Essential tremor

Essential tremor can affect almost any part of your body, but the trembling occurs most often in your hands — especially when you try to do simple tasks, such as drinking a glass of water, tying your shoelaces, writing or shaving. You may also have trembling of your head, voice or arms. By definition, essential tremor isn’t caused by other diseases or conditions, although it’s sometimes confused with Parkinson’s disease. It can occur at any age, but is most common in older adults. About half of all cases of essential tremor appear to occur because of a genetic mutation. This is referred to as familial tremor. Exactly what causes essential tremor in people without a known genetic mutation isn’t clear.

Essential tremor symptoms:

  • Begin gradually
  • Worsen with movement
  • Occur in the hands first, affecting one hand or both hands
  • Can include a “yes-yes” or “no-no” motion of the head
  • Are aggravated by emotional stress, fatigue, caffeine or extremes of temperature

Essential tremor vs. Parkinson’s disease
Many people associate tremors with Parkinson’s disease, but the two conditions differ in key ways:

When tremors occur. Essential tremor of the hands typically occurs when your hands are in use. Tremors from Parkinson’s are most prominent when your hands are at your sides or resting in your lap.
Associated conditions. Essential tremor doesn’t cause other health problems, whereas Parkinson’s is associated with a stooped posture, slow movement and a shuffling gait.
Parts of body affected. Essential tremor can involve your hands, head and voice. Tremors from Parkinson’s typically affect your hands, but not your head or voice.

Essential tremor is not life-threatening, but symptoms often worsen over time. If the tremors become severe, you may find it difficult to:

  • Hold a cup or glass without spilling
  • Eat normally
  • Put on makeup or shave
  • Talk, if your voice box or tongue is affected
  • Write — handwriting may become increasingly large, shaky and illegible

There is no specific test for essential tremor. Determining the diagnosis is often a matter of ruling out other conditions that could be causing your symptoms. To do this, your doctor may suggest the following:

Neurological exam
This exam involves checking your:

  • Tendon reflexes
  • Muscle strength and tone
  • Ability to feel certain sensations
  • Posture and coordination

Laboratory tests
Your blood and urine may be tested for problems such as:

  • Thyroid disease
  • Drug side effects

Performance tests
To evaluate the tremor itself, you may be asked to:

  • Drink from a glass
  • Hold your arms outstretched
  • Write
  • Draw a spiral

Some people with essential tremor may not require treatment if their symptoms are mild. But if your essential tremor is making it difficult to work or perform daily activities, you may want to discuss treatment options with your doctor.


Beta blockers. Normally used to treat high blood pressure, beta blockers — such as propranolol (Inderal), atenolol, metoprolol and nadolol — help relieve tremors in some people. They may not be an option if you also have asthma, diabetes or certain heart problems.
Anti-seizure medications. Epilepsy drugs — including primidone (Mysoline), gabapentin (Neurontin) and topiramate (Topamax) — may be effective in people who don’t respond to beta blockers. The main side effects are drowsiness and flu-like symptoms, which usually disappear within a short time.
Tranquilizers. Doctors sometimes use drugs such as diazepam (Valium) and alprazolam (Xanax) to treat people whose tremors are made much worse by tension or anxiety. Side effects can include confusion and memory loss. Additionally, these medications should be used with caution because they can be habit-forming.
Botulinum toxin type A (Botox) injections. You’re probably familiar with Botox as a treatment for facial wrinkles, but it can also be useful in treating some types of tremors, especially of the head and voice. Botox injections can improve problems for up to three months at a time. But if it’s used to treat hand tremors, it can sometimes cause weakness in your fingers.

Physical therapy exercises can sometimes reduce tremor and improve coordination and muscle control. Occupational therapists may suggest some of the following adaptive devices to reduce the effect of your tremors on your daily activities:

  • Heavier plates, glasses and utensils
  • Wrist weights
  • Wider writing implements

Surgery may be an option for people whose tremors are severely disabling and who don’t respond to medications.

The most common procedure is called deep brain stimulation, which involves inserting a long, thin electrical probe into your thalamus — the portion of your brain responsible for causing your tremors. A wire from the probe is tunneled under your skin to your chest, where a pacemaker-like device has been inserted. This device transmits painless electrical pulses to interrupt signals from your thalamus that may be causing your tremors.

Although there have been no scientific studies to confirm the benefit, some people with essential tremor have found the following treatments helpful:

  • Acupuncture
  • Hypnosis
  • Massage
  • Biofeedback

The following suggestions can sometimes help reduce or relieve tremors:

Avoid caffeine. Caffeine can cause your body to produce more adrenaline, which may make your tremors worse. Avoid other stimulants as well.
Use alcohol sparingly. Some people notice that their tremors improve for up to an hour after they drink alcohol, but drinking isn’t a good solution for people with essential tremor. That’s because tremors tend to worsen once the effects of alcohol wear off. What’s more, larger amounts of alcohol eventually are needed to relieve tremors, which can lead to chronic alcoholism. If you have essential tremor, it’s best to drink sparingly or not at all.
Learn to relax. Stress tends to make tremors worse, and a relaxed state often improves them. Although it’s not possible to eliminate all stress from your life, you can change how you react to stressful situations using a range of relaxation techniques. Many people also find that physical exercise — walking, jogging, swimming or biking — is a great stress reliever.
Rest well. Fatigue can exacerbate tremors. Try to get at least seven hours of sound sleep every night. If you have trouble falling asleep, wake up repeatedly or awaken early and can’t go back to sleep, talk to your doctor.