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Benign Essential Tremor

(Essential Tremor; Familial Tremor)



Benign essential tremor (ET) is a movement disorder most commonly noticed by shaking in the hands. It occurs in about 5% of older adults. It may also cause shaking of the head, voice, arms, and trunk. It occurs less often in the legs and feet. The 2 types of tremor that are common with ET include:

  • Postural tremor—shaking in certain positions only, such as with arms outstretched
  • Kinetic or action tremor—shaking that gets worse during activities, such as eating or shaving

ET can be socially isolating in some cases. It may interfere with normal daily activities such as writing or speaking.


Causes    TOP

A tremor is a problem with how the nerves and brain talk to the muscles. This problem causes the abnormal movements. For some people, this is caused by a genetic mutation. For others, the cause is not clear.


Risk Factors    TOP

A family history of tremors is the only known risk factor for essential tremor. The condition may occur at any age. It is more likely to occur in teens and people older than 50 years old.


Symptoms    TOP

Essential tremor (ET) is generally not serious, but its severity may vary and worsen over time. Symptoms may include:

  • Tremor that occurs when standing or moving the limbs, but not usually at rest
  • Uncontrollable, rhythmic movement
  • Shaking most common in hands, arms, head, or voice
  • Shaking only in certain positions or during activity
  • Trouble with fine motor skills, such as drawing, sewing, or playing an instrument
  • Changes in volume and smoothness while speaking
  • Shaking that gets worse from caffeine, stress, fatigue, or heat
  • Shaking that may decrease when using alcohol
  • Hearing loss
  • Problems with social, functional, or job-related abilities in more severe cases

Tremors must not be related to other health conditions in order for someone to have the ET diagnosis.


Diagnosis    TOP

You will be asked about your symptoms and medical history. The doctor will be able to see the tremor. How the tremor behaves and what part of the body it affects will also be noted. The doctor may also look for other signs of changes in the nervous system. This may include changes in smell or hearing or loss of balance.


Treatment    TOP

Most people with essential tremor do not require treatment. Mild tremors may be relieved or even eliminated by simple measures, including:

  • Staying well-rested
  • Avoiding caffeine
  • Avoiding stimulants often found in over-the-counter medications, such as cold remedies
  • Avoiding temperature extremes

The following treatment options may be helpful:


Benign essential tremor may be treated with:

  • Beta-blockers
  • Antiseizure medications
  • Benzodiazepines
  • Antipsychotic medication
  • Botulinum injections


Surgery may be an option in rare cases where tremors are disabling and medications do not help. There are 2 possible approaches.

  • Deep brain stimulation (DBS)—sends painless electrical pulses to the brain, interrupting faulty signals
  • Thalamotomy—destroys a tiny part of the brain (less commonly performed than DBS)

Prevention    TOP

There are no current guidelines to prevent benign essential tremor.


International Essential Tremor Foundation

National Institute of Neurological Disorders and Stroke


Health Canada

Parkinson Canada


About essential tremor. International Essential Tremor Foundation website. Available at:
...(Click grey area to select URL)
Accessed February 21, 2018.

Essential tremor. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116382/Essential-tremor . Updated February 20, 2018. Accessed February 21, 2018.

Muth C. Essential tremor. JAMA. 2016;316(20):2162. Available at:
...(Click grey area to select URL)
Accessed February 21, 2018.

Essential tremor. International Radiosurgery Support Association website. Available at:
...(Click grey area to select URL)
Accessed February 21, 2018.

Lorenz D, Deuschl G. Update on pathogenesis and treatment of essential tremor. Current Opin in Neurol. 2007;20(4):447-452.

Sadeghi R, Ondo WG. Pharmacological management of essential tremor. Drugs. 2010:70(17):2215-2228.

Smaga S. Tremor. Am Fam Physician. 2003;68(8):1545-1552.

Xie T, Bernard J, Warnke P. Post subthalamic area deep brain stimulation for tremors: A mini review. Transl Neurodegener. 2012;1(1):20.

3/7/2018 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116382/Essential-tremor : Crawford P, Zimmerman EE. Tremor: sorting through the differential diagnosis. Am Fam Physician. 2018;97(3):180-186. Available at: https://www.aafp.org/afp/2018/0201/p180.html.

Last reviewed March 2018 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 3/7/2018

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