It usually starts with something small. The teacup rattles against the saucer on the way from the kitchen. Your signature at the bank looks less like your signature than it used to. Someone hands you a bowl of soup and you find yourself using two hands, then wondering when that started.
Tremor is one of the most common changes people notice after 50, and one of the most quietly distressing. Partly because it is visible, and partly because almost everyone jumps straight to the same fear: is this Parkinson’s? For the majority of people, it is not. But it is worth understanding what is going on, because tremor is very treatable, and because the thing people most often do about it, which is nothing at all, is the one option that helps least.
TL;DR
- Essential tremor is the most common movement disorder, affecting roughly 4 to 5 per cent of people over 65 in Ireland and internationally. It is far more common than Parkinson’s disease.
- Timing is the key clue. Essential tremor appears when you use your hands (pouring, writing, holding a cup). Parkinson’s tremor typically appears at rest, when the hand is sitting still in your lap.
- Common reversible causes are often missed: an overactive thyroid, too much caffeine, and everyday medications including inhalers, some antidepressants and thyroid replacement.
- Treatment works. Propranolol and primidone reduce tremor substantially for many people, and occupational therapy aids can make daily life easier without any medication at all.
- See your GP if tremor affects daily tasks. Ring 112 immediately if a tremor starts suddenly on one side with weakness, facial droop or slurred speech.
What tremor actually is
A tremor is an involuntary, rhythmic shaking of part of the body. Everyone has one. Hold your hands out in front of you and there is a very fine oscillation there, too small to see. It is called physiological tremor, and it becomes visible when it is amplified by tiredness, stress, caffeine, low blood sugar, or a strong cup of coffee on an empty stomach.
The question that matters clinically is not whether your hands shake, but when they shake. This is the first thing any neurologist will ask, and it is worth paying attention to before your appointment.
Essential tremor: the common one nobody has heard of
Essential tremor is an action tremor. It shows up when the hands are doing something: holding a glass, buttoning a shirt, bringing a fork to your mouth, signing a form. Put your hands in your lap and it settles.
It usually affects both hands, though rarely to exactly the same degree. It often involves the head, producing a small yes-yes or no-no nodding movement, and it can affect the voice, giving it a slight quaver that people sometimes mistake for emotion. It tends to worsen gradually over years rather than months.
Around half of people with essential tremor have a family history of it, often described in families as “the shakes” and attributed to nerves. If your mother’s hands did the same thing at the same age, that is genuinely useful information for your GP.
One quirk is worth naming honestly. A small amount of alcohol temporarily reduces essential tremor in a majority of people who have it, sometimes dramatically. This is a real neurological effect, not imagination. It is also a well-documented route into problem drinking, because a glass of wine that steadies your hands before a social occasion is a very easy habit to build. If you have noticed this and started relying on it, tell your GP. It is a clinical clue, not a confession.
Essential tremor or Parkinson’s?
The distinction matters, and the pattern is usually clear enough to reassure people early.
- Essential tremor: happens with action, affects both sides fairly evenly, often involves head or voice, no change in walking or facial expression, frequently a family history, may ease briefly with alcohol.
- Parkinson’s tremor: happens at rest and eases when you move, usually starts on one side and stays worse on that side, often a rolling movement between thumb and fingers, and comes alongside slowness of movement, stiffness, smaller handwriting and reduced arm swing when walking.
Slowness and stiffness are the deciding features. A tremor on its own, without those, is very unlikely to be Parkinson’s. If you would like more detail on that condition, we have covered it separately in our guide to Parkinson’s disease in Ireland.
Causes worth ruling out first
Before anyone reaches for a neurology referral, there are several straightforward explanations that are easily missed:
- Overactive thyroid. A classic cause of fine tremor, along with weight loss, palpitations and heat intolerance. A simple blood test settles it, and it is entirely treatable.
- Medication. Salbutamol and other inhalers, some antidepressants, lithium, sodium valproate, amiodarone, steroids and over-replacement of thyroxine can all produce tremor. If yours began within weeks of a new prescription or a dose change, say so.
- Caffeine. Six or seven cups of tea a day is normal in plenty of Irish households and quite enough to amplify tremor.
- Alcohol withdrawal. Tremor that is worst in the morning and settles after a drink points here rather than to essential tremor.
- Anxiety and exhaustion. Real physical causes of real physical shaking, not a dismissal.
What to expect from your GP
Bring three things: when the tremor happens, when it started, and a full list of your medications including anything bought over the counter. If you can, ask someone to record a short video on a phone of your hands at rest and then holding a cup. That thirty-second clip is often more useful than ten minutes of description.
Your GP will examine you, check thyroid function and usually a broader set of bloods, and review your prescriptions. If a referral to neurology is needed, waiting times vary considerably by region; ask your GP about the National Treatment Purchase Fund and whether your case can be flagged as urgent. If you hold a medical card or GP visit card, these appointments and investigations are covered.
Treatment, and the case for not treating
Plenty of people with mild essential tremor need no treatment at all. Knowing what it is, and knowing it is not Parkinson’s, is sometimes the whole intervention.
When tremor interferes with daily life, first-line medications are propranolol, a beta blocker, and primidone, an anti-seizure medicine used at low doses. Both reduce tremor meaningfully for around half of people who take them. Propranolol is not suitable if you have asthma or a slow heart rate, which is one reason a proper medication review matters. Primidone is usually started at a very low dose in the evening because it can cause drowsiness at first.
Where those do not suit, topiramate or gabapentin are sometimes tried. Botulinum toxin injections can help head and voice tremor. For severe tremor that has not responded to medication, deep brain stimulation and MRI-guided focused ultrasound are options a neurologist can discuss, including eligibility for the HSE Treatment Abroad Scheme where a procedure is not available here.
The practical adaptations that change days
An occupational therapy referral through HSE primary care is one of the most underused options in this whole area. Simple changes make a genuine difference: weighted cutlery and pens, wide-based mugs filled two-thirds rather than to the brim, drinking through a straw, anchoring your elbows on the table, using both hands, button hooks, elasticated laces, voice dictation on your phone, and contactless payment instead of counting coins at a busy till.
That last one matters more than it sounds. The most damaging effect of tremor is rarely the tremor itself. It is the slow retreat from cafés, restaurants, card games and church collections because of embarrassment. Withdrawal of that kind carries its own well-documented health cost, and it is the part worth resisting hardest.
When to act quickly
Ring 112 or 999 if shaking begins suddenly, particularly on one side, alongside weakness, facial droop, slurred speech or confusion. That combination needs assessing for stroke, not scheduling with a GP.
Otherwise, book the ordinary appointment. At Críonna Health we see the same pattern repeatedly: people live with a symptom for four or five years, assume nothing can be done, and discover in a fifteen-minute consultation that quite a lot can. Shaky hands are common, they are usually benign, and they are one of the more treatable things you will bring through a surgery door.
This article is for general information and is not medical advice. If you are concerned about a tremor, speak to your GP or see hse.ie.
📷 Photo by Claudia Love on Unsplash
