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You're most likely to notice essential tremor in your hands. About 9 in 10 people with essential tremor have hand tremor.¹ It may start in only one hand, but over time both hands are usually affected.

You may notice the tremor when you stretch out your arms and try to hold them steady, but they shake. Or you may notice it when you do something with your hands, such as eating or writing. Doctors call this type of tremor an action tremor.²

The second most common kind of essential tremor is head tremor. About half the people with essential tremor have this.¹ You can have tremor in your hands and head at the same time. Your head can shake either up and down or from side to side. Sometimes your voice may also shake, especially if you're older.² Your body or legs can also have a tremor.³

But if you only have a tremor in your voice, tongue, chin, or leg (without a tremor in your hands or head), you don't have essential tremor.⁴

The tremor may be worse when you are tired or stressed. You may notice that drinking alcohol reduces the tremor.¹

Your doctor will try to find out whether anything is causing your tremor. Some illnesses, such as a stroke, thyroid problems and Parkinson's disease, can cause a tremor. Some medications can also cause tremor. Your doctor will only diagnose essential tremor if he or she can't find a definite reason for your tremor.⁴ If there's a sudden change in how bad your tremor is, it may be that something is causing it.

Your doctor will ask you about the medications you take, your family history and any other symptoms that you have. Your doctor will examine you, and you'll have blood tests. For example, you may have a test to make sure your thyroid gland (a gland in your neck) isn't overactive.

Some people may need tests, such as a CT scan or MRI scan, to look for other problems that may be causing a tremor, such as a stroke.

You may need to see a doctor who specializes in the nervous system (a neurologist).

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.