Neurology
Medicines for Essential tremor
A common movement disorder that causes a rhythmic shaking, usually of the hands, which is worse with action — such as holding a cup or writing — and is often harmless but can be treated when it interferes with daily life.
Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.
Quick answer
What is Essential tremor?
Essential tremor is one of the most common movement disorders. It causes a rhythmic, involuntary shaking that most often affects the hands and arms, but can also involve the head, voice or, less often, the legs.
- How it is treated: Treatment is guided by how much the tremor affects daily life, and many people with a mild tremor need no medication at all once they understand the condition and are reassured.
- Self-care: Simple measures can make a real difference.
- When to seek help: See your GP if a tremor is new, is getting worse, or is starting to affect everyday activities such as eating, drinking, writing or work, so that the cause can be assessed and treatment discussed.
What it is
Essential tremor is one of the most common movement disorders. It causes a rhythmic, involuntary shaking that most often affects the hands and arms, but can also involve the head, voice or, less often, the legs. Its hallmark is that the tremor appears or worsens with action — when you reach for something, hold a cup of tea, bring a spoon to your mouth, write or sign your name — rather than when the limb is resting. This is an important difference from Parkinson's disease, which typically causes a tremor at rest along with slowness of movement and stiffness; essential tremor is a distinct condition and is not Parkinson's. The tremor often runs in families, can begin at any age but becomes more common with age, and is frequently made worse by tiredness, stress, caffeine and certain medicines. Many people notice that a small amount of alcohol briefly eases the shaking, which is a recognised feature, though alcohol is not a treatment. The condition is usually benign in the sense that it is not dangerous, but for some people it can be socially embarrassing or make everyday tasks difficult.
How it is treated
Treatment is guided by how much the tremor affects daily life, and many people with a mild tremor need no medication at all once they understand the condition and are reassured. Where the tremor interferes with eating, drinking, writing, work or confidence, treatment can help reduce it, though it usually lessens rather than abolishes the shaking. Avoiding triggers such as excess caffeine, tiredness and stress is a sensible first step. When medicine is offered, a beta-blocker (propranolol is the one most often used) or primidone — a medicine that is also used as an anti-epileptic — are the established first-line choices, and the decision between them depends on a person's other conditions and how they respond. Treatment is reviewed over time, and people with a severe tremor that does not respond to medicine may be referred to a specialist to consider other options.
For this condition, these medicines
Medicine classes used for Essential tremor
Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.
Symptom checker
Symptoms that can point to Essential tremor
Essential tremor can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:
Beyond medication
Lifestyle and self-care
Simple measures can make a real difference. Cutting back on caffeine in coffee, tea, cola and energy drinks often reduces the shaking, as does getting enough sleep and finding ways to manage stress, since tiredness and anxiety tend to make the tremor worse. Although a little alcohol may briefly ease the tremor, it is not a sensible treatment and regular use to control symptoms should be avoided. Practical aids help with daily tasks — weighted cups and cutlery, wide-handled pens, using both hands for a task, and resting the elbows on a table to steady the arms. Letting people around you know about the condition can take away the worry of being judged when your hands shake in public.
When to get help
When to see a doctor
See your GP if a tremor is new, is getting worse, or is starting to affect everyday activities such as eating, drinking, writing or work, so that the cause can be assessed and treatment discussed. It is worth getting medical advice rather than assuming a tremor is simply part of ageing. Tell your doctor promptly if the shaking is mainly there at rest and is joined by slowness, stiffness or changes in walking, balance or handwriting, as these features point away from essential tremor and need looking into. Seek urgent help if a tremor comes on suddenly, affects only one side of the body, or appears alongside weakness, numbness, slurred speech, confusion or a severe headache, as these may signal a different and more urgent problem.
Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.
Answers
Essential tremor: frequently asked questions
What medicines are used for essential tremor?
When treatment is needed, the two established first-line medicines are a beta-blocker — most often propranolol — and primidone, a medicine that is also used as an anti-epileptic. Both can reduce the shaking, and the choice between them depends on your other conditions and how you respond. They tend to lessen the tremor and make daily tasks easier rather than stop it completely. Many people with a mild tremor do not need any medicine once the condition has been explained and they have been reassured, and avoiding triggers such as too much caffeine, tiredness and stress can help on its own.
Is essential tremor the same as Parkinson’s disease?
No — they are different conditions, although both cause shaking. The key difference is when the tremor appears. Essential tremor is an action tremor: it shows up or worsens when you use the hands, such as when reaching, holding a cup or writing. Parkinson’s typically causes a tremor at rest — when the hand is sitting still — together with other features such as slowness of movement, stiffness and changes in walking and balance. Essential tremor often runs in families and may briefly ease with a little alcohol, which is not a feature of Parkinson’s. If there is any doubt about which condition is causing a tremor, a doctor can assess it, and referral to a specialist may be arranged.
Does essential tremor run in families?
It often does. Essential tremor frequently affects more than one member of a family, and many people with the condition have a parent, brother, sister or child who also has a tremor, which is why it is sometimes called familial tremor. Having a family history does not mean you will definitely develop it, and the tremor can vary a lot in how severe it is between relatives. The condition can also occur in people with no family history at all. Knowing that it runs in your family can be reassuring, as it points towards this generally benign condition rather than another cause, but any new or worsening tremor is still worth having checked.
Will my essential tremor keep getting worse?
Essential tremor tends to be slowly progressive, meaning it often becomes a little more noticeable over many years, but this varies greatly from person to person and it is not a dangerous condition. For some people it stays mild and never needs treatment; for others it gradually starts to interfere with tasks like eating, drinking or writing, at which point medicines can help. Tiredness, stress and caffeine can temporarily make any tremor worse, so managing these can smooth out day-to-day fluctuations. If the tremor becomes more troublesome, it is worth seeing your doctor, as treatment can be started or adjusted, and people with a severe tremor that does not respond to medicine can be referred to a specialist for other options.
Keep reading
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Sources
Where this is drawn from
- NICE CKS: Tremor.
- Brain & Spine Foundation
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