How is Essential Tremor diagnosed

Diagnosing Essential Tremor (ET) depends on a doctor’s careful evaluation, rather than a single medical test.

Because ET can resemble other tremor disorders, it is essential for GPs to feel confident in assessing tremors and to stay up to date with continuing professional development (CPD) regarding tremor diagnosis and management. In particular, GPs need to understand the differences between various types of tremors. Sometimes a GP will refer a patient straight to a neurologist who specialises in movement disorders if the diagnosis is unclear or further assessment is needed.

The diagnostic process

Most people start by visiting their GP to discuss their tremor. This has a different outcome for many. Some say that their GP knew about Essential Tremor and some say that they didn’t. Others say their GP said that “nothing could be done about their tremor” and were sent home. This isn’t true.

When you visit the GP use the ‘ET basics checklist’ document available for download on this page to be prepared. Your GP can help you with aspects of daily living, suggest allied health professionals appropriate to your symptoms and assist you with systems such as NDIS and My Aged Care.

Diagnosis to a treatment plan is not a straight pathway but one thing is certain – it is necessary and getting a referral to a movement disorder specialist, usually a neurologist, is part of that process.

A referral to a movement disorder specialist will help to reach an accurate diagnosis. They will be able to rule out other conditions and guide you through treatment options, including advanced therapies.

ET Basics | checklist for appointments

Use this step-by-step checklist and cheat sheets for appointments with GPs and specialists. These are designed to aid someone living with Essential Tremor to prepare for a medical appointment, easing communication and making the most of your consultation.

ET Basics Checklist Thumbnail

Other causes of tremor apart from Essential Tremor

Accurate diagnosis is crucial because several other conditions can cause tremor similar to Essential Tremor (ET). Misdiagnosis can result in inappropriate treatment and prolonged uncertainty for patients. Doctors rule out these other causes as part of the differential diagnosis:

A large number of people have a faint tremor that is usually too slight to notice. Stress, fear, anger, anxiety or fatigue can make it more noticeable.

Some prescription medicines can cause tremor as a side effect. These include asthma inhalers (beta-adrenoceptor agonists), mood stabilisers such as lithium or valproic acid, thyroid hormone, some antidepressants, antipsychotics and certain heart medicines like amiodarone or procainamide. Over-the-counter medication, herbal supplements and illicit drugs can also trigger tremor.

Resulting from damage to the cerebellum (the back part of the brain), these tremors are typically intention tremors, worsening during purposeful movement. Tremor relating to cerebellar damage can happen for many reasons: multiple sclerosis, stroke, brain tumour, degenerative conditions or sometimes trauma. It is usually an intention tremor, meaning it gets worse as the person being assessed approaches a target (like trying to touch their nose or pick up a cup).

Tremor can develop after a head injury, even if the injury seemed mild at the time. The injury could affect different parts of the brain, including the cerebellum, but not always.

Tremor may occur in Parkinson’s, dystonia (involuntary muscle contractions), multiple sclerosis or after a stroke.

Why Essential Tremor is less recognised than Parkinson’s

Essential Tremor (ET) affects more Australians than Parkinson’s, yet it receives far less public attention. This gap in recognition stems from several interconnected factors:

Parkinson’s has benefited from decades of advocacy, driven by global awareness campaigns like those of the Michael J. Fox Foundation, as well as high-profile entertainers, musicians and athletes who have leveraged their platforms to help shift Parkinson’s from a private struggle to a public conversation.

ET, by contrast, lacks similar visibility in media, research and public conversation.

People widely recognise Parkinson’s as a progressive, life-limiting condition with complex symptoms beyond tremor. ET, while not life-threatening, can be highly disabling, affecting writing, eating, speaking and confidence. Yet it is often seen as less severe, despite the profound functional and emotional toll it can take.

Australia does not currently have a national organisation focused solely on ET. Most information and support come through wider neurological associations or international groups. Without a coordinated voice, ET receives less attention in areas such as public awareness campaigns, research funding and policy development when compared to conditions that have established national networks.

Many people with ET never receive a formal diagnosis. Tremor is frequently dismissed as “just ageing” or mistaken for anxiety, leading to widespread under-recognition. This minimisation not only delays support but also reinforces stigma, as people may misjudge visible symptoms as personal weakness or emotional instability. The result is a diluted patient population, which weakens the data needed to drive advocacy, funding and research. Without visibility, the ET community remains largely absent from public health planning, policy development, clinical prioritisation and access to clinical trials or emerging treatments.

Together, these factors contribute to ET being under-recognised, underfunded and often overlooked, despite its prevalence. Raising awareness, improving public understanding and building stronger advocacy networks can help close this gap and ensure people living with ET feel seen, supported and empowered.

How Essential Tremor is different from Parkinson’s

Essential Tremor (ET) and Parkinson’s are both movement disorders that involve shaking, but they differ in meaningful ways. These include how and when tremors appear, what other symptoms are present, how the conditions progress and how doctors manage them.

ET is around eight times more common than Parkinson’s. While they are separate conditions, up to 20% of people with ET may later develop Parkinson’s and around 10% report a family history of Parkinson’s. Whether ET increases the risk of developing Parkinson’s remains unclear and is still debated by researchers.

Parkinson’s usually appears after age 60 and is most common in older adults. ET can begin at any age, including childhood or adolescence. ET affects about 1 in 100 people overall and up to 1 in 20 people over 60, making it significantly more common than Parkinson’s.

In ET, the tremor typically appears during movement or when holding a position, like reaching for a cup or writing. Doctors refer to this tremor as an action or movement tremor. It usually affects both hands and arms and may also involve the head or voice or inside the body.

In Parkinson’s, the tremor often starts when muscles are at rest. It typically begins on one side of the body, with a distinctive “pill-rolling” motion of the fingers. The tremor usually stops during movement and rarely affects the head or voice.

Tremor is the main symptom of ET, but it is not always the only one. For some people, especially as they age or develop head or voice tremors, ET can lead to balance problems or reduced walking confidence. Recent research and specialist guidelines now recognise that balance and gait problems are a common part of ET, particularly in people with more severe or long-standing symptoms. Doctors used to think that ET affected only tremor, but we now know that some people with ET, especially those in the “ET-plus” group (which includes extra symptoms) can be at a greater risk of falls or have an unsteady walk.

Changes in brain areas that control movement and coordination cause these balance issues in people with ET. Parkinson’s, on the other hand, causes a broader range of symptoms. These include slowed movements, muscle stiffness, a shuffling walk, balance issues and often non-motor symptoms such as sleep problems, reduced facial expression and thinking changes. These symptoms do not appear in ET.

Doctors diagnose ET by observing a consistent action tremor and ruling out other neurological conditions. A family history of ET or temporary improvement after drinking a small amount of alcohol can help support the diagnosis.

Parkinson’s is diagnosed based on typical signs – especially slowness of movement and muscle stiffness. Doctors often confirm the diagnosis when symptoms improve with Parkinson’s medications like Levodopa. Brain scans may help rule out other conditions if the diagnosis is unclear.

ET tends to progress slowly over many years and often remains mild to moderate. Parkinson’s is a progressive neurological condition that typically worsens over time. In later stages, symptoms can include thinking or memory changes and increasing disability.

Although severe ET can be disabling, it does not lead to the same wide range of motor and non-motor issues that people with advanced Parkinson’s often face.

Doctors use different medications to manage each condition. For ET, common first-line treatments include beta-blockers (like propranolol) and anti-seizure medications (like primidone). If these aren’t effective, they may prescribe medications like topiramate or gabapentin.

Doctors usually treat Parkinson’s with medications that boost dopamine in the brain, especially Levodopa. Deep brain stimulation (DBS) surgery may help with both conditions, but the targets in the brain and expected outcomes differ. Parkinson’s medications do not work for ET and treatments for ET do not improve Parkinson’s symptoms.

Both conditions can make everyday activities more challenging, but in different ways.

ET mainly affects fine motor tasks such as eating, writing or using tools. It can also cause social embarrassment, but many people adapt by using assistive tools or strategies.

Parkinson’s has a broader impact. In addition to tremor, slowness and stiffness can make walking, dressing and speaking harder. Fatigue and cognitive changes can further reduce independence. Support systems for Parkinson’s are generally more established, but people with ET can also benefit from occupational therapy and adaptive devices.

Feature Essential Tremor (ET) Parkinson’s
Tremor type Action tremor – appears during movement Resting tremor – appears when muscles are relaxed
Low amplitude. Amplitude is more variable, ranging from

barely perceptible tremor to a high amplitude tremor.

Higher, faster frequency.

 High amplitude. Lower, slower frequency.
Tremor location Hands, head, voice; often both sides Hands (starting on one side), jaw, legs
Age of onset Often starts earlier (teen years to 50s) Typically starts after age 60
Movement symptoms No slowness, stiffness or freezing Bradykinesia, rigidity and postural instability common
Progression Slow and may stabilise Progressive with increasing symptoms over time
Other symptoms May have balance issues in late stages Includes sleep problems, mood changes and cognitive symptoms
Response to alcohol Often improves temporarily No effect
Family history Common – often inherited Sometimes present but less consistent
Cause Not linked to dopamine loss Caused by loss of dopamine-producing brain cells
Treatment Medications, lifestyle changes, surgical options like Deep Brain Stimulation (DBS) and MR-guided focused ultrasound (MRgFUS) Medications (e.g. Levodopa), DBS, lifestyle support
Olivia Nassaris CEO, Essential Tremor Australia with Nichole aka "Shakey Nan" and an ET-branded cake in front of Parliament House, Canberra

Join the ET community in Australia

We founded Essential Tremor Australia to support the 300,000+ Australians living with ET.

ET is the most common movement disorder, yet it remains widely misunderstood.

We raise awareness to reduce the stigma of ET, advocate for the community, and provide support and information to live well with the condition.