Essential Tremor

Overview

What is essential tremor?

Essential tremor is a movement disorder that causes parts of your body to shake. This kind of shaking isn’t controllable, and you can’t keep yourself from doing it. Essential tremor usually affects your hands and arms but can also affect your head, voice and other body parts.

In its advanced stages, this condition can severely disrupt some of the most basic tasks and parts of life, such as eating, drinking and dressing yourself. Many people also struggle with feelings of embarrassment or anxiety about the symptoms of this condition.

What is the difference between essential tremor vs. Parkinson’s disease?

Essential tremor and Parkinson’s disease are both movement disorders that involve some kind of tremor. However, there are some key differences, too:

Essential tremorParkinson’s disease
Tremors are worst when using the affected body part, and go away or lessen when at rest.Tremors are worst when the affected body part is at rest, and go away or lessen when in use.
Tremors usually occur on both sides of your body, but one side may be slightly more affected than the other.Tremors are often asymmetric, affecting one side much more than the other.
Tremors often involve your head and neck. They almost never involve your legs and feet.Tremors rarely affect your head and neck. They sometimes involve your legs and feet.
Handwriting can be quite difficult and shaky due to tremors, but it doesn’t become unusually small.Handwriting can become unusually small (micrographia).
Essential tremor often runs in families.Parkinson’s disease only rarely runs in families.
Essential tremor solely involves tremor.Parkinson’s disease also involves other features, such as slowed movements, stiffness and changes in walking and balance.

Who does essential tremor affect?

Essential tremor can happen to anyone, though it’s more common as people age. It’s most likely to start between ages 10 and 19 or between 50 and 59. This disorder also tends to run in families and is sometimes called “familial tremor.”

How common is essential tremor?

Essential tremor is common. Experts estimate that it affects about 1% of all people worldwide, and about 5% of people over age 60. It’s the most common form of tremor and one of the most common movement disorders.

How does essential tremor affect my body?

Essential tremor causes parts of your body to shake when you try to use them. This is usually a problem when using your hands but can also affect your head, voice and other body parts. Essential tremor is a condition that gets worse slowly, taking years to reach levels where it starts to disrupt a person’s life.

In the earlier stages, essential tremor isn’t a problem. Some people may find it makes certain activities harder, but many can compensate. However, as the condition worsens, it can cause problems with fine-detail work and activities, such as handwriting, using eating utensils, sewing or tasks requiring precision.

As essential tremor worsens, this condition can have more severe effects. People who have it may not be able to feed themselves or even cook because of how severely their hands shake. Others may not be able to write, dress, bathe or otherwise take care of themselves.

Symptoms and Causes

What are the symptoms of essential tremor?

The key symptom of essential tremor is shaking — usually your hands — when you’re trying to use them. That shaking can take different forms and usually happens under certain circumstances. The forms and circumstances where tremors are likely include:

  • Action tremor: This is a form of essential tremor that happens during actions, such as reaching for an object.
  • Postural tremor: This is shaking that happens when you hold part of your body in a specific pose, such as holding a hand outstretched and keeping it at the same height.

Essential tremor almost always affects both sides of your body but often affects one side more than the other. In addition to your hands, tremors can affect other parts of your body such as your head, voice, face and trunk.

The tremor itself isn't dangerous, but it can cause problems with everyday activities as the condition worsens. Eventually, people with essential tremor may have trouble with activities such as eating with utensils and drinking from a glass, dressing themselves and writing.

Essential tremor gets better or worse under certain circumstances. Examples include:

May help tremorsMay make tremors worse
Alcohol (in small amounts*).Anxiety, fatigue or stress.
Rest.Certain medications.
Cooling your arm, such as with ice or cold packs.Exercise.
Illness.
Electrolyte, thyroid or blood sugar problems.

*You shouldn’t self-treat with alcohol because of the risk of alcohol misuse or addiction. Some medications that treat essential tremor also have severe or dangerous interactions with alcohol. You should talk to your healthcare provider about alcohol use and tremors, and whether or not it’s safe or wise to drink alcohol at all when you have this condition.

Tremor terms

When healthcare providers diagnose essential tremor, they analyze the way the tremors happen. Two key components of tremors are their frequency and their amplitude. The following example explains these terms and what they look like in a hand tremor:

  • Amplitude: The amplitude of a tremor is the end-to-end distance your hand travels during a tremor. The larger the distance, the greater the tremor’s amplitude. The tremor amplitude usually increases as the essential tremor progresses and may vary in certain circumstances such as with action or posture.
  • Frequency: Each shake of your hand is one tremor cycle. The frequency of a tremor is how many cycles you have in one second. The international unit for cycles per second is a Hertz (abbreviated Hz). Essential tremor usually causes six to 12 tremor cycles per second, but this usually slows down as tremor amplitude increases and can vary from person to person.

What causes essential tremor, and is there anything that triggers it?

Experts don’t know exactly why essential tremor happens or if there are triggers that cause them to happen. However, there’s evidence that it happens because of the changes in certain parts of your brain.

And while experts don’t know exactly why essential tremor happens, they do know that this condition can run in families. About half of all essential tremor cases are inherited. This condition appears to be an autosomal dominant inherited condition. That means if one parent passes a mutated gene that causes essential tremor to you, there’s about a 50% chance that you’ll inherit the condition.

Is essential tremor contagious?

Essential tremor isn’t contagious, and you can’t catch it from or spread it to other people.

Diagnosis and Tests

How is essential tremor diagnosed?

Your healthcare provider can diagnose essential tremor based on your symptoms and a neurological examination. There aren’t any tests that can confirm whether or not a person has essential tremor.

However, an important part of the diagnostic process is ruling out other conditions that could cause similar symptoms. Ruling out those other conditions may involve blood tests and imaging tests.

What tests may be done to diagnose essential tremor?

When your healthcare provider suspects essential tremor, they may need to rule out other conditions. The most common and likely tests that help rule out other conditions include:

Management and Treatment

How is essential tremor treated, and is there a cure?

There’s no cure for essential tremor, but there are ways to treat it. The main treatment options are medications, assistive devices, botulinum toxin, deep brain stimulation and focused ultrasound. Your healthcare provider may recommend deep brain stimulation or focused ultrasound if other treatments aren’t enough to help your tremors.

  • Medication: The most common medications, taken either on their own or in combination, to treat essential tremor are beta-blockers like propranolol and anti-seizure drugs like primidone.
  • Adaptive devices: Many devices have been developed to improve tremor control, such as weighted items, tremor-canceling devices, vibration devices and peripheral nerve stimulation.
  • Botulinum toxin: This involves injection into the tremoring muscles to temporarily weaken the muscles and lessen tremor severity.
  • Deep brain stimulation: This is a surgery to implant a device that delivers electrical impulses to a specific part of your brain. The electrical impulses interrupt the signals that cause essential tremor muscle movements. This can improve tremors on both sides of your body.
  • Focused ultrasound: This procedure uses ultra-high-frequency sound waves focused onto a single point in your brain involved in the production of tremor, destroying the targeted tissue. This destruction can greatly reduce the severity of the tremor and improve hand steadiness. This can improve tremors on only one side of your body.

Complications/side effects of treatments

The possible complications and side effects of treatments for essential tremor depend on many factors, including the treatments themselves. Your healthcare provider is the best person to tell you what side effects or complications are possible in your specific situation, and what you can do to manage or avoid them.

How to take care of myself/manage symptoms?

A trained, qualified healthcare provider should be the one to diagnose and treat essential tremor. Essential tremor isn't life-threatening or dangerous, but tremors can also be a part of other conditions, some of which are treatable if caught quickly. It’s important to call your healthcare provider and make an appointment if you start experiencing tremors that you can’t explain.

How soon after treatment will I feel better, and how long does it take to recover?

The recovery time from the various treatments depends on many factors, especially the treatments themselves. The best source of information about your situation is your healthcare provider because they can consider all the factors and give you information that’s relevant to your specific case and circumstances.

Prevention

How can I reduce my risk of developing essential tremor or prevent it altogether?

Essential tremor happens unpredictably, so you can’t prevent this condition or reduce your risk of developing it.

Outlook / Prognosis

What can I expect if I have essential tremor?

Essential tremor is usually progressive, meaning it gets worse over time. This is usually a slow process. The average rate that arm or hand tremors get worse is between 1.5% and 5% a year.

Essential tremor starts small and usually only affects your hands at first. Over time, usually many years, the tremors may spread to affect your arm and head. As the condition progresses, you may begin to struggle with certain activities and may need help to do them.

How long does essential tremor last, and can it go away?

Essential tremor is a permanent, life-long condition once it starts. It’s not curable, and it doesn’t go away on its own.

What’s the outlook for essential tremor?

In years past, the term “benign,” meaning “harmless,” was a standard part of its name, as in “benign essential tremor.” However, experts now recognize that while essential tremor isn’t harmful directly, it can cause severe disruptions in your life.

People with more severe tremors struggle with activities such as cooking, using kitchen utensils, drinking from a cup, hygiene activities, grooming and dressing. Some people who have essential tremor eventually can’t live independently and need to live with family or in an assisted living or skilled nursing facility setting.

Living With

How do I take care of myself?

Essential tremor is a condition that starts with very mild symptoms, if they’re even noticeable at all, and progresses slowly. It usually takes years before the symptoms reach a point where it’s recommended to start a treatment. Even then, many people can choose not to receive treatment until their symptoms are more severe.

The best things you can do to care for yourself include the following:

  • Don’t be afraid to talk about your symptoms honestly. Many people feel embarrassed by this condition. Talking to your healthcare provider honestly about what you’re experiencing gives them the full picture of your condition, helping them treat you more effectively.
  • See your healthcare provider as recommended. Follow-up visits with your healthcare provider can help with monitoring your condition. This lets them adjust medications as needed or offer you treatment alternatives that might work better.
  • Take medication as prescribed. Medications can help reduce the symptoms of essential tremor, keeping this condition from disrupting your life as severely as it would without treatment. If your healthcare provider prescribes medication, you should take them exactly as prescribed. Some medications for essential tremor can have unpleasant or serious side effects if you stop taking them suddenly. That’s why it’s important not to stop them without first talking to your healthcare provider.
  • Learn the things that make your tremors worse, and then avoid them. Essential tremor often gets worse when you’re tired, stressed, anxious or otherwise upset. Caffeine can also make the symptoms worse. Avoiding all of the above — whenever possible — can make a big difference in the symptoms you experience.
  • Let technology help. Technology advancements mean there are new ways to help people with essential tremor. Some of the most important advances are in the form of adaptive devices, which can greatly benefit your quality of life and ability to live independently.

When should I see my healthcare provider, or when should I seek care?

You should schedule to see your healthcare provider if you start to have unexplained shaking or tremors. Your healthcare provider will schedule regular follow-up visits to monitor your condition and adjust treatments as necessary. You should see them as recommended because these visits are important in helping you minimize this condition’s disruptive effects.

You should also see your healthcare provider if you notice your symptoms are getting worse, to the point where they’re disrupting your activities and routine. You should see them, too, if you have side effects from medications or treatments that are similarly disruptive.

When should I go to the ER?

Essential tremor isn’t a condition that directly threatens your health and well-being, so it’s unlikely that it will directly cause symptoms that need emergency medical care. However, you should talk to your doctor to find out if there are any possible reasons you might need emergency medical care. They can tell you what to watch for and what you need to do to take care of yourself if such problems occur.

A note from Cleveland Clinic

Essential tremor is a condition that causes parts of your body, most often your hands and arms, to shake. In its earlier stages, essential tremor is often minor and nothing more than an inconvenience or an annoyance. While essential tremor isn’t a dangerous condition, it can still keep you from taking care of yourself and living independently if the tremors become more severe.

It’s also common for people to feel embarrassed or ashamed of the tremors this condition causes. That can cause anxiety, depression and other mental health concerns. Fortunately, there are multiple ways to treat this condition, and many devices can help a person manage or adapt to this condition, helping minimize this condition’s impacts on quality of life.

Last reviewed by a Cleveland Clinic medical professional on 06/28/2022.

References

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  • Pathak A, Redmond JA, Allen M, Chou KL. A noninvasive handheld assistive device to accommodate essential tremor: a pilot study. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4156033/#SD1) Mov Disord. 2014;29(6):838-842. Accessed 6/28/2022.
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