Essential tremor (ET) is one of the most prevalent movement disorders in the world, affecting millions of people. Medications that are commonly used to treat ET include antiepileptic or antihypertensive medications. Primidone and propranolol are considered effective, first-line agents for treating ET, while atenolol, alprazolam and topiramate are considered second-line agents. Gabapentin appears to improve ET when used as a monotherapy, although not as an adjunct therapy. Alternatives to pharmacologic treatment for refractory ET include botulinum toxin A injections, deep-brain stimulation of the ventral intermediate nucleus of the thalamus and thalamotomy. Future developments in the treatment of ET will depend on valid animal models and a greater understanding of its pathophysiology.