Best Tips for Treating, Living With Essential Tremor

Managing life's stresses help treatments work
elderly couple with cane holding hands

Managing stressful feelings and situations is a life skill for all of us, but it’s especially important if you struggle with essential tremor. While medication and lifestyle changes can help control symptoms, stress, in particular, can easily aggravate the condition.

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At first, essential tremor can resemble Parkinson’s disease. But you can tell the two conditions apart because essential tremor generally kicks in while your hands are in motion — eating, drinking or writing. On the other hand, there is a tendency for tremors from Parkinson’s to affect you when you’re still, says neurologist Kristin Appleby, MD.

However, it’s important to note that people with essential tremor also can have tremors when their hands are at rest. Also, some people with Parkinson’s disease do not have tremor, so it is important to see a neurologist for diagnosis.

Tremors generally affect people’s hands, but occasionally they affect their head, jaw or voice. A small number of people who struggle with ET can have balance problems.

Exploring causes for tremors

While essential tremor can run in families, many people have no family history of tremors. Dr. Appleby says medications for other conditions, such as lithium or antidepressants, may also contribute to tremors. Hyperthyroidism can also cause tremors that mimic ET.

People most often will first notice symptoms either in their 20s – or not until later in their 60s.

Neurologists recommend lifestyle changes and medications to address essential tremor. If these don’t work, doctors may recommend implanting a Deep Brain Stimulator (or DBS), Dr. Appleby says. Once implanted in the brain, this electrode emits pulses of energy to block abnormal activity that can cause tremors.

Don’t let stress snowball

For any of these solutions to work, patients must reduce stress, including the stress the tremors themselves cause.

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“People don’t want to go to restaurants because they’re embarrassed,” Dr. Appleby says. “Anytime anyone is angry, stressed out, or embarrassed, it can make the tremor worse, which increases their stress level. It just snowballs.”

So Dr. Appleby encourages patients to avoid stress triggers. “Most people know what helps them relax themselves,” she says.

Essential tremor is not entirely stress-related, she adds. “And since totally avoiding stress is impossible, it is what it is. But reducing stress lower the impact of tremors.”

Medications can help

Beyond reducing stress, Dr. Appleby says neurologists will try different medications — most often propranolol, a blood pressure medication, or primidone, an anti-seizure drug.

They’re about equally likely to work in the general population, she says. However, propranolol can cause or exacerbate low blood pressure causing dizziness, while primidone can make people very tired or feel off balance.

Tips for day-to-day living

Beyond meds, essential tremor patients also should choose tasks they plan to do thoughtfully, as well as the timing for these tasks. The National Institutes of Health recommends:

  • Save tougher tasks for your best time of day. If the tremors seem better or worse at certain times of the day, or on certain days, plan to do handwriting tasks like paying bills or filling out greeting cards at those times when you feel better.
  • Consider a travel mug or straw for drinking. If you have trouble holding a coffee mug still, use a travel cup all the time. Straws also can make drinking easier.
  • Buy heavier, larger utensils. Using heavier eating utensils can sometimes “dampen out” tremors, Dr. Appleby says. You also may want to eat with utensils that have a larger handle to make control easier.
  •  Wear clothes that make it easy to dress. Buy clothes with Velcro fasteners or button hooks that make putting them on and off less challenging.
  • Find shoes that are easy to wear. Consider wearing slip-on shoes or using shoehorns.

The NIH also recommends that people with essential tremor avoid caffeine and get enough sleep.

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When surgery is an option

If medications either don’t work or aren’t tolerated well, patients can turn to implantation of a Deep Brain Stimulator, or DBS.  

“It is brain surgery, but the incision sites on the head are smaller than a quarter.” Dr. Appleby says. “And it helps the vast majority of people with essential tremor.”

During the procedure, surgeons implant a device that delivers electrical stimulation to the part of the brain that is partly responsible for the tremors, which can calm them. It is like a pacemaker for the brain.

However, being realistic is important when it comes to surgery or any other essential tremor treatment, Dr. Appleby says.

“Having the tremor stop entirely is not a reasonable expectation, though it does happen. We can usually get the tremors very well-controlled, but we’re not striving for perfection. The true goal is for people accomplish whatever they need to do, with as little tremor as possible.”

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