A common movement condition
Essential tremor mainly causes a rhythmic shaking, most often affecting the hands and arms, and sometimes the head, voice or legs. Learn about risk factors and how to manage symptoms.
While essential tremor can be persistent, it is often manageable with appropriate strategies, helping many people maintain their daily activities and confidence.
There are some recognised patterns of essential tremor, including:
- classic essential tremor – an action tremor affecting the hands and arms, present when reaching, holding or using the hands, and often easing at rest
- essential tremor plus – a term sometimes used when mild additional features, such as slight balance change or subtle gait difficulty, are present alongside the typical tremor
- head or voice tremor – some people notice shaking of the head (sometimes a ‘yes-yes’ or ‘no-no’ movement) or a quivering quality to the voice, either alongside or instead of hand tremor.
Over time, essential tremor may affect:
- confidence and comfort in social situations, due to visible shaking
- head position or movement, if head tremor is present
- steadiness of the hands during tasks such as writing, eating or drinking
- voice quality, if the voice is affected.
What happens in the brain?
The exact cause of essential tremor is not fully understood. Still, it is thought to relate to abnormal activity in a brain circuit involving the cerebellum (the part of the brain responsible for coordinating smooth movement) and its connections to other movement-control areas.
This differs from Parkinson’s disease, which mainly involves loss of dopamine-producing cells in a different part of the brain (the substantia nigra). This distinction in brain circuitry helps explain why essential tremor and Parkinson’s disease present clinically differently and respond to different treatments.
What increases the risk of essential tremor?
Essential tremor doesn’t have a single identified cause, but several factors are associated with increased likelihood of developing it.
Factors that can’t be changed include:
- age – risk increases with age, and essential tremor becomes more common in older adults, though it can begin at any age, including in childhood or early adulthood
- family history and genetics – essential tremor often runs in families, and in these cases it is sometimes called ‘familial tremor’. Several genes have been linked to increased risk, though a specific genetic cause isn’t identified in everyone.
Factors that may influence symptoms, though their role in causing essential tremor itself is less clear, include:
- caffeine and stimulant use – can temporarily worsen tremor severity in some people
- certain medications – some medications can worsen tremor as a side effect, independent of essential tremor itself
- stress, fatigue and anxiety – commonly worsen tremor intensity, without necessarily causing the underlying condition.
Since essential tremor is primarily genetic and not preventable through lifestyle changes, management aims to reduce symptom severity and improve quality of life, helping readers understand treatment priorities.
Common patient questions
No. Although both conditions cause tremor, essential tremor and Parkinson’s disease are separate diagnoses.
Essential tremor typically causes shaking during movement or when holding a position, which can help you understand your experience better and feel more in control.
No, essential tremor does not turn into Parkinson’s disease. They are distinct conditions with different underlying mechanisms, although it is possible, though uncommon, for someone to have develop given that Parkinson’s becomes more frequent with ageing.
There is no cure, but several options can help manage symptoms if they interfere with daily life. These may include:
- lifestyle adjustments (such as reducing caffeine)
- medications (such as certain beta-blockers or anti-seizure medications)
- occupational therapy for adaptive strategies and equipment
- for more significant or treatment-resistant cases, procedures such as focused ultrasound or deep brain stimulation.