Nocturnal Leg Cramps
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Nocturnal Leg Cramps

(Muscle Cramps; Nocturnal Muscles Cramps; Age-Related Cramps)

En Español (Spanish Version)

Definition

Nocturnal leg cramps are sudden contractions of the lower leg and foot muscles, usually awakening you from sleep. The calf muscles are most often involved. The cramps are harmless and do not mean that you have a serious disease.

The Calf Muscles

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Causes

Although the specific cause is unknown, these cramps may be related to imbalances in local muscle chemistry. Many activities and diseases are associated with nocturnal leg cramps:

  • Overexertion of the muscles
  • Standing on hard surfaces
  • Prolonged sitting
  • Certain leg positions while sedentary
  • Dehydration
  • Diseases
  • Certain medications
    • Blood pressure medicines
    • Statins (that lower cholesterol)
    • Morphine
    • Lithium

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

The following factors increase your chance of developing nocturnal leg cramps. If you have nocturnal leg cramps, tell your doctor about any of these risk factors:

  • Age over 50
  • Overexertion
  • Pregnancy
  • Staying in certain positions for a long time
  • Flat feet or other foot or ankle deformities
  • Alcoholism
  • Neurologic diseases
  • Certain medications
  • The diseases mentioned above

Symptoms

  • Sudden nighttime calf (or foot) cramps

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include the following:

  • Blood tests for hormone or chemical imbalances, but most tests are normal
  • Checking your foot pulses to assure adequate circulation

Treatment

Talk with your doctor about the best treatment plan for you. If no specific cause can be found, treatment options include the following:

  • When cramps occur, pull against them with your leg muscles. Also, grab your foot (feet) and pull up.
  • Standing on the affected leg often stops the cramping.
  • Massage and hot or cold treatments will help the muscles relax.

Medications

None of these medicines has earned full approval for either safety or efficacy. Quinine , while often effective to prevent cramps, has a significant risk of major allergic reactions. The other prescription medications carry risks as well. So they are not generally recommended, except in severe cases.

Over-the-Counter

  • Diphenhydramine hydrochloride (Benadryl)
  • Vitamin E 800 U/day
  • Calcium
  • Magnesium

Prescription

  • Quinine sulfate
  • Simple muscle relaxants (eg, meprobamate , Equanil, Robaxin )
  • Verapamil hydrochloride (Calan, Isoptin, Verelan)
  • Chloroquine phosphate (Aralen)
  • Hydroxychloroquine sulfate (Plaquenil)
  • Carbamazepine (Tegretol)
  • Phenytoin (Dilantin)

Prevention

To reduce your chance of getting nocturnal leg cramps, take the following steps:

  • Stretch three times a day and just before going to bed.
    • Face a wall and put your hands on the wall and keep them there. Step backward, keeping your knees locked and your heels on the floor until you feel a strong pull in your calves. Hold that position for 10 seconds. Repeat two or three times.
  • Exercise feet and legs regularly.
  • Drink plenty of liquids.
  • Eat plenty of potassium-rich foods (eg, bananas, tomatoes, potatoes, broccoli, cantaloupe, oranges, and grapefruit).
  • Wear comfortable, supportive shoes.
  • Sleep with toes up, not pointed downward.

RESOURCES:

Colorado Gerontological Society and Senior Answers and Services
http://www.senioranswers.org/

Postgraduate Medicine Online
http://www.postgradmed.com/

CANADIAN RESOURCES:

Canadian Family Physician
http://www.cfpc.ca/cfp/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

Butler JV, Mulkerrin EC, O’Keeffe ST. Nocturnal leg cramps in older people. Postgrad Med J . 2002;78:596-598.

Leg cramps–unknown cause. Prodigy Knowledge, British National Health Service website. Available at: http://www.prodigy.nhs.uk/guidance.asp?gt=Leg%20cramps . Accessed September 14, 2005.

Leg disorders (restless legs syndrome and nocturnal cramps). New York Methodist Hospital website. Available at: http://www.nym.org/healthinfo/docs/095/doc95full.html . Accessed September 14, 2005.

Nocturnal leg cramps. EBSCO Dynamed website. Available at: http://dynaweb.ebscohost.com . Accessed June 8, 2008.

Pharmacologic management of nocturnal leg muscle cramps. Virtual Hospital, The University of Iowa website. Available at: http://www.vh.org/adult/provider/pharmacyservices/PTNews/1996/06.96.html . Accessed September 14, 2005.



Last reviewed January 2008 by Robert Leach, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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