Essential tremor is the most common movement disorder that causes involuntary shaking, mainly in the hands and arms. It can affect people of any age but most frequently occurs in older adults. Essential tremor is not dangerous but can interfere with daily activities and cause embarrassment. Many people can manage symptoms with lifestyle changes, assistive devices, medicines, or a combination of approaches.

Essential tremor is a condition that causes rhythmic, involuntary shaking known as tremor. The shaking most often affects hands and arms but may affect other parts of the body over time. The tremor usually occurs when a person is moving, such as when reaching for an object or holding arms outstretched. Essential tremor can also affect the head, voice, jaw, or face, and sometimes the legs. Shaking may subside or become less noticeable when at rest.

Essential tremor typically affects both sides (bilateral). The condition may begin at any age, but usually starts in later life. Some people notice symptoms in early adulthood, and cases occur in children as well. Symptoms persist for at least three years, and the condition may progress over time to become more pronounced or affect more parts of the body. Essential tremor affects up to 5% of people worldwide, and is equally common in men and women. (Although in children, it is somewhat more common in boys than girls.)

Some people with essential tremor develop additional mild neurological signs, such as slight gait changes or memory issues, which are sometimes referred to as essential tremor-plus. It is not clear whether these symptoms result from a certain type of essential tremor or another distinct condition.

The causes of essential tremor are not fully understood. The condition often runs in families, and researchers are exploring the role of other factors, such as environmental exposures.

The condition is linked to abnormalities in brain circuits, especially those connecting the cerebellum, the brainstem, and the thalamus, which relays information about movement to the cerebral cortex. A hypothesis is that the tremor is linked to the overactive central network oscillators in the brain that include the cerebellum, thalamus, cortex, and the inferior olivary nucleus. This increased activity may drive the tremor. Some studies suggest essential tremor may be a neurodegenerative condition. It is also associated with higher rates of Parkinson’s disease and dementia.

Risk factors for essential tremor include age and family history. The main risk factors are:

• Older age, as essential tremor occurs most often in adults starting around age 30 and especially in adults over age 65
• Family history, as having a parent or close relative with essential tremor increases risk. As many as two-thirds of people with the condition have at least one parent who also showed signs of tremor. Several gene variants are linked to the condition.

Other factors may trigger symptoms or make them worse, including:

• Caffeine intake can increase symptoms in some people, especially in high amounts.
• Exposure to harmane, a neurotoxin found in cooked meat.
• Certain medicines, such as those for mood disorders or asthma, may trigger or worsen tremor.
• Lack of sleep can lead to more noticeable tremor.
• Stress can lead to more pronounced symptoms.

Symptoms of essential tremor include involuntary shaking that is most noticeable during movement or when holding a posture. The symptoms can range from mild to severe and often worsen with age. The tremor usually affects both sides but may be slightly worse on one side. The legs or feet are not usually affected.

Main symptoms include:

• Shaking of the hands and arms, especially when reaching, writing, or holding objects
• Difficulty with fine motor tasks, such as using utensils, writing, drawing, pouring liquids or using small objects, such as keys or buttons
• Head nodding or shaking, usually developing after a person has experienced hand and arm tremor for a while
• Voice tremor, causing a quivering or shaky sound when speaking
• Jaw or face tremor
• Mild gait changes or balance problems, especially in later stages
• Cognitive changes, such as mild memory or concentration difficulties, in some people

People should contact a doctor if they notice a new or worsening tremor, especially after taking medicine or if tremor interferes with usual activities.

Essential tremor is diagnosed based on a person’s medical history and a detailed physical exam.

Doctors ask about the onset, duration, and pattern of tremor, family history, and any factors that worsen or relieve symptoms. They also review medicines and other health conditions that could cause tremor.

During the physical exam, doctors look for rhythmic shaking in the hands and arms under different circumstances, especially when reaching for an object. They check for tremor in the head, voice, jaw, or face and assess for other neurological signs, such as muscle stiffness, slow movement, or abnormal posture, which usually indicate a different diagnosis. The exam may include tasks like writing, drawing spirals, pouring water, or finger-to-nose testing to observe tremor characteristics. They may also ask about what seems to reduce or increase symptoms. For example, essential tremor usually decreases while resting or after having alcohol.

Essential tremor is a clinical diagnosis, meaning doctors rely on history and examination rather than specific lab tests. However, doctors may order medical tests to rule out other causes of tremor. These may include:

• Thyroid function tests to check for overactive thyroid (hyperthyroidism)
• Blood tests to measure liver and kidney function as well as possible heavy metal exposure
• Tests to screen for Wilson disease, a rare genetic disorder that affects copper metabolism that can also cause tremor
• Brain imaging tests, such as MRI or CT scan, to rule out structural brain problems if symptoms are unusual or have a sudden onset
• Dopamine transporter imaging (DaTSCAN) to distinguish essential tremor from Parkinson’s disease

Electromyography (EMG) or accelerometry, which are tests that measure the speed and size of tremor movements, are used in complex cases to rule out other types of tremor. In most cases, routine tests show normal results. Diagnosis relies on signs and symptoms and excluding other conditions.

Treatment for essential tremor aims to reduce symptoms and improve daily functioning. Not everyone needs treatment, especially if symptoms are mild. Treatment options include lifestyle changes, medicines, and adaptive devices. In a small number of cases, doctors may recommend surgical procedures.

Treatment for essential tremor can include a combination of lifestyle changes as well as certain therapies and medicines. These include:

• Avoiding caffeine, managing stress, and getting enough sleep to help reduce tremor
• Adaptive aids, like weighted utensils, button hooks, slip-on shoes, and larger-handled tools, that make daily tasks easier
• Occupational therapy, which teaches strategies for reducing the impact of symptoms
• Peripheral nerve stimulation devices, worn at the wrist, which deliver electrical stimulation that may reduce tremor in some people
• Limb cooling with ice packs, which can reduce tremor in some cases
• Wearable orthotic devices, such as wrist braces, may help control tremor

Doctors may prescribe medicines if tremor continues to interfere with daily life:

• Beta blockers, such as propranolol, are usually the first medicines doctors prescribe to reduce tremor severity and provide some relief to about half of people with the condition. Beta blockers may cause fatigue, slow heartbeat, or worsen asthma.
• Primidone, a seizure medicine, helps some people either alone or in combination with beta blockers. It can cause drowsiness, nausea, or balance problems, especially at higher doses.
• Other medicines, such as topiramate, gabapentin, benzodiazepines, and calcium-channel blockers, may be used if other medicines are not tolerated or effective.
• Botulinum toxin injections can help with severe head or voice tremor or when oral medicines do not work.

For severe, disabling symptoms that do not respond to lifestyle changes or medicines, other treatments, including surgery and other non-surgical procedures, may be considered. Many of these treatments target the thalamus, which may play a role in symptoms. These treatments may include:

• Deep brain stimulation (DBS), which is an adjustable and reversible treatment that involves implanting electrodes in the brain to deliver electrical stimulation and control tremor.
• MRI-guided focused ultrasound (MRgFUS), a noninvasive procedure that uses focused ultrasound waves to destroy a small area of the thalamus to reduce tremor.
• Radiofrequency thalamotomy, a procedure that uses heat to destroy a small area of the thalamus to reduce tremor.
• Gamma Knife thalamotomy, a radiosurgical method that uses precisely targeted radiation to destroy a small area of the thalamus in severe cases.

Treatment is tailored to each person’s needs, and regular follow-up is important to adjust therapies and monitor for side effects.

Complications of essential tremor include difficulties with daily activities, social embarrassment, and medical problems related to tremor or treatment. The main complications are:

• Trouble eating, drinking, writing, or using tools, which can affect independence and daily activities
• Speech problems, if the tremor affects the vocal cords
• Balance and gait changes, which may increase the risk of falls
• Mild cognitive changes, such as memory or concentration difficulties, in some people
• Emotional distress, anxiety, or depression, due to embarrassment or loss of function
• Side effects from medicines used to treat essential tremor, including fatigue, drowsiness, nausea, or balance problems
• Risks from surgical treatments, such as infection, stroke, speech or balance difficulties, or hardware complications

People should contact a doctor promptly if tremor worsens, interferes with daily life, or if they experience new symptoms or side effects from treatment.

The outlook for people with essential tremor is mixed. The condition is not life-threatening, and many people manage symptoms well with lifestyle changes and medicine. However, essential tremor usually progresses slowly, with tremor severity increasing. Some people may experience stable symptoms for years, while others notice gradual worsening.

Most people with essential tremor live normal lifespans and remain active and independent with adaptive strategies and treatment options. However, for many, quality of life can be affected by loss of function, embarrassment, or social withdrawal. Essential tremor may be associated with a higher risk of developing Parkinson’s disease or mild cognitive changes.

Regular follow-up and a team approach can improve outcomes and support daily functioning.

This article was medically reviewed in June 2026.