Essential hand tremor (EHT) is a prevalent neurological condition affecting geriatric populations, yet its underlying mechanisms remain poorly understood. This study aims to investigate the neural substrates associated with motor tasks in EHT patients, illuminating the complex neural activity characterizing this condition. Twenty participants underwent a thorough evaluation to ensure eligibility, excluding factors such as mental illness, drug dependency, or Parkinson’s disease (PD). Functional magnetic resonance imaging (fMRI) was utilized to examine brain activation patterns during non-handwriting tasks (NHWT) and handwriting tasks (HWT). Participants received training to standardize hand and forearm movements for effective fMRI assessment. fMRI data preprocessing included motion correction, filtering, removal of linear trends, normalization to Montreal Neurological Institute (MNI) space, and spatial smoothing. Distinctive patterns of brain activation were observed during motor tasks in individuals with EHT compared to controls. During NHWT, the EHT group showed significantly increased activation in the precentral gyrus, supplementary motor area, thalamus, and posterior cerebellar lobe, highlighting their role in mediating motor challenges in EHT. Similarly, during HWT, the EHT group exhibited heightened activation in the precentral gyrus and supplementary motor areas. In contrast, reduced activation was noted in the caudate nucleus, inferior temporal gyrus, and precuneus during HWT in the EHT group compared to controls. These findings align with previous research on involuntary movement disorders, such as early-stage PD, emphasizing the importance of the caudate nucleus and related regions in EHT. In conclusion, this study sheds light on the intricate neural activity underlying motor tasks in EHT patients. The identified neural regions and their functions offer insights into the neurophysiological basis of EHT-related motor impairments. These findings have the potential to enhance the understanding of EHT beyond its surface-level effects. This study has identified the brain regions involved in motor tasks affected by EHT. This sets a foundation for future research to better understand the complexities of this neurological condition. These discoveries may lead to novel therapeutic interventions tailored to address the unique challenges faced by individuals with EHT, representing a significant milestone in understanding and managing EHT.