Essential Tremor: Causes, Symptoms, and Diagnosis

Essential Tremor


What is Essential Tremor?

Essential tremor (ET) is the most common movement disorder. It is a progressive, often inherited disorder that usually begins in later adulthood. Patients with ET typically experience tremors when the arms are held up (such as while reading a newspaper) and when the hands are being used for activities like eating, drinking or writing. The tremors also may affect the head, voice, tongue and legs and worsen with stress, fatigue and stimulant medications.

What Causes Essential Tremor?

The true cause of essential tremor is still not understood, but it is thought that the abnormal electrical brain activity that causes tremor is processed through the thalamus. The thalamus is a structure deep in the brain that coordinates and controls muscle activity.

Genetics is responsible for causing ET in half of all people with the condition. A child born to a parent with ET will have up to a 50% chance of inheriting the responsible gene, but may never actually experience symptoms. Although ET is more common in the elderly  and symptoms become more pronounced with age  it is not a part of the natural aging process.

Who Gets Essential Tremor?

Essential tremor is the most common movement disorder, affecting up to 10 million people in the U.S.


While ET can occur at any age, it most often strikes for the first time during adolescence or in middle age (between ages 40 and 50).

Essential Tremor

Symptoms of Essential Tremor

The tremor is more likely to be noticed in the hands. The arms, head, eyelids, or other muscles may also be affected. The tremor rarely occurs in the legs or feet. A person with essential tremor may have trouble holding or using small objects such as silverware or a pen.

The shaking most often involves small, rapid movements occurring more than 5 times a second.

Specific symptoms may include:

  • Head nodding
  • Shaking or quivering sound to the voice if the tremor affects the voice box
  • Problems with writing, drawing, drinking from a cup, or using tools if the tremor affects the hands

The tremors may:

  • Occur during movement (action-related tremor) and may be less noticeable with rest
  • Come and go, but often get worse with age
  • Worsen with stress, caffeine, and certain medications
  • Not affect both sides of the body the same way

How common is essential tremor?

Essential tremor is a common disorder, affecting up to 10 million people in the United States. Estimates of its prevalence vary widely because several other disorders, as well as other factors such as certain medications, can result in similar tremors. In addition, mild cases are often not brought to medical attention, or may not be detected in clinical exams that do not include the particular circumstances in which an individual’s tremor occurs. Severe cases are often misdiagnosed as Parkinson disease.

What Makes Essential Tremor Worse?

Certain factors may make your tremors temporarily worse, including:

  • emotional stress
  • fatigue
  • hunger
  • very cold or very hot temperatures
  • caffeinated drinks
  • smoking cigarettes

What is the treatment for essential tremor?

Essential tremor cannot be cured. Treatment reduces the severity of the tremor, sometimes greatly. There are various treatments that are used. Some people only take medication when they are in situations in which their tremor worsens. For example, if they are giving a presentation or going to a job interview.

Patients with significant functional impairment usually opt for some form of treatment. Less impaired patients may choose to forgo treatment all together. Some patients that aren’t functionally impaired desire treatment because their tremor is a significant source of embarrassment. Once a patient desires therapy, there are several options:


Medicines may help relieve symptoms. The most commonly used drugs include:

  • Propranolol, a beta blocker
  • Primidone, a drug used to treat seizures

These drugs can have side effects.

  • Propranolol may cause fatigue, stuffy nose, or slow heartbeat, and it may make asthma worse.
  • Primidone may cause drowsiness, problems concentrating, nausea, and problems with walking, balance, and coordination.

Other medications that may reduce tremors include:

  • Antiseizure drugs
  • Mild tranquilizers
  • Blood pressure drugs called calcium-channel blockers

Botox injections given in the hand may be tried to reduce tremors.


In severe cases, surgery may be tried. This may include:

  • Focusing high-powered x-rays on a small area of the brain (stereotactic radiosurgery)
  • Implanting a stimulating device in the brain to signal the area that controls movement

Home Care

For tremors made worse by stress, try techniques that help you relax. For tremors of any cause, avoid caffeine and get enough sleep.

For tremors caused or made worse by a medication, talk to your doctor about stopping the drug, reducing the dosage, or switching. Do not change or stop medications on your own.

Severe tremors make it harder to do daily activities. You may need help with these activities. Things that can help include:

  • Buying clothes with Velcro fasteners, or using button hooks
  • Cooking or eating with utensils that have a larger handle
  • Using straws to drink
  • Wearing slip-on shoes and using shoehorns