Patient information from BMJ

Essential tremor

Last published:Dec 07, 2021

If you have essential tremor, your hands tremble or your head shakes. This can make it hard for you to do everyday things, like drink a cup of tea without spilling it. There are medicines that can help.

What is essential tremor?

If you have essential tremor, your hands or head start shaking, usually when you’re trying to do something.

The name essential tremor means that you have a tremor but doctors can't find a reason for it. Doctors aren't sure why some people get essential tremor, but it seems to run in families.

What are the symptoms?

You're most likely to notice shaking in your hands. About 7 in 10 people with essential tremor get it in their hands. The tremor may start in only one hand. But usually, with time, both hands are affected.

You won't notice the tremor when you are resting or sleeping. It happens when you're holding a position, like stretching your arms out, or when you're trying to do something with your hands, like write.

About half of people with essential tremor also have a head tremor. Their head shakes up and down, or from side to side. Some people also find their voice shakes. The tremor may be worse when you are tired or stressed.

Your doctor will check to see if your tremor is caused by an illness or a medicine you are taking. He or she will ask about your medicines, your family history, and any other symptoms.

Your doctor will examine you, and you'll have blood tests, including a test to make sure your thyroid gland (a gland in your neck) is working properly.

You may need other tests, including scans to see images of the inside of your body (such as CT scans and MRI scans), to check for other illnesses that cause a tremor, such as a stroke. You will only be diagnosed with essential tremor if your doctor has ruled out other causes for your tremor.

What treatments work?

If your tremor interferes with your life, there are treatments that may help. They can’t cure the tremor, but they can make it less noticeable. If your tremor doesn’t bother you, you may decide not to have treatment at all.

Things you can do for yourself

Lifestyle changes help some people with essential tremor. You could try:

• yoga or relaxation exercises

• avoiding caffeine (coffee, tea, and chocolate), and

• avoiding getting stressed or tired.

Medicines

Several medicines are used to help control the shaking caused by essential tremor. Two of them are propranolol and primidone.

Both of these medicines can cause side effects in some people. Your doctor should discuss these with you before you start taking these medicines. For example:

• propranolol can cause dizziness, sleep problems, and nausea. Rarely, it can cause more serious side effects, such as shortness of breath. If this happens, tell your doctor immediately.

• primidone can cause nausea, vomiting, and sudden jerky movements when you first start taking it. These side effects usually pass after a while.

If you can’t take these medicines, or if they don't help, your doctor might suggest medicines that are usually used for treating epilepsy. They are called anticonvulsants. 

If your symptoms are severe, and other medicines haven't worked well enough, your doctor may suggest medicines that have a more sedative effect. But this is not common.

Other treatments

If you have very bad essential tremor and have tried several different medicines without finding one that helps, your doctor may advise surgery on the brain. This is very rare.

What will happen to me?

Many people aren't bothered by the tremor and don't even go to see their doctor. It usually starts as a mild problem, although it may slowly get worse. If your tremor bothers you, there are treatments that can help.

Where to get more help

You might be able to find support groups or charities either locally or online. For example, in the UK, the National Tremor Foundation (tremor.org.uk) offers support and help to people with essential tremor.