Essential Tremor: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Essential Tremor?
A neurologist, a doctor who treats brain and nerve conditions, usually treats essential tremor. A primary care doctor can often make the diagnosis with an exam and your history. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is essential tremor?
Essential tremor is a movement disorder that causes involuntary, rhythmic shaking, especially in the hands. Involuntary means you shake without trying to and cannot stop the shaking at will. It is the most common type of tremor. The shaking usually happens during movement and is usually not seen at rest. It does not shorten life. It is not a dangerous problem, but some people find it annoying and embarrassing.
Symptoms
The shaking is most often noticed in the forearms and hands. The arms, head, eyelids, or other muscles may also shake. The legs and feet are rarely affected. Other signs can include:
- Trouble holding or using small objects, such as silverware or a pen.
- Problems with writing, drawing, drinking from a cup, or using tools.
- Head nodding.
- A shaking or quivering voice if the tremor affects the voice box.
The tremor may come and go, but it often gets worse with age. It can get worse with stress, caffeine, lack of sleep, and certain medicines. It may not affect both sides of the body the same way. Sometimes the tremor affects the vocal cords, which may lead to speech problems.
Causes and who gets it
The exact cause is unknown. Research suggests that the part of the brain that controls muscle movements does not work correctly. Essential tremor can run in families. When it happens in more than one family member, it is called familial tremor. A gene from one parent is usually enough to cause familial tremor. Researchers have not yet identified the genes that cause essential tremor. It can also appear in people with no family history.
It affects both men and women and is most common in people older than 65. It can start at any age. It affects up to 10 million people in the United States.
How doctors diagnose it
A doctor can diagnose it with a physical exam and questions about your history. The doctor checks if the shaking happens at rest or during movement, and where it happens. Tremor from Parkinson's disease is most noticeable when the hands are at rest. Tests may check for other causes. These include an overactive thyroid, alcohol withdrawal, too much caffeine, or certain medicines. Blood tests and imaging tests are usually normal in essential tremor. Severe cases are often mistaken for Parkinson's disease.
Treatment
Treatment may not be needed unless the shaking gets in the way of daily activities or causes embarrassment. At home, try relaxing techniques for stress, avoid caffeine, and get enough sleep. Weighted utensils, straws, half-filled cups, Velcro clothes, and slip-on shoes can make daily tasks easier. A physical, speech, or occupational therapist may also help.
The medicines used most often are propranolol, a beta blocker, and primidone, a seizure medicine. Propranolol may cause tiredness, a stuffy nose, or a slow heartbeat, and it may make asthma worse. Primidone may cause drowsiness, trouble concentrating, nausea, and problems with walking, balance, and coordination. Follow your doctor's instructions, and do not change or stop any medicine on your own. Botulinum toxin injections may be tried to reduce tremor. They can be used for people who do not respond to medicines taken by mouth.
In severe cases, surgery may be tried. Deep brain stimulation uses electrodes in the brain and a small device under the skin of the upper chest. Focused ultrasound uses MRI to aim sound waves at a tiny area of the brain. It is approved only for people whose essential tremor does not respond well to anti-seizure or beta-blocking drugs.
When to see a doctor
Contact your doctor if you have a new tremor. Also call if daily tasks are hard or your medicines cause side effects. Call 911 or go to the emergency room if new shaking comes with sudden weakness, sudden dizziness, a change in vision, or being unable to speak.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can check for other causes of shaking and review medicines that may make it worse.
Common questions
Is essential tremor dangerous?
No, essential tremor is not a dangerous problem. It does not shorten life. In some cases, it can make work, writing, eating, or drinking hard.
Is essential tremor the same as Parkinson's disease?
No, they are different conditions. Essential tremor mostly happens during movement and is usually not seen at rest. Parkinson's tremor is most noticeable when the hands are at rest.
Does essential tremor run in families?
Yes, essential tremor can run in families. It can also appear in people with no family history.
Does alcohol help essential tremor?
A small amount of alcohol may ease the shaking, but doctors do not recommend it as a treatment. Alcohol use disorder may develop, especially if you have a family history of such problems.
Sources
- MedlinePlus - Essential tremor
- MedlinePlus Genetics - Essential tremor
- National Institute of Neurological Disorders and Stroke - Tremor
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
