8 Essential Tremor Symptoms You Should Know About

Essential tremor is one of the most common movement disorders affecting millions of people worldwide. This neurological condition causes involuntary, rhythmic shaking that typically affects the hands, but can also impact other parts of the body. Unlike other tremor-related conditions, essential tremor usually occurs during voluntary movements and tends to worsen over time. Understanding the symptoms of essential tremor is crucial for early recognition and appropriate management of this condition.

While essential tremor is not life-threatening, it can significantly impact daily activities and quality of life. The condition often runs in families, which is why it’s sometimes referred to as familial tremor. In this comprehensive guide, we’ll explore the most common symptoms of essential tremor to help you recognize this condition and understand when to seek medical attention.

1. Hand Tremors During Action

The most characteristic symptom of essential tremor is rhythmic shaking of the hands that occurs during voluntary movements. This is known as an “action tremor” or “kinetic tremor,” which distinguishes it from tremors that occur at rest.

These hand tremors typically become noticeable when you’re performing everyday tasks such as:

• Writing or signing documents
• Holding a cup or glass
• Using utensils while eating
• Pouring liquids
• Threading a needle or performing other fine motor tasks

The tremor usually affects both hands, though it may be more pronounced in one hand than the other. The shaking typically occurs at a frequency of 4-12 cycles per second and appears as a back-and-forth movement. Many people notice that the tremor worsens when they’re trying to hold their hands in a specific position or when reaching for objects.

2. Progressive Worsening Over Time

Essential tremor is a progressive condition, meaning the symptoms gradually become more noticeable and severe over many years. This progression is typically slow and varies significantly from person to person.

In the early stages, the tremor may be barely noticeable and only appear during times of stress, fatigue, or when performing precise movements. As the condition progresses, the tremor may:

• Occur more frequently throughout the day
• Become visible during a wider range of activities
• Increase in amplitude, making the shaking more pronounced
• Begin to affect additional body parts beyond the hands
• Interfere more significantly with daily tasks

The rate of progression is highly individual. Some people experience minimal changes over decades, while others may notice more rapid worsening. It’s important to note that essential tremor does not lead to other serious neurological conditions, though it can significantly impact quality of life as it progresses.

3. Head Tremors (Titubation)

Approximately one-third of people with essential tremor develop head tremors, medically known as titubation. This symptom typically appears as a rhythmic shaking of the head in a “yes-yes” (up and down) or “no-no” (side to side) pattern.

Head tremors associated with essential tremor have several characteristics:

• The movement is involuntary and cannot be controlled voluntarily
• The tremor may be constant or intermittent
• It can occur when the head is at rest or during movement
• The amplitude can range from subtle to quite pronounced
• It may worsen with stress or anxiety

Head tremors can be particularly distressing for individuals as they are highly visible to others. Some people find that the head tremor is more noticeable when they’re concentrating, sitting still, or in social situations. Unlike the hand tremor, head tremor may be present even when the head is supported.

4. Voice Tremor (Vocal Tremor)

Voice or vocal tremor affects approximately 20-30% of individuals with essential tremor. This symptom manifests as a shaky, quivering quality to the voice that can make speech sound tremulous or wavering.

Characteristics of voice tremor include:

• A rhythmic oscillation in vocal pitch and volume
• Voice that sounds shaky or quivering, particularly on sustained vowels
• Increased difficulty with voice control during sustained speech
• Worsening when speaking in public or during stressful situations
• No associated difficulty with language, word-finding, or articulation

The voice tremor results from rhythmic contractions of the muscles in the larynx (voice box) and can range from barely noticeable to significantly impacting communication. Some people find that singing is less affected than speaking. This symptom can be particularly challenging in professional settings or social situations where clear communication is important.

5. Difficulty with Fine Motor Tasks

As essential tremor affects precision and control of movements, individuals often experience increasing difficulty with tasks requiring fine motor coordination. This functional impairment is often what prompts people to seek medical attention.

Common fine motor difficulties include:

• Handwriting changes – writing may become larger, shakier, or illegible
• Difficulty buttoning shirts or fastening jewelry
• Challenges applying makeup or shaving
• Trouble using keys in locks
• Difficulty typing or using a computer mouse precisely
• Problems with drawing, painting, or craft activities

These difficulties typically worsen with actions that require sustained posture or precise hand-eye coordination. Many people develop compensatory strategies, such as using both hands for tasks normally done with one hand, or avoiding certain activities altogether. The impact on daily functioning can range from mild inconvenience to significant disability, depending on the severity of the tremor.

6. Tremor Triggered or Worsened by Certain Factors

Essential tremor characteristically fluctuates in severity depending on various internal and external factors. Understanding these triggers can help individuals manage their symptoms and predict when tremors may be more problematic.

Common factors that worsen essential tremor include:

• Emotional stress and anxiety: Stressful situations often cause noticeable worsening of tremor
• Fatigue: Tremors typically become more pronounced when tired
• Caffeine: Coffee, tea, and other caffeinated beverages can exacerbate tremor
• Certain medications: Some drugs, including certain asthma medications and mood stabilizers, may worsen tremor
• Temperature extremes: Being very cold or overheated can increase tremor severity
• Low blood sugar: Hunger or hypoglycemia may intensify shaking
• Specific postures: Holding arms outstretched or in certain positions against gravity

Interestingly, many people with essential tremor notice that consuming small amounts of alcohol temporarily reduces their tremor. However, this is not recommended as a management strategy due to the risks associated with regular alcohol consumption.

7. Tremor in Other Body Parts

While hand tremors are the hallmark of essential tremor, the condition can affect various other parts of the body, though less commonly. As the condition progresses, additional body areas may become involved.

Other body parts that may be affected include:

• Arms: Tremor can occur throughout the entire arm, not just the hands
• Legs and feet: Lower extremity tremor is less common but can occur, potentially affecting balance
• Trunk: Tremor of the torso is rare but can occur in more severe cases
• Tongue: Tongue tremor may be visible when the tongue is extended
• Facial muscles: Subtle tremor of facial muscles can occasionally be present
• Jaw: Rhythmic jaw movements may occur in some cases

The presence of tremor in multiple body parts doesn’t necessarily indicate more severe disease, but it can increase the functional impact of the condition. Leg tremor, while less common, can affect balance and walking, particularly in older adults.

8. Absence of Other Neurological Symptoms

An important characteristic of essential tremor is what symptoms are not present. Essential tremor is an isolated tremor disorder, meaning it doesn’t typically cause other neurological problems. This helps distinguish it from other conditions that cause tremor.

Notable absent symptoms in essential tremor include:

• No significant slowness of movement (bradykinesia)
• No muscle rigidity or stiffness
• No problems with balance or walking in early stages
• No cognitive decline or memory problems directly caused by the tremor
• No muscle weakness
• No abnormal postures
• No resting tremor (tremor that occurs when muscles are completely relaxed)

If you experience tremor along with any of these other symptoms, it’s important to consult a healthcare provider, as this may indicate a different condition. The presence of additional neurological symptoms should prompt a thorough evaluation to rule out other movement disorders.

What Causes Essential Tremor?

The exact cause of essential tremor remains not fully understood, but research has identified several important factors that contribute to the development of this condition.

Genetic Factors: Essential tremor has a strong hereditary component, with approximately 50-70% of cases having a family history of the condition. When essential tremor runs in families, it’s inherited in an autosomal dominant pattern, meaning a child has a 50% chance of developing the condition if one parent is affected. This genetic link is why the condition is sometimes called familial tremor. However, the specific genes involved are still being studied, and multiple genetic factors likely contribute.

Neurological Abnormalities: Research suggests that essential tremor involves abnormal communication between certain areas of the brain, particularly the cerebellum (which controls coordination) and the thalamus (which relays motor signals). Studies using brain imaging have shown structural and functional changes in these regions in people with essential tremor. The condition appears to involve problems with the neural circuits that control precise movements.

Age: While essential tremor can begin at any age, it becomes increasingly common with advancing age. The condition can appear in childhood, but most people first notice symptoms in their 40s or later. The risk continues to increase with age, making it particularly common among older adults.

Environmental Factors: While genetics play a major role, environmental factors may also contribute. Some studies have suggested possible links to certain toxin exposures, though this research is ongoing and not conclusive. The interaction between genetic predisposition and environmental factors is an active area of research.

Frequently Asked Questions

Is essential tremor the same as Parkinson’s disease?

No, essential tremor and Parkinson’s disease are different conditions. Essential tremor primarily causes action tremor (shaking during movement) and usually affects both sides of the body symmetrically. Parkinson’s disease typically causes resting tremor (shaking when muscles are relaxed), along with stiffness, slowness of movement, and balance problems. Essential tremor is more common than Parkinson’s disease and has a better overall prognosis.

Will essential tremor get worse over time?

Yes, essential tremor is typically a progressive condition, meaning symptoms gradually worsen over time. However, the rate of progression varies greatly between individuals. Some people experience very slow progression over many decades with minimal impact on daily life, while others may notice more rapid changes. The tremor generally does not lead to other serious health problems or reduce life expectancy.

Can stress cause essential tremor?

Stress doesn’t cause essential tremor, but it can significantly worsen existing tremor. Essential tremor has underlying genetic and neurological causes. However, emotional stress, anxiety, fatigue, and other factors can make the tremor temporarily more noticeable and severe. Many people find their tremor is worse during stressful situations and improves when they’re relaxed.

At what age does essential tremor usually start?

Essential tremor can begin at any age, from childhood through late adulthood. However, there are two common peaks of onset: one in the teenage years or early 20s, and another after age 40. The condition becomes increasingly common with advancing age. When it begins earlier in life and runs in families, it’s more likely to have a genetic component.

Does essential tremor affect life expectancy?

No, essential tremor does not affect life expectancy. While the condition can significantly impact quality of life and the ability to perform daily tasks, it is not a life-threatening condition. Unlike some other neurological disorders, essential tremor doesn’t lead to other serious health complications or reduce lifespan. However, managing the condition is important for maintaining independence and quality of life.

Can essential tremor go away on its own?

No, essential tremor is a chronic condition that does not go away on its own. Once it develops, it is typically lifelong, though the severity can fluctuate. The tremor may be less noticeable at times, particularly when you’re relaxed, but it doesn’t spontaneously resolve. However, various management strategies can help reduce symptoms and improve function. Consulting with a healthcare provider is important for appropriate evaluation and management options.

Why does alcohol temporarily reduce essential tremor?

Many people with essential tremor notice that small amounts of alcohol temporarily reduce their tremor, though the exact mechanism is not fully understood. It’s thought that alcohol may affect the same brain circuits involved in essential tremor, particularly in the cerebellum and thalamus. However, using alcohol to manage tremor is not recommended due to the risks of dependence, other health problems, and the fact that the effect is temporary and the tremor may worsen as the alcohol wears off.

Is there a test to diagnose essential tremor?

There is no single definitive test for essential tremor. Diagnosis is primarily based on medical history, family history, and physical examination by a healthcare provider. The doctor will assess the characteristics of your tremor, check for other neurological signs, and rule out other conditions that can cause tremor. In some cases, blood tests may be ordered to exclude other causes such as thyroid problems. Imaging studies like MRI are usually normal in essential tremor but may be done to rule out other conditions.

References:

• National Institute of Neurological Disorders and Stroke – Tremor Information
• Mayo Clinic – Essential Tremor
• Johns Hopkins Medicine – Essential Tremor
• Cleveland Clinic – Essential Tremor
• National Center for Biotechnology Information – Essential Tremor