Essential tremor particularly affects the hands where patients exhibit a rhythmic trembling (shaking movement) and may also involve the legs, head, jaw, voice (quivering speech), leg and rarely, the trunk and tongue.

The tremor may be exaggerated when asked to perform a skilled task, movement with arms outstretched or when the emotions are aroused or if the patient is anxious rather than at rest. It is recognisable when seen in postural (voluntarily maintaining a position against gravity) and kinetic (performing any kind of movement) positions.

The condition usually affects both sides of the body equally (bilateral). It may involve different body pains. When seen initially, it is most often in the hands, usually the dominant hand is first affected and eventually both hands may be involved. Handwriting becomes less legible and drinking liquids is difficult to manage. The individual may have to use both bands or use a straw to drink. Eating soup may become impossible. Dysfunction with fine manipulation and embarrassment are also problems. Tremor of the head may also occur. The shakiness may be a 'yes-yes" or a "no-no" movement. Shakiness of the voice may occur which gives a quavering intonation to speaking.

Essential tremor is not accompanied by any other symptoms.