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Essential Tremor

What Is Essential Tremor?

Essential tremor, also known as benign essential tremor, is a brain disorder that causes a part of your body to shake uncontrollably. The unintentional shaking motion is called a tremor. The hands and forearms are the most commonly affected areas. However the following can also be affected:

  • head
  • face
  • tongue
  • neck
  • torso

In rare cases, tremors can occur in the legs and feet.

Other medical conditions, such as Parkinson’s disease, can cause tremors. With essential tremor, however, there’s no known underlying condition that triggers the tremors. The tremors can begin at any age, but they most commonly affect elderly people.

Essential tremor is a fairly common disorder, affecting approximately 10 million people in the Unites States. It isn’t life-threatening and doesn’t cause any serious health problems.

What Are the Symptoms of Essential Tremor?

The tremors associated with essential tremor are small, rapid movements. You may experience tremors constantly, frequently, or occasionally. Both sides of your body may or may not be equally affected. Most people experience tremors when they’re trying to do something, such as tying their shoelaces. These tremors are known as "action tremors." Other people may experience tremors when they’re not doing anything. These are called "tremors at rest."

Tremors can range from minor to severe. Your tremors may be so minor that they don’t affect your everyday life, or they may be severe enough to interfere with your normal activities.

The following are symptoms of essential tremor in different parts of the body:

  • You may experience noticeable shakiness in the hands or arms when trying to do activities with your hands.
  • Tremors in the head and neck can make your head shake in an up-and-down or side-to-side motion.
  • Parts of your face may appear to twitch, such as your eyelids.
  • Tremors in the tongue or voice box can make your voice sound shaky when you’re speaking.
  • Tremors in your core, legs, and feet can cause problems with balance. They can also make your gait, or the way you walk, appear abnormal.

Certain factors may make your tremors temporarily worse, including:

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

What Causes Essential Tremor?

Tremors can be caused by alcohol abuse, an overactive thyroid, a stroke, and a variety of neurological conditions. However, these tremors are not characterized as essential tremor.

The exact cause of essential tremor is unknown. Scientists haven’t found any absolute genetic or environmental causes, and no cellular defect has been linked to the condition. However, recent research suggests that essential tremor may be triggered by changes in certain areas of the brain. As with most medical conditions, research is ongoing.

What Are the Risk Factors for Essential Tremor?

People are at a higher risk of developing essential tremor if they’re over age 40.

Genetics can also affect risk. Essential tremor may be inherited, but it can also occur in people who don’t have a family history of the condition. When there’s a family history of essential tremor, it’s called familial tremor. Your child has a 50 percent chance of developing essential tremor if you have the disorder.

How Is Essential Tremor Diagnosed?

Doctors diagnose essential tremor by observing the tremors and by ruling out other causes. Your doctor may perform a physical exam to evaluate the severity of your tremors. They might also perform certain imaging tests, including CT and MRI scans, to determine whether you have an underlying condition that’s causing your tremors, such as Parkinson’s disease.

Is Essential Tremor Treatable?

There’s no cure for essential tremor, but the progression of symptoms is gradual and slow. There are also treatments that may help relieve your symptoms. You may not need treatment if your symptoms are minor. Your doctor will advise treatment if your symptoms are severe and interfering with your normal activities. Treatment options include:


Medications for essential tremor include the following:

  • Beta-blockers, such as propranolol limit adrenaline and prevent tremors from getting worse
  • Blood pressure medications, such as flunarizine, limit adrenaline.
  • Anticonvulsant medications, such as primidone, work to reduce the excitability of nerve cells.
  • Mild tranquilizers, such as alprazolam, are also a treatment option.


You can go to physical therapy to improve coordination and muscle control. Botox injections can also be done in your hands to weaken the muscles and minimize or stop shaking.


Surgery is done when other treatments fail to provide relief. It’s a last resort. Surgical options include the following:

  • Deep brain stimulation is a procedure in which small electrodes are placed in the area of your brain that controls movement to block the nerve signals that cause tremors.
  • Stereotactic radiosurgery is a procedure in which high-powered X-rays are pinpointed on a small area of the brain to correct tremors.

What Is the Outlook for People with Essential Tremor?

Many people with essential tremor live normal lives. The famous actress Katharine Hepburn led a successful career despite essential tremor that affected her head and voice.

The severity of your tremors may stay relatively the same or may get worse over time. The tremors might also spread to other areas of your body.

You may have to make some adjustments if your tremors are severe. These changes may include:

  • wearing slip-on shoes
  • using a buttonhook to fasten buttons
  • using straws to drink out of cups
  • using an electric razor instead of a manual razor

Some research suggests that people with essential tremor have a higher risk of developing Parkinson’s disease or sensory problems, such as a loss of smell or hearing. However, these associations are still being investigated.

Content licensed from:

Written by: Rose Kivi
Medically reviewed on: Dec 17, 2015: Deborah Weatherspoon, Ph.D, MSN, RN, CRNA

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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