Essential Tremor

Last Updated November 2023 | This article was created by editorial staff and reviewed by Kyle Bradford Jones, MD, FAAFP

What is essential tremor?

Essential tremor is a disorder in your nervous system. It causes shaking movements that you can’t control, most often in your hands. You might notice this tremor when your arms are reaching out in front of your body. It is caused by problems in communication between certain areas of the brain. A tremor affects people in different ways. Some people hardly notice it. Other people may be embarrassed by it. A tremor can sometimes interfere with activities such as eating, drinking, or writing.

Essential tremor is just one kind of tremor. Other things that can cause a tremor include:

  • Parkinson’s disease
  • Multiple sclerosis
  • Fatigue after exercise
  • Extreme emotional stress
  • Brain tumors
  • Some prescription medicines
  • Alcohol or drug withdrawal

There is no cure for essential tremor, but it can be treated.

Symptoms of essential tremor

Many diseases or conditions cause tremors. Symptoms that could indicate your tremor is essential tremor include:

  • Shaking in your hands.
  • Head nodding or shaking.
  • Quivering voice.
  • Tremors worsen with emotional stress.
  • Tremors worsen with purposeful movement.
  • Rest helps to relieve tremors.

Often, tremors are the only symptom you have when you have essential tremor. Other conditions that cause tremors come with other symptoms.

What causes essential tremor?

It is not clear why some people get essential tremor. It seems to run in families. You may be more likely to have essential tremor if a parent or other close family member has tremor. Tremor can start at any age, but it often begins after age 40. It can get worse as you get older.

Are there different kinds of tremor?

Yes, many things can cause tremor. Not all tremors are essential tremors. For example, Parkinson’s disease causes tremor that you might notice when your hands are resting in your lap or at the sides of your body. A stroke can cause tremor that gets worse when you reach for something. Thyroid problems or low blood sugar can cause mild tremor. Tremor can be caused by some medicines. These include heart medicines, decongestants, medicines for breathing problems, and tricyclic antidepressants. Drinks that contain caffeine also may cause a tremor.

How is essential tremor diagnosed?

Your doctor will probably perform an exam and tests to look for possible causes of your tremor. These tests rule out other causes and can include a neurological exam, blood and urine tests, and physical performance tests. If they don’t find another cause of your tremor, you may be diagnosed with essential tremor. There is no specific test for essential tremor.

Can essential tremor be prevented or avoided?

Doctors don’t know exactly what causes essential tremor, so it can’t be prevented. If your doctor determines your tremor is caused by medicine or caffeine, you may be able to avoid essential tremor in the future by avoiding those substances.

Essential tremor treatment

The goal in treating essential tremor is to provide symptom relief that can improve quality of life. Mild tremors may not need treatment. If your essential tremor interferes with your ability to function or bothers you, there are some treatments that could help. These include medicine, focused ultrasound, or deep brain stimulation.

  • Medicine– Your doctor might suggest oral medicines to help decrease the severity of your tremor. These could include beta blockers, anti-seizure medicines, tranquilizers, or Botox injections.
  • Therapy– Physical therapy can help you improve your muscle strength, control, and coordination. Occupational therapy can help you make modifications to reduce the effects of tremors, such as using heavier glasses to drink out of.
  • Surgery– If your tremor is very disabling and you haven’t had good results with medicine, you could qualify for surgery. Usually this is deep brain stimulation (DBS). Electrodes are implanted into the area of your brain that coordinates muscle control.

Living with essential tremor

Lifestyle changes are often recommended to prevent the tremor from getting worse. Your doctor will ask you to avoid caffeine, cold medicines, and certain other medicines if they seem to make your tremor worse. These medicines won’t make your tremor go away. However, the medicine may control the tremor enough to allow you to do normal activities without frustration or embarrassment.

Symptoms do tend to get worse over time. Eventually you might start having trouble with daily functions, including:

  • Holding a glass of liquid without spilling
  • Eating normally
  • Putting on makeup or shaving
  • Talking, if it affects your tongue or voice box

Questions to ask your doctor

  • Is essential tremor the sign of another condition?
  • Is there anything I can be doing to reduce my symptoms?
  • How can medicine help my tremors?
  • Will the tremors get worse as I get older?
  • Can I pass essential tremor down to my children?
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