When should I consider referring a patient with essential tremor to a neurologist for further evaluation?

Consider referring a patient with essential tremor to a neurologist for further evaluation if:

• The tremor symptoms are disabling and first-line treatment as specified in the BNF is ineffective or not tolerated.
• There is troublesome tremor of the head, in which case referral to a movement disorder clinic is advised.

Before referral, review the patient's regular medication, check thyroid function, and assess alcohol consumption using a tool such as AUDIT.