Parkinson's Tremor vs Essential Tremor: How to Tell Them Apart

Both Parkinson’s disease and essential tremor can make your hands shake — but they are different conditions with different causes, different patterns of shaking, and very different treatments. People who have been told they have one are often worried they really have the other. This guide walks through how doctors tell them apart, what each tremor typically looks like, and when it’s worth a neurology referral.

Medical disclaimer. This article is for general information only. It cannot diagnose your tremor. Only a clinician — ideally a neurologist familiar with movement disorders — can evaluate which type of tremor you have. See our full Medical Disclaimer.

The quick answer

Parkinson’s tremor typically shows up at rest, often in one hand, and may look like rolling a small object between thumb and forefinger (“pill-rolling”). It usually settles when the hand is doing something.
Essential tremor typically shows up during action — holding a cup, writing, eating — and often affects both hands. It usually settles when the hand is fully resting.

This pattern — rest vs action — is the single most useful clue, but it isn’t the whole story. Neurologists also look at the rest of the body, how the tremor changes over time, and other neurological signs.

What is essential tremor?

Essential tremor is the most common movement disorder. It is a neurological condition that causes rhythmic shaking, most often of the hands but sometimes the head, voice, or other body parts. It typically:

Affects both hands, often roughly equally.
Shows up during action — when you hold something, reach for something, or write.
Quiets down when the hands are fully at rest.
Can get worse with caffeine, stress, fatigue, or low blood sugar.
Often runs in families.
May respond to a small amount of alcohol (this is a clue, not a treatment).

Essential tremor can start at any age, including young adulthood, and tends to worsen gradually over many years.

What is Parkinson’s tremor?

Parkinson’s disease is a degenerative brain condition caused by loss of dopamine-producing cells. Tremor is one of its most recognizable features, but Parkinson’s tremor has its own personality:

Usually shows up at rest — when the hand is sitting in a lap or hanging by the side.
Often starts on one side of the body and only later spreads.
Has a classic “pill-rolling” quality (thumb against fingers).
Often settles or improves when the hand starts doing something.
Comes with other Parkinson’s features: slowness of movement, stiffness, smaller handwriting, softer voice, reduced facial expression, or changes in walking.

Not everyone with Parkinson’s has tremor. For more on that, see our article Can You Have Parkinson’s Without a Tremor?

Side-by-side: the main differences

Feature	Parkinson’s tremor	Essential tremor
When it appears	At rest	During action (holding/reaching)
Sides affected	Usually starts on one side	Usually both sides, often symmetric
Body parts	Hand, arm, leg, chin, jaw	Hands most common; also head and voice
Pattern	“Pill-rolling,” slower (4–6 Hz)	Faster, finer (6–12 Hz)
Effect of movement	Often quiets with action	Often worsens with action
Effect of alcohol	Usually no effect	Often temporarily improves
Family history	Usually no	Often yes
Other neurological signs	Slowness, stiffness, posture/gait changes	Usually none

The “rest vs action” test you can try (carefully) at home

This is not a diagnostic test, but neurologists do something similar in the clinic. Sit comfortably with both hands resting palm-down on your thighs and watch them. Then slowly raise your hands and hold them out in front of you. Then reach to touch your nose, and reach to hold a cup.

If shaking is most obvious when your hands are doing nothing and quiets when you reach for things, that pattern is more typical of Parkinson’s tremor.
If shaking is most obvious when you hold or reach and your hands are quiet at rest, that pattern is more typical of essential tremor.

Make a short phone video of yourself doing this and bring it to your doctor — it is genuinely useful.

Other clues clinicians look for

The “rest” position when walking

A Parkinson’s tremor often becomes more visible when a person is walking, because the arm is relatively at rest. Essential tremor doesn’t usually behave this way.

Handwriting

In Parkinson’s, handwriting often becomes smaller (micrographia) and may trail off across a line. In essential tremor, handwriting is usually shakier and larger, with wavy or jagged lines.

Voice changes

Essential tremor can produce a shaky, quivering voice. Parkinson’s tends to produce a softer or more monotone voice, not a shaky one.

Head tremor

A head tremor (a nodding “yes-yes” or shaking “no-no” movement) is much more common in essential tremor than in Parkinson’s.

One side vs both sides

Parkinson’s almost always starts asymmetrically. Essential tremor is usually fairly symmetric from the start.

Can you have both?

Yes. Some people have essential tremor for many years and later develop Parkinson’s, and large studies have looked at whether long-standing essential tremor is associated with higher Parkinson’s risk. The two conditions can coexist. This is one reason the clinical exam matters — a quick visual assessment can miss the second diagnosis.

Other things that can look like tremor

Tremor can also be caused by:

An overactive thyroid (hyperthyroidism).
Certain medications, including some used for asthma, mood, or stimulants.
Caffeine or stimulant overuse.
Alcohol withdrawal.
Low blood sugar.
Anxiety (often called “physiologic tremor”).
Dystonic tremor, cerebellar tremor, and other less common neurological causes.

That’s part of why a clinical evaluation is important — many treatable causes can mimic both Parkinson’s and essential tremor.

How doctors diagnose each one

Both Parkinson’s disease and essential tremor are diagnosed mainly by clinical examination — there is no single blood test or scan that confirms either. A neurologist evaluates:

The pattern, speed, and triggers of the tremor.
Whether other Parkinson’s signs are present (slowness, stiffness, walking changes, smaller handwriting).
Family history.
Medication and medical history.
Response to a trial of medication when appropriate.

Imaging may be ordered in some cases. A DaTscan (a scan of dopamine activity in the brain) can help distinguish Parkinson’s from essential tremor when the picture is unclear, but it’s not a routine test. It is not needed for most diagnoses.

How treatment differs

This is one reason getting the diagnosis right matters: the medications used for the two conditions are very different.

Parkinson’s disease is most often treated with dopamine-based medications such as carbidopa-levodopa and several other classes.
Essential tremor is most often treated with beta-blockers (such as propranolol) or primidone — neither of which is a Parkinson’s medication.
For both, some people benefit from procedures such as deep brain stimulation (DBS) or focused ultrasound, but the targets and decision criteria differ.

Do not start, stop, or change any medication based on this article. The right plan depends on your specific situation.

When to talk to a doctor

Ask your doctor — and request a neurology referral if needed — if you notice any of the following:

A new tremor that has been getting worse over weeks or months.
Tremor in only one hand, especially with slowness or stiffness on the same side.
A reduced arm swing, smaller handwriting, or softer voice along with the tremor.
A tremor that interferes with eating, writing, dressing, or work.
Falls, near-falls, or new balance problems.
A family history of essential tremor or Parkinson’s and a new tremor of your own.

Seek urgent medical attention for sudden onset of shaking, sudden weakness on one side, sudden trouble speaking, or sudden severe imbalance. Those are stroke warning signs and need emergency care.

Frequently asked questions

Can essential tremor turn into Parkinson’s?

Essential tremor does not “turn into” Parkinson’s. They are different conditions. Some people who have had essential tremor for years go on to develop Parkinson’s separately, which is one reason any change in tremor pattern is worth re-evaluating.

If alcohol calms my tremor, is it essential tremor?

Alcohol often temporarily improves essential tremor and usually doesn’t affect Parkinson’s tremor. This is a useful clue but not a definitive test, and it isn’t a treatment — regular drinking is not recommended as a way to manage tremor.

Is a tremor in just one hand more likely Parkinson’s?

A tremor that starts in one hand, especially at rest and accompanied by slowness or stiffness on the same side, raises the suspicion of Parkinson’s and should be evaluated. Other causes are still possible — a clinical exam sorts this out.

Do I need a brain scan?

Often no. Most diagnoses are made by a neurologist’s clinical examination. Imaging such as a DaTscan or MRI is reserved for unclear cases or to rule out other causes.

Can a primary care doctor diagnose this?

A primary care doctor can recognize the pattern and begin treatment in many cases, but when the diagnosis is unclear, when symptoms are progressing, or when treatment isn’t working as expected, a referral to a neurologist or movement-disorder specialist is appropriate.

Sources

National Institute of Neurological Disorders and Stroke (NINDS). Essential Tremor. ninds.nih.gov
National Institute of Neurological Disorders and Stroke (NINDS). Parkinson’s Disease. ninds.nih.gov
International Essential Tremor Foundation. About Essential Tremor. essentialtremor.org
Parkinson’s Foundation. Tremor. parkinson.org
Mayo Clinic. Essential tremor — Symptoms and causes. mayoclinic.org
Bhatia KP, Bain P, Bajaj N, et al. Consensus Statement on the classification of tremors. Movement Disorders. 2018;33(1):75-87.
Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Movement Disorders. 2015;30(12):1591-1601.

This article is for general information only and is not medical advice. Please see our Medical Disclaimer and discuss your symptoms with a qualified clinician.

Parkinson’s Tremor vs Essential Tremor: How to Tell the Difference