How can I effectively counsel patients with essential tremor about lifestyle modifications to manage their symptoms?

When counselling patients with essential tremor on lifestyle modifications to manage their symptoms, focus on the following key points:

• Review and manage contributing factors: Assess and review the patient’s regular medications to identify any that may exacerbate tremor, and check thyroid function as thyroid disorders can influence tremor severity.
• Assess alcohol consumption: Use a validated tool such as the Alcohol Use Disorders Identification Test (AUDIT) to evaluate alcohol intake, as alcohol can temporarily reduce tremor but excessive use may worsen symptoms or cause other health issues.
• Advise on symptom triggers and coping strategies: Educate patients about avoiding known tremor triggers such as stress, caffeine, and fatigue, and encourage stress management techniques.
• Encourage physical activity: While specific evidence for essential tremor is limited, general physical exercise may help improve overall motor function and quality of life.
• Refer appropriately: Refer patients for neurological assessment if tremor symptoms are disabling or if first-line pharmacological treatments are ineffective or not tolerated. Consider referral to a movement disorder clinic for troublesome head tremor.

These lifestyle and management strategies aim to reduce tremor impact and improve daily functioning, with specialist input when necessary ³.