The commonest movement disorder, far more common than Parkinson's — and treatable with a tablet most people have heard of.
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Essential tremor is a rhythmic shaking, most often of the hands, that appears when you are using them. It is the commonest movement disorder there is — substantially more common than Parkinson's disease, by a factor of around eight to ten.
The question almost everyone arrives with is whether this is Parkinson's, and the distinction is more straightforward than people expect.
Essential tremor shows itself when you are doing something — lifting a cup, holding a fork, signing your name, pouring a drink. Parkinson's tremor shows itself when the hand is doing nothing at all, sitting still in your lap, and it settles when you reach for something.
That is the single most useful thing on this page. A tremor that is worse at rest and better on movement points to Parkinson's; a tremor that is fine at rest and worse on movement points to essential tremor. Parkinson's also brings slowness and stiffness, which essential tremor does not.
It is often called "benign", and that word does it a disservice. It does not shorten life, but avoiding eating out, dreading having to sign something in front of someone, or giving up a job that needs steady hands is not a benign experience. It is treatable, and most people who try treatment get a worthwhile improvement.
Stress, tiredness, caffeine, being watched, hunger, and temperature extremes. The "being watched" part is genuinely difficult — knowing that someone is looking makes the tremor worse, which makes it more noticeable, which makes it worse again.
A small amount of alcohol temporarily reduces the tremor in the majority of people, sometimes dramatically. It is a recognised feature and a useful diagnostic clue.
It is also a real risk, and worth naming plainly. Self-medicating a tremor with alcohol is a well-recognised route into dependence, and the tremor rebounds worse afterwards. If you have found yourself relying on it, that is worth saying to a doctor — it is a common story and not one to feel ashamed of.
No slowness of movement, no stiffness, no shuffling walk, no loss of facial expression, and no loss of smell. Those belong to Parkinson's.
Wilson's disease — a treatable disorder of copper metabolism — should be considered in anyone developing a tremor under about 40. It is rare, it is missed, and it is entirely treatable if found.
Dystonic tremor, which has a different pattern and different treatment, is also worth distinguishing.
Essential tremor is diagnosed by the pattern of the tremor and the absence of other neurological signs. No blood test or scan confirms it; tests are done to exclude other things.
An overactive thyroid, medication side effect, dystonic tremor, functional tremor, anxiety, alcohol withdrawal, Wilson's disease, or an enhanced physiological tremor — the normal fine tremor everyone has, exaggerated by caffeine, stress or tiredness.
This is well suited to a remote consultation, and rather better suited than people assume — because the diagnosis rests almost entirely on the history and on watching the tremor, both of which work over video.
A short clip of your hands — at rest, reaching for something, holding a cup, and writing — is genuinely informative, and often more useful than a description. Record it before the consultation if you can.
It works, and that is precisely the problem. A small amount reduces the tremor for a couple of hours, then it rebounds worse than before, and the amount needed creeps up.
Using alcohol to manage a tremor is a recognised route into dependence. If you have found yourself doing it, say so — propranolol does the same job without the trap.
Essential tremor is not usually notifiable to the DVLA, but you must tell them if it affects your ability to control a vehicle safely. If you are unsure, that is worth discussing directly.
This is a condition the NHS handles well. If you can get a GP appointment, that is a perfectly good route.
This page follows NICE Clinical Knowledge Summaries on tremor, NICE guideline NG71 on Parkinson's disease for the differential, and Association of British Neurologists guidance on tremor.
Guidance notes that essential tremor can cause substantial functional and psychosocial impairment, and that the historical label "benign essential tremor" understates its impact on daily life and employment.
Reviewed against NICE CKS, NICE NG71 and Association of British Neurologists guidance current at the date shown above.
Almost certainly not, if the tremor comes on when you use your hands and disappears when they rest in your lap. Parkinson's does the opposite.
Parkinson's also brings slowness and stiffness, which essential tremor does not. This distinction can usually be settled in a single consultation.
Far more common than Parkinson's — roughly eight to ten times as common.
It is the commonest movement disorder there is, which is worth knowing when you are lying awake worrying about the alternative.
Alcohol temporarily reduces the tremor in most people with essential tremor, and it is a recognised diagnostic clue.
It is also a trap. The tremor rebounds worse, the amount needed rises, and self-medicating this way is a known route into dependence. Propranolol does the same job without that.
It progresses slowly, usually over decades. Many people manage for years before treatment is worth it.
It does not shorten life and it does not lead to Parkinson's.
Possibly. Around half of cases run in families, usually in a dominant pattern, which means roughly a one-in-two chance for each child.
Severity varies enormously between relatives, so an affected parent tells you little about how badly a child would be affected.
It roughly halves the tremor in about half to two-thirds of people. It does not abolish it.
Expecting complete disappearance leads to unnecessary disappointment with a treatment that is actually helping.
Yes, and many people prefer that. Taken an hour or so before a presentation, a meal out or a wedding, it works well.
Daily dosing suits people whose tremor affects them constantly; situational dosing suits everyone else.
Quite possibly, and it is always worth checking. Salbutamol inhalers, too much levothyroxine, lithium, valproate, SSRIs and steroids can all do it.
Adjusting the culprit has resolved plenty of tremors entirely.
Usually not. Essential tremor is a clinical diagnosis, and no scan confirms it.
A DaTscan is reserved for the minority of cases where the difference from Parkinson's genuinely cannot be settled by examination.
Not usually — essential tremor is not automatically notifiable.
You must tell them if it affects your ability to control a vehicle safely, and if you are unsure whether it does, that is worth a proper conversation.
August 30, 2026
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