitamin deficiency cause tingling?

Yes. Vitamin B12 deficiency is a common cause of tingling in the hands and feet, especially in older adults, vegans and people taking metformin or acid-reducing medicines. Deficiencies of B1, B6 and copper, and too much B6 from supplements, can also cause it.