What Is an Essential Tremor?

A tremor is an involuntary shaking and rhythmic movement that can affect many parts of the body. Quick contractions of muscles cause it. Essential tremors (previously called “benign essential tremors”) are the most common forms of tremor. You’re more likely to develop an essential tremor as you get older — about 5% of people over 60 years old have an essential tremor. 

But how do you know if your tremor is an essential tremor or something else? And how can you keep an essential tremor from getting in the way of your daily activities? Let’s take a look at essential tremor and your options for managing and treating it.

What are the symptoms of an essential tremor?

Essential tremors usually develop gradually. People often notice shaking in their hands and arms that can make it hard to do certain activities like writing, drawing, or using everyday objects. An essential tremor is involuntary — that means you can’t make yourself start or stop it.

Typically, an essential tremor:

• Occurs in the hands and forearms

• Happens with voluntary movement, like reaching for an object or doing activities

• Is less noticeable when you aren’t moving

• Affects both sides of the body (but it can be more noticeable on one side)

• Can get worse with stress, lack of sleep, and with certain medications

What causes an essential tremor? 

Researchers aren’t sure what causes an essential tremor. Some studies suggest that it’s due to a problem in the brainstem and cerebellum (parts of the brain). But so far, studies haven’t proven this. 

It’s not clear why some people develop an essential tremor and others don’t. Researchers think it might be due to a genetic mutation, that’s because about half of people with an essential tremor have family members who have it. Studies in twins show that if one twin develops an essential tremor, the other twin usually develops it, too. 

Here’s what’s clear: As you get older, the risk of developing an essential tremor goes up. About 5% of people older than 65 experience an essential tremor. But that number goes up to 90% in people who are older than 90. 

How do you diagnose an essential tremor?

There’s no test to diagnose an essential tremor. Your healthcare provider will talk to you about what you’ve been experiencing and perform a physical exam. They will also make sure you don’t have another reason for having a tremor, like: 

• Parkinson’s disease: People with Parkinson’s disease usually have a tremor that’s very noticeable when they’re resting. The tremor is usually more obvious on one side.

• Medical conditions: Certain medical conditions, like overactive thyroid, alcohol withdrawal, or hypoglycemia, can cause tremors.

• Exposures: Caffeine, nicotine, medications, and heavy metal poisoning can all lead to tremors.

• Emotional tremor: Some people can develop tremors due to anxiety or nervousness. 

What are the treatments for an essential tremor?

There are several medications that can help treat essential tremors, including:

• Propranolol

• Primidone

• Gabapentin

• Clonazepam

• Topiramate

People who have very severe symptoms may need other types of treatment, including:

• Deep brain stimulation

• High-intensity MRI-guided focused ultrasound

• Botox injections

Researchers are also investigating new treatments for essential tremor in clinical trials. Many are still looking for volunteers to participate.

What happens if I don’t do anything about my essential tremor?

Essential tremors don’t go away on their own. But you don’t need to start treatment for your essential tremor.

Most healthcare providers recommend things other than medication for people who can still perform their usual activities, like:

• Weighted devices: There are devices that can help people with an essential tremor complete their daily activities. These include weighted pens, a computer mouse, and kitchen objects.

• Stabilization devices: A stabilization device is a piece of adaptive equipment that helps steady your tremor so you can perform activities.

• Lifestyle changes: Making sure you get enough sleep and reducing caffeine intake can help your tremor.

• Relaxation techniques: Some people shake more when they’re stressed. Relaxation techniques, like meditation and breathing exercises, can help. 

• Changes in routines: Small changes can make a big difference. Switching to velcro fasteners on shoes, zippers on clothes, and using straws can have a big impact.

Not treating your essential tremor won’t make it worse. But essential tremors tend to get worse over time, even with treatment.

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Written by:

Ronald W. Dworkin, MD, PhD

Ronald W. Dworkin, MD, is a board-certified anesthesiologist who has been practicing anesthesiology in a community hospital for 30 years. He has taught in the honors program at George Washington University for over 10 years and works as a senior fellow at the Hudson Institute.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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