The Brain and Essential Tremor

Medically Reviewed by Zilpah Sheikh, MD on January 08, 2025
Written by Lori M. King, PhD
7 min read

Essential tremor is a movement disorder that causes tremors, which are rhythmic, periodic, repetitive motions that you can’t control. It generally affects both your hands, especially early on. It's a progressive condition, which means it tends to worsen over time. So, after you've had it for a while, it may also affect your arms, head, larynx (voice box), jaw, face, torso, and legs. Generally, it progresses slowly, so it usually takes years before you need treatment, if at all.

Essential tremor is probably a neurological condition, which means it starts in your brain, spinal cord, or nerves. About 50% of people who develop essential tremor have another family member who has it. The rest of the time, doctors may not be able to identify the cause or trigger.

It isn't life-threatening and doesn't affect your lifespan. However, it can cause disability in some people because the tremors may make it challenging to eat, dress themselves, or write. If your symptoms are making it difficult to care for yourself daily, there are several treatments your doctor can recommend, including medicines, adaptive devices, and surgical procedures.

Keep reading to learn more about the potential treatments for essential tremors.

Doctors don’t know the exact cause of essential tremors. About half of people who get it have it in their family, but researchers haven't found one single gene that causes it. It's probably caused by multiple factors, including what you've been exposed to in your environment. This is because:

  • People can get it sporadically, without a family history
  • Even in people with a family history, the age of symptom onset can vary
  • In twins, one may get it, while the other twin doesn't

Whatever causes essential tremors seems to cause changes in certain parts of your brain that may prevent your cerebellum from communicating well with other parts of your brain. Your cerebellum is the part of your brain that helps control your muscle coordination.

Is essential tremor hereditary?

Doctors think that about half of essential tremor cases are hereditary because they run in families. Usually, it's passed from a parent to their child in an autosomal dominant way. This means that if you have essential tremor, you have about a 50% chance of passing it on to each of your biological children. But whether they develop the condition may depend on the environmental factors they're exposed to.

Diseases causing tremors

Essential tremor is the most common disorder that causes postural or action tremors. Action tremors are those that happen while you're using a body part, such as reaching for an object. Researchers estimate that about 5% of the population has essential tremor.

Other conditions that may cause tremors include:

  • Other neurological conditions, such as Parkinson's disease, multiple sclerosis, or stroke
  • Having an overactive thyroid
  • Liver or kidney failure
  • Having high or low blood sugar
  • Having a lot of stress, feeling anxious, or being very fatigued
  • Having too much caffeine in your diet
  • Exposure to heavy metals and neurotoxins, such as mercury, manganese, lead, arsenic, organic solvents, and pesticides
  • Taking corticosteroids, some chemotherapy drugs, or some other medicines, such as those for asthma or psychiatric or neurological disorders

Essential tremor is the most common movement disorder, affecting up to 10 million people in the U.S.

It can happen at any age, but it most often appears first in your teens or later when you're between ages 40 and 50. You may be more likely to get it at a younger age if it runs in your family.

The main symptoms of essential tremor include:

  • Tremors that are most obvious in your hands (rarely, they may affect your legs and feet)
  • Trouble doing tasks with your hands, such as writing or using tools
  • Shaking or quivering in your voice
  • Uncontrollable head nodding
  • Tremors that happen when you move and are less noticeable when you rest
  • Tremors that may get worse when you take certain medicines, have too much caffeine, or feel very stressed.
  • Tremors that may get better when you drink a little bit of alcohol
  • Tremors that get worse as you get older
  • Tremors that don't affect both sides of your body the same way. 

The Movement Disorders Society criteria for diagnosis of essential tremor include the following:

  • A tremor in your hands and forearms
  • A tremor that's bilateral (on both sides of your body) and postural (appears when you hold your hands or arms in certain positions)
  • A tremor that's visible to other people and persistent (doesn't go away and come back)
  • You may also have a tremor in your head

Shaking hands

Tremors in the hands and forearms are the most common and obvious sign of essential tremor.

Studies show that people with essential tremor may be at risk for other medical and psychiatric conditions. The most common ones include:

  • High blood pressure
  • Pain disorders
  • High levels of fats in your blood (hyperlipidemia)
  • Fatigue and sleep-related disorders
  • Diabetes
  • Anxiety
  • Depression
  • Substance abuse disorder

Some studies suggest that people with essential tremors may be at an increased risk for Parkinson's disease and dementia. But other studies don't support those findings.

Your doctor will likely start by asking about your medical and family history and doing a physical exam. As part of the physical exam, they will likely do a neurological exam to test:

  • Your muscle tone and strength
  • Your reflexes
  • Your ability to balance
  • Your speech patterns
  • Whether your tremor happens when your muscles are resting or moving
  • Where your tremor happens — for instance, on only one side or both sides of your body
  • What your tremor looks like — for instance, they will document the frequency and amplitude (size) of your tremor (The frequency of essential tremor is usually about 6-12 Hertz, but it tends to go down as you get older. The amplitude tends to increase as you get older.)

To help rule out other causes of tremor, your doctor may also have you do blood and urine tests. They may send you for imaging tests to help them see if you have damage in certain areas of your brain. They may also have you do an electromyogram, which can show if you have problems with your muscles or nerves. It measures your involuntary muscle movements and how your muscles respond to nerve stimulation.

If you're having trouble doing daily activities, they may also do functional limitation tests. For instance, they may want to see how well you do when handwriting or eating and drinking.

You may not need treatment if you're able to function well day-to-day. 

If your symptoms are impairing your function, there are several options including:

Medication for essential tremor

You may need to try several different medicines or combinations of medicines before you find one that works for you. There are many medicines that you can try, including:

First-line therapies are those that are FDA-approved or supported by high-quality clinical trials, such as:

These medicines block the stimulation of your nerve cells by brain chemicals called neurotransmitters. 

Second-line therapies are those that are supported by good-quality clinical trials, such as:

Third-line therapies are those with support from lower-quality studies, such as:

  • Clozapine (Clozaril)
  • Nimodipine (Nimotop)

For some people with head or vocal cord tremors, botulinum toxin injections may help ease those symptoms. It may also help some people with hand tremors who haven't been helped by medicine.

Adaptive devices

These are external devices that can help change or control how severe your tremors are. For instance, some people can reduce their tremors and improve their function by using wrist weights. Other commercially available devices can help too. For example, weighted utensils can make eating easier. Devices with active tremor cancelation are also available.

Stress and anxiety can make your tremors worse, so some people can ease their tremors by practicing nonmedical relaxation techniques or using biofeedback.

Deep brain stimulation (DBS)

It's the most common surgical treatment for essential tremor. Studies show that about 70%-90% of hand tremor symptoms can be relieved with deep brain stimulation. 

During the procedure, your surgeon will implant an electrode in a part of your brain called your thalamus and attach it to a pacemaker-type device under the skin of your chest. This device causes tiny, painless shocks that disrupt faulty electrical messages in your brain to ease your tremors. 

MRI-guided focused high-intensity ultrasound

This therapy was approved by the FDA in 2016. It uses MRI to guide a high-intensity, focused ultrasound to destroy tissue in your thalamus. The procedure is painless, with no cutting or drilling into your brain. You don’t need anesthesia, and you’re awake and responsive the whole time. But it doesn’t work for everyone, and any improvement in your tremors can fade over time.

Radio-surgical gamma knife thalamotomy

This procedure uses high-energy gamma rays (radiation) to destroy brain cells in the part of your thalamus causing your tremor. This therapy isn't used as much as others because it may increase your risk for tumors after your radiation exposure.

Because experts don’t know the trigger for essential tremor, there is no way to prevent it. But knowing that it has a genetic link gives researchers clues as they look for treatments and prevention.

There is no cure for essential tremor, and it doesn't go away on its own. But treatments that ease your symptoms may improve your quality of life. These include drugs and surgery to ease tremors.

But not every treatment or procedure is effective for every person with essential tremor. Your doctor will recommend a personal treatment plan, including lifestyle changes that may help reduce your tremors.

Essential tremor is one of the most common movement disorders. It causes tremors — rhythmic movements that you can't control — generally in your hands. If it isn't affecting your ability to function, you may not need treatment. But if your symptoms are making it hard for you to care for yourself, there are several treatment options available.

Can you live a long life with essential tremor?

Yes, absolutely. Essential tremor likely won't affect your lifespan. But the symptoms can make it more challenging for you to care for yourself. If this is the case for you, talk to your doctor; they have treatments they can recommend to help control your symptoms.