Essential tremor

Overview

Essential tremor is a condition that causes a part of your body to shake uncontrollably. It most often affects your hands, but can also affect your head, voice, or legs. The shaking is rhythmic, like a back-and-forth movement, and typically happens when you are trying to use that body part.

Yes, essential tremor is one of the most common movement disorders. It affects millions of people worldwide.

Essential tremor can affect people of all ages, but it is most common in people over 40. Both men and women can develop it. Often, it runs in families.

Symptoms

Common symptoms

• Shaking in your hands when you do tasks like holding a cup, writing, or using tools
• Head nodding or shaking
• A shaky voice
• Less commonly, shaking in your legs or trunk

Symptoms in children

• Children with essential tremor may have shaking in their hands that becomes noticeable during activities like drawing or eating.
• The tremor is usually mild and may not interfere much with daily life, but it can cause embarrassment.

Symptoms in older adults

• In older adults, the tremor may become more pronounced and can make everyday activities like dressing or eating more difficult.
• It can also lead to frustration or social withdrawal.

Causes

Main causes

• The exact cause of essential tremor is unknown.
• It is thought to involve abnormal electrical signals in the brain that control movement.
• Often it runs in families, so genetics play a role.

Risk factors

• Family history – having a parent or sibling with essential tremor increases your risk.
• Age – it becomes more common after 40.

When to see a doctor

See a doctor urgently if:

• If the tremor appears suddenly, especially after a head injury, or with other symptoms like severe headache, weakness, numbness, or confusion.

Book a routine appointment if:

• If you notice a persistent tremor that interferes with daily activities, it's a good idea to see your doctor to discuss it.

Diagnosis

A doctor will ask about your symptoms, medical history, and family history. They will do a physical exam and ask you to perform tasks like holding a glass of water or drawing a spiral. They may also order tests to rule out other causes.

Tests that may be done

• Blood tests to check for thyroid problems or other conditions
• Sometimes an MRI of the brain to look for other causes

What to expect at your appointment

The doctor will ask when the tremor happens (during activities or at rest) and whether you have any other symptoms. Diagnosis is usually based on your history and the exam. No single test can confirm essential tremor.

Treatment

Treatment is not always needed if the tremor is mild. When it affects your quality of life, options include lifestyle changes and medical treatments. The goal is to reduce the shaking to a manageable level.

Self-care at home

• Avoid caffeine, which can make tremor worse.
• Get enough sleep and reduce stress.
• Try relaxation techniques like deep breathing or meditation.

Medical treatments

A doctor may prescribe medications such as beta-blockers or anti-seizure drugs to help control the tremor. The choice depends on your overall health and possible side effects. Always follow your doctor’s guidance.

When is surgery considered?

For severe tremor that does not improve with medication, a procedure called deep brain stimulation (DBS) may be an option. This involves placing electrodes in the brain to regulate abnormal signals. It can be very effective but is a major surgery with risks.

Living with this condition

Essential tremor can make tasks like eating, writing, using tools, or applying makeup challenging. Adaptive devices such as weighted utensils, non-slip mats, and enlarged grips can help.

Lifestyle tips

• Stay active to maintain strength and coordination.
• Consider physical or occupational therapy to learn new techniques.
• Use assistive devices as needed.

Diet and exercise

A healthy diet and regular exercise are good for overall health. Some people find that reducing caffeine and alcohol helps. Exercises like yoga or tai chi may improve balance and reduce stress.

Mental health and emotional wellbeing

Living with a visible tremor can be stressful and may lead to anxiety or social withdrawal. It is important to talk about these feelings with loved ones or a professional. If you feel overwhelmed, seek support.

Prevention

There is no known way to prevent essential tremor because it often runs in families. However, avoiding triggers like caffeine and stress may help manage symptoms.

Vaccines

not applicable

Screening programmes

not applicable

Complications

If left untreated

• Difficulty with daily activities like eating, bathing, or dressing
• Social embarrassment and reduced quality of life
• Rarely, severe tremor can cause problems with feeding or lead to falls

Long-term outlook

Essential tremor is a lifelong condition, but it is not life-threatening. Many people manage well with treatment and support. It does not shorten life expectancy, and with the right help, most people can continue to lead fulfilling lives.

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