19 Unmistakable Red Flags Your Body Might Be Battling Essential Tremor

Essential tremor (ET) is a common neurological disorder that causes involuntary, rhythmic shaking—most often in the hands, but sometimes in the head, voice, legs, or other parts of the body. While the exact cause remains unknown in many cases, more than half of diagnosed individuals inherit a genetic mutation linked to chromosomes 2, 3, or 6. Unlike other movement disorders, essential tremor has no specific test for diagnosis; instead, doctors rely on a combination of physical and neurological examinations, often using MRI scans to rule out other conditions with similar symptoms. For some, essential tremor is mild and doesn’t require treatment, but for others, the symptoms can interfere with everyday tasks like eating, writing, or even speaking. When necessary, medications or other interventions can help manage the condition. To help you recognize the warning signs early, we've updated our list to 19 Unmistakable Red Flags Your Body Might Be Battling Essential Tremor. Read on to learn what to watch for and when to seek medical advice.

1. Periodic Uncontrollable Shaking

An individual affected by periodic uncontrollable shaking may be affected by essential tremor. This uncontrollable shaking most often occurs in the parts of the body controlled by voluntary muscles. Periodic uncontrollable shaking is most common in an individual's face, head, hands, neck, thumb, and arms. At first, the periodic uncontrollable shaking in the affected body part may be mild and barely noticeable during regular activities. Sometimes these uncontrollable rhythmic movements will cease entirely when the affected muscles are at rest or when the individual is sleeping. At other times, the involuntary movements will worsen when the individual is attempting to make a targeted movement with the affected muscles. The periodic shaking can worsen over time as the affected individual advances in age. This involuntary shaking can spread from the body part that has been initially affected on to other body parts depending on the underlying cause of essential tremor.

2. Nodding Head

An individual with essential tremor may experience uncontrollably nodding their head. While the most prevalent part of the body to be affected by essential tremor is the hands, some may experience essential tremor in their head. A head tremor precipitated from essential tremor is a regular tremor that exhibits a rhythmic and repeated shaking action an affected individual is unable to control. Around thirty-five percent of all essential tremor patients experience the nodding head or head tremor independently or with hand tremors. An individual who experiences a nodding head caused by essential tremor will not experience a change in their condition upon changing the direction of their head. A nodding head or head tremor associated with essential tremor will disappear when the patient is lying down and sleeping. Individuals who have a family history of tremor are more likely to develop head nodding or a tremor of the head.

3. Shaking Voice

An individual whose voice shakes frequently may be affected by essential tremor. Shaking voice and vocal tremor are terms used to describe when an individual experiences involuntary movements of the muscles located in their throat, vocal cords, and voice box. In rare cases, a tremor in the muscles located in an individual's chest, mouth, or abdomen may be the cause of their vocal tremor. A vocal tremor is almost always due to rhythmic muscle movements when it is caused by essential tremor. The rhythmic muscle movements in the muscles that control the voice can result in a quivering sound in the affected individual's voice. An individual who has a shaking voice may experience alterations in the pitch or volume of their voice and interruptions in their production of vocal sounds. Because the muscles in an individual's throat, voice box, and vocal cords weaken as they advance in age, a shaking voice from essential tremor most often manifests in the fifth or sixth decade of life.

4. Tremors Worsening With Stress

An essential tremor patient may notice their symptoms become worse with stress. Stress manifests with changes in an individual's physical state, mental state, and emotional state. Common causes of stress include confrontations, deadlines, job loss, new job, death of a loved one, divorce, marital difficulties, legal problems, retirement, illnesses, and financial problems. The worsening of essential tremor when the individual is under stress falls under the physical changes that occur in their body. Other physical changes, besides shaking, induced by stress include sweaty palms, weight gain, weight loss, erectile dysfunction, chronic fatigue, and stooped posture. The mechanism behind how stress causes a patient's essential tremor to become worse is not clear, but it is thought to be associated with how the stress response speeds up numerous chemical and molecular processes in the body. The increased speed of these processes can exacerbate the effect of the inappropriate nerve signals that cause essential tremor.

5. Issues With Balance

An individual with balance issues may also be affected by essential tremor. Essential tremor patients can exhibit several different characteristics in the way they walk that can explain why they would experience issues with their balance. Individuals who have essential tremor may have a more variable stride and a wider step than those who do not. These changes in gait are not readily noticeable upon first or second glance but have been identified in multiple studies as the main component of the pathophysiology of balance problems in essential tremor. Individuals who experience the subtype of essential tremor known as kinetic tremor, a tremor of the head, and a vocal tremor are at a greater risk of developing issues with balance. It should be acknowledged that some medications used to treat symptoms of essential tremor have also been known to produce issues with balance and dizziness as a side effect.

6. Tremors Worsening Due To Fatigue

An individual affected by essential tremor may experience worsening tremors due to fatigue. The medical term used to describe a tremor that becomes more pronounced with fatigue is an enhanced physiologic tremor. The only way this symptom is identified is a noticeable increase in tremor movement when the affected individual does not have an adequate amount of energy in the body. It is thought that an affected individual's voluntary muscle groups are affected in the pathogenesis of this manifestation of essential tremor. Certain nutrients and an adequate amount of water in the body are required for the nerves and muscles to work together properly. A fatigued individual may have depleted levels of fluids, vitamins, or minerals in their body that are important to the functionality of their nerves, nerve impulses, and muscle fibers. Inadequate amounts of water in the body cause the involuntary contraction of muscle fibers, and deficiencies in certain nutrients can disrupt electrical impulses between nerves. A combination of these mechanisms produces worsening tremors due to fatigue.

7. Worsen With Movement

An essential tremor patient may experience symptoms that worsen when they make certain movements. An individual with essential tremor tends to experience more pronounced tremors when they are attempting to use fine motor skills to accomplish normal daily activities, including eating, writing, applying makeup, shaving, brushing teeth, drinking, and typing. This manifestation of essential tremor can greatly impair an individual's ability to accomplish such essential tasks. It is thought that essential tremor is the result of incorrect communications between an affected individual's cerebellum and other parts of their brain. The cerebellum is the part of the brain responsible for the proper coordination of muscle contraction and relaxation. Because essential tremor is thought to be caused by the abnormalities related to muscle movement and coordination, an affected individual is likely to experience worsening symptoms when they are making purposeful and voluntary movements of their muscles.

8. Comparison To Parkinson's Disease

Several key differences can be used to distinguish essential tremor from Parkinson's disease. The tremor seen in Parkinson's disease patients mostly occurs when they are at rest, where the tremor seen in essential tremor occurs mostly during movement. Individuals affected by essential tremor are more likely to have a family history of the condition, whereas Parkinson's disease patients rarely have a family history of tremor. An individual who has Parkinson's disease is more likely to have a tremor that begins unilaterally (on one side of the body), and an essential tremor patient experiences symptoms bilaterally or on both sides of their body. A Parkinson's disease patient tends to experience no effects when they consume alcohol, whereas an individual with essential tremor experiences an improvement in symptoms with the consumption of alcohol. Someone affected by Parkinson's disease will experience other symptoms like slowed movements, problems with balance, unsteady gait, and rigidity, and an individual with essential tremor does not experience these manifestations.

9. Aggravated By Extreme Temperatures

An individual with essential tremor may experience an aggravation of their symptoms when their body is exposed to extreme temperatures. Nerve impulse conduction and the functionality of the muscle fibers are altered in healthy individuals when they are exposed to extremely hot or extremely cold temperatures. Therefore, an individual who has essential tremor is likely to experience more difficulty with their symptoms when they are in extremely hot or cold temperatures. Cold temperatures naturally cause a decrease in overall blood flow to the muscle tissues and induce shivering movements for heat generation in the body. These compensatory mechanisms cause increased difficulty for an affected individual because they are compounded by the abnormalities that occur because of essential tremor. Hot temperatures have not been concluded to make essential tremor worse or better in any large population of patients because not enough information is available regarding the impact of hot temperatures.

10. How Tremors Begin

The symptoms of essential tremor may begin at any age, but it is most common in those over forty years old. Most individuals who have essential tremor will experience a rhythmic motion of both of their hands that becomes more prominent in certain physiologic situations. Some essential tremor patients do not experience the progression or worsening of symptoms over time, when others may experience a rapid progression of symptoms as they age. It is thought many individuals affected by essential tremor experience the slow movement of symptoms from their hands to their arms, and from their arms to their trunk. Essential tremor may move from an individual's arms to their chest, neck, or head. Some patients may experience symptoms of essential tremor more prominently on one side of their body than the other side initially. It is much less common for an individual to experience the movement of their symptoms down their trunk and into their legs, but it does happen in a small number of cases.

11. Difficulty With Handwriting and Fine Motor Skills

Essential tremor can gradually make handwriting shaky, inconsistent, or even unreadable. What may begin as a slight unsteadiness when writing can develop into more pronounced tremors, making it difficult to form legible letters. Many individuals first notice this issue when signing documents, filling out forms, or writing personal notes, as their usual penmanship becomes jagged or irregular. Beyond handwriting, essential tremor also affects fine motor skills necessary for everyday tasks. Simple actions such as buttoning a shirt, fastening jewelry, zipping a jacket, or tying shoelaces may become increasingly difficult. Activities requiring precision, like sewing, painting, or assembling small objects, may require additional concentration or adaptations. Some individuals find that using heavier pens, weighted utensils, or stabilizing braces helps improve control. As symptoms progress, seeking assistive tools, such as voice-to-text software or adaptive clothing with Velcro fasteners, can help maintain independence in daily activities.

12. Trouble Holding Utensils and Drinking From a Cup

One of the most frustrating aspects of essential tremor is how it affects simple, everyday tasks—especially eating and drinking. Many individuals struggle to hold utensils steadily, which can make meals stressful and messy. Using a fork or spoon may result in unintentional spills, and cutting food with a knife can require extra effort. Eating soups, rice, or other small foods may become particularly challenging due to the fine motor control required. Drinking from a cup or glass presents similar difficulties, as tremors can cause liquids to slosh, spill, or even make it hard to lift a drink to the mouth without hesitation. Some individuals compensate by using straws, two-handed grips, or spill-proof cups with lids. Adaptive utensils, such as weighted silverware or cups with stabilizing handles, can help improve control and reduce frustration. Adjusting meal habits, such as using foods that require less precise handling, may also make dining more manageable.

13. Increased Sensitivity to Caffeine and Stimulants

Many individuals with essential tremor report that their symptoms worsen after consuming caffeine, nicotine, or other stimulants. Caffeine, found in coffee, tea, sodas, and energy drinks, is well known for its stimulating effects on the nervous system. In those with essential tremor, it can exacerbate involuntary shaking by increasing nerve excitability and muscle responsiveness. Similarly, nicotine and certain medications, such as decongestants or stimulants for ADHD, may heighten tremor severity. Understanding these effects can help individuals make lifestyle adjustments. Some people find that switching to decaffeinated coffee, herbal teas, or caffeine-free sodas helps reduce symptom intensity. Others may notice that limiting nicotine or avoiding stimulant medications (when possible) leads to more stable motor control. While eliminating caffeine entirely isn’t necessary for everyone, tracking personal triggers through a symptom journal can help determine how different substances impact tremors and allow individuals to make informed dietary and medication choices.

14. Difficulty Using a Touchscreen or Typing on a Keyboard

With the widespread use of smartphones, tablets, and computers, essential tremor can pose significant challenges in daily digital interactions. Many individuals experience difficulty using a touchscreen, as tremors make precise taps, scrolling, or swiping actions difficult. Accidental selections, repeated key presses, or struggling to hit small buttons on a screen can make texting, browsing, or using apps frustrating. Typing on a keyboard can also become problematic, as involuntary movements lead to errors, extra keystrokes, or difficulty maintaining accuracy. This can slow productivity and cause frustration, especially for those who rely on computers for work. To compensate, many individuals turn to voice-to-text features, predictive text, or styluses with stabilizing grips. Adaptive technology, such as tremor-friendly keyboards, touchscreen sensitivity adjustments, or assistive typing tools, can also help make digital communication smoother. Small adjustments, such as using a larger touchscreen device or keyboard shortcuts, can significantly improve ease of use.

15. Tremors That Improve With Alcohol – But Only Temporarily

A well-documented but intriguing phenomenon is that some individuals with essential tremor notice an improvement in their symptoms after consuming a small amount of alcohol. This occurs because alcohol affects the brain’s communication pathways, particularly within the cerebellum, which plays a role in coordinating movement. As a result, tremors may temporarily lessen or become less noticeable shortly after drinking. However, this effect is not a reliable or sustainable solution. While some individuals may see improvement, alcohol’s impact varies from person to person, and excessive consumption can lead to negative consequences, including dependency, increased anxiety, or worsened tremors over time. Long-term reliance on alcohol for symptom relief is not recommended, as the risks outweigh the benefits. Instead, individuals should consult a doctor for medically approved treatments, such as medications specifically designed to manage tremors. Understanding how alcohol influences symptoms can help patients make informed choices about their consumption habits.

16. Emotional or Psychological Effects

Living with essential tremor isn’t just a physical challenge—it can also take a serious toll on emotional and psychological well-being. Many individuals experience frustration, embarrassment, or even self-consciousness, especially when their symptoms become noticeable in public. Simple actions like signing a receipt, holding a cup, or using a phone in social settings can attract unwanted attention, leading to feelings of discomfort and vulnerability. Over time, these experiences can contribute to avoidance behaviors, where individuals withdraw from social interactions or stop participating in activities they once enjoyed. Fear of being judged, misunderstood, or labeled as nervous can cause anxiety, reducing overall confidence. If left unaddressed, these feelings can lead to depression and social isolation, further impacting quality of life.

17. Difficulties With Speech and Facial Expressions

Essential tremor is most commonly associated with hand or head movements, but it can also affect the muscles responsible for speech and facial expressions. Many individuals experience vocal tremors, causing their voice to sound shaky, quivering, or unstable. This can make it difficult to maintain a steady volume, causing fluctuations in loudness and pitch. Some individuals struggle with clarity, as their words may sound slurred or hesitant. This is often mistaken for nervousness, aging, or even intoxication by those unfamiliar with the condition. In addition to vocal tremors, some individuals experience subtle, involuntary movements in their lips, jaw, or facial muscles. These movements can affect articulation, making it harder to pronounce certain words clearly. Facial tremors may also cause unintended expressions, such as a slight quivering of the lips or twitching around the eyes, which can further impact social interactions.

18. Changes in Sleep Patterns

While essential tremor symptoms often diminish during sleep, many individuals still experience secondary sleep disturbances that can affect overall well-being. The physical fatigue from managing tremors throughout the day can lead to restlessness at night, while mental stress and anxiety about worsening symptoms may cause difficulty falling or staying asleep. Some individuals report experiencing light, fragmented sleep, waking frequently during the night, or struggling with racing thoughts related to their condition. Fatigue can also exacerbate tremors during waking hours, creating a frustrating cycle. When the body is overtired, muscle control weakens, and symptoms may feel more pronounced, making daily tasks even more difficult. Sleep deprivation can also contribute to increased irritability, reduced focus, and a greater susceptibility to stress—all of which can make tremors worse.

19. Progression Over Time and Increased Severity With Age

Essential tremor is generally considered a progressive neurological disorder, meaning that symptoms tend to worsen gradually over time. While the rate of progression varies from person to person, many individuals notice that what started as a slight tremor in one hand eventually becomes more pronounced, affecting both hands, the head, or even the voice. Tasks that were once manageable, such as writing, eating, or dressing, may become increasingly difficult as tremors intensify. Although essential tremor does not typically shorten lifespan, it can significantly impact daily life if left unaddressed. Some individuals may develop more severe tremors as they age, which can interfere with personal independence. Recognizing these changes early allows individuals to explore treatment options that can help maintain stability and functionality.

Recognizing the Signs and Taking Action

Essential tremor is more than just occasional shakiness—it’s a progressive neurological condition that can impact daily activities, confidence, and overall quality of life. While symptoms may start as mild, recognizing early warning signs allows individuals to seek medical guidance, explore treatment options, and implement lifestyle adjustments to manage their condition effectively. Although there is no cure, medications, therapy, and adaptive techniques can help individuals maintain independence and continue their normal routines with fewer disruptions. Understanding how stress, fatigue, diet, and other triggers influence tremors can also empower those affected to take proactive steps toward symptom management. If you or a loved one experiences any of these red flags, consulting a healthcare professional can provide clarity, support, and treatment options tailored to individual needs. By staying informed and seeking help when necessary, those with essential tremor can continue to lead active and fulfilling lives.