Nocturnal leg cramps
- John W Winkelman, MD, PhD
John W Winkelman, MD, PhD
- Chief, Sleep Disorders Clinical Research Program
- Departments of Psychiatry and Neurology
- Massachusetts General Hospital
- Associate Professor of Psychiatry
- Harvard Medical School
- Section Editors
- Ira N Targoff, MD
Ira N Targoff, MD
- Section Editor — Muscle Disease
- Professor of Medicine, Section of Rheumatology
- University of Oklahoma Health Sciences Center
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
Nocturnal leg cramps, also termed sleep-related leg cramps, are a common lower-extremity condition that produces pain and can disrupt sleep. Symptoms result from involuntary muscle contractions, which are sudden in onset, usually affecting the calf or foot.
Nocturnal leg cramps are reviewed here. Other nighttime disorders of leg discomfort or movement, including restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS), are discussed separately. (See "Clinical features and diagnosis of restless legs syndrome/Willis-Ekbom disease and periodic limb movement disorder in adults".)
Nocturnal leg cramps are common and frequently unreported to clinicians [1,2]. In the general population, they are present in nearly 50 percent of those over the age of 50, have an increased prevalence and frequency with age, and show no gender preference.
Nocturnal leg cramps have been reported in about 7 percent of children and adolescents . Peak occurrence in this population was at 16 to 18 years of age, with no cases reported less than eight years of age. Pediatric nocturnal leg cramps are typically benign, self-limited, and infrequent [3,4].
CAUSES AND PATHOGENESIS
Leg cramps can be idiopathic, which is most common, or secondary to other medical conditions. Secondary causes include structural disorders or leg positioning; neurologic disorders; metabolic disorders, including extracellular fluid volume depletion and electrolyte disturbances; and medications [5-16]. Patients with the most common form of leg cramps have no fluid or electrolyte imbalance.
- Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly: prevalence, drug and disease associations. Int J Clin Pract 1999; 53:494.
- Naylor JR, Young JB. A general population survey of rest cramps. Age Ageing 1994; 23:418.
- Leung AK, Wong BE, Chan PY, Cho HY. Nocturnal leg cramps in children: incidence and clinical characteristics. J Natl Med Assoc 1999; 91:329.
- Leung AK, Wong BE, Cho HY, Chan PY. Leg cramps in children. Clin Pediatr (Phila) 1997; 36:69.
- Parisi L, Pierelli F, Amabile G, et al. Muscular cramps: proposals for a new classification. Acta Neurol Scand 2003; 107:176.
- Maquirriain J, Merello M. The athlete with muscular cramps: clinical approach. J Am Acad Orthop Surg 2007; 15:425.
- McGee SR. Muscle cramps. Arch Intern Med 1990; 150:511.
- Zimlichman R, Krauss S, Paran E. Muscle cramps induced by beta-blockers with intrinsic sympathomimetic activity properties: a hint of a possible mechanism. Arch Intern Med 1991; 151:1021.
- Atreja A, Abacan C, Licata A. A 51-year-old woman with debilitating cramps 12 years after bariatric surgery. Cleve Clin J Med 2003; 70:417.
- Morii H. [Safety profile of raloxifene]. Clin Calcium 2004; 14:100.
- Baskol M, Ozbakir O, Coşkun R, et al. The role of serum zinc and other factors on the prevalence of muscle cramps in non-alcoholic cirrhotic patients. J Clin Gastroenterol 2004; 38:524.
- Stroup J, Kane MP, Abu-Baker AM. Teriparatide in the treatment of osteoporosis. Am J Health Syst Pharm 2008; 65:532.
- Gupta S, Gupta V, Kapoor B, Kapoor V. Pyrazinamide induced hyperuricaemia presenting as severe bilateral leg cramps. J Indian Med Assoc 2007; 105:341.
- Garrison SR, Dormuth CR, Morrow RL, et al. Nocturnal leg cramps and prescription use that precedes them: a sequence symmetry analysis. Arch Intern Med 2012; 172:120.
- Allen RE, Kirby KA. Nocturnal leg cramps. Am Fam Physician 2012; 86:350.
- Miller TM, Layzer RB. Muscle cramps. Muscle Nerve 2005; 32:431.
- Nygaard IH, Valbø A, Pethick SV, Bøhmer T. Does oral magnesium substitution relieve pregnancy-induced leg cramps? Eur J Obstet Gynecol Reprod Biol 2008; 141:23.
- Sohrabvand F, Shariat M, Haghollahi F. Vitamin B supplementation for leg cramps during pregnancy. Int J Gynaecol Obstet 2006; 95:48.
- Sebo P, Cerutti B, Haller DM. Effect of magnesium therapy on nocturnal leg cramps: a systematic review of randomized controlled trials with meta-analysis using simulations. Fam Pract 2014; 31:7.
- Schwellnus MP. Muscle cramping in the marathon : aetiology and risk factors. Sports Med 2007; 37:364.
- Monderer RS, Wu WP, Thorpy MJ. Nocturnal leg cramps. Curr Neurol Neurosci Rep 2010; 10:53.
- American Academy of Sleep Medicine. Sleep related leg cramps. In: International classification of sleep disorders, 3rd ed., American Academy of Sleep Medicine, Darien, IL 2014. p.299-303.
- Garrison SR, Dormuth CR, Morrow RL, et al. Seasonal effects on the occurrence of nocturnal leg cramps: a prospective cohort study. CMAJ 2015; 187:248.
- Rana AQ, Khan F, Mosabbir A, Ondo W. Differentiating nocturnal leg cramps and restless legs syndrome. Expert Rev Neurother 2014; 14:813.
- Walters AS. Clinical identification of the simple sleep-related movement disorders. Chest 2007; 131:1260.
- Davison S. Standing: a good remedy. JAMA 1984; 252:3367.
- Nield LS, Kamat D. Prevention, diagnosis, and management of diaper dermatitis. Clin Pediatr (Phila) 2007; 46:480.
- Daniell HW. Simple cure for nocturnal leg cramps. N Engl J Med 1979; 301:216.
- Hallegraeff JM, van der Schans CP, de Ruiter R, de Greef MH. Stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults: a randomised trial. J Physiother 2012; 58:17.
- Coppin RJ, Wicke DM, Little PS. Managing nocturnal leg cramps--calf-stretching exercises and cessation of quinine treatment: a factorial randomised controlled trial. Br J Gen Pract 2005; 55:186.
- Katzberg HD, Khan AH, So YT. Assessment: symptomatic treatment for muscle cramps (an evidence-based review): report of the therapeutics and technology assessment subcommittee of the American academy of neurology. Neurology 2010; 74:691.
- Young JB, Connolly MJ. Naftidrofuryl treatment for rest cramp. Postgrad Med J 1993; 69:624.
- Voon WC, Sheu SH. Diltiazem for nocturnal leg cramps. Age Ageing 2001; 30:91.
- Baltodano N, Gallo BV, Weidler DJ. Verapamil vs quinine in recumbent nocturnal leg cramps in the elderly. Arch Intern Med 1988; 148:1969.
- Ayres S Jr, Mihan R. Nocturnal leg cramps (systremma): a progress report on response to vitamin E. South Med J 1974; 67:1308.
- More on muscle cramps. Drug Ther Bull 1983; 21:83.
- Guay DR. Are there alternatives to the use of quinine to treat nocturnal leg cramps? Consult Pharm 2008; 23:141.
- Hyodo T, Taira T, Takemura T, et al. Immediate effect of Shakuyaku-kanzo-to on muscle cramp in hemodialysis patients. Nephron Clin Pract 2006; 104:c28.
- Parrow A, Samuelsson SM. Use of chloroquine phosphate--a new treatment for spontaneous leg cramps. Acta Med Scand 1967; 181:237.
- Chan P, Huang TY, Chen YJ, et al. Randomized, double-blind, placebo-controlled study of the safety and efficacy of vitamin B complex in the treatment of nocturnal leg cramps in elderly patients with hypertension. J Clin Pharmacol 1998; 38:1151.
- Connolly PS, Shirley EA, Wasson JH, Nierenberg DW. Treatment of nocturnal leg cramps. A crossover trial of quinine vs vitamin E. Arch Intern Med 1992; 152:1877.
- Garrison SR, Allan GM, Sekhon RK, et al. Magnesium for skeletal muscle cramps. Cochrane Database Syst Rev 2012; :CD009402.
- Serrao M, Rossi P, Cardinali P, et al. Gabapentin treatment for muscle cramps: an open-label trial. Clin Neuropharmacol 2000; 23:45.
- Lee FY, Lee SD, Tsai YT, et al. A randomized controlled trial of quinidine in the treatment of cirrhotic patients with muscle cramps. J Hepatol 1991; 12:236.
- El-Tawil S, Al Musa T, Valli H, et al. Quinine for muscle cramps. Cochrane Database Syst Rev 2010; :CD005044.
- El-Tawil S, Al Musa T, Valli H, et al. Quinine for muscle cramps. Cochrane Database Syst Rev 2015; :CD005044.
- U.S. Food and Drug Administration Medwatch: Quinine products. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/default.htm (Accessed on August 25, 2011).
- Qualaquin (quinine sulfate): New Risk Evaluation and Mitigation Strategy - Risk of serious hematological reactions. www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm218424.htm (Accessed on July 12, 2010).
- Westwood AJ, Spector AR, Auerbach SH. CPAP treats muscle cramps in patients with obstructive sleep apnea. J Clin Sleep Med 2014; 10:691.
- CAUSES AND PATHOGENESIS
- CLINICAL MANIFESTATIONS
- Diagnostic evaluation
- Diagnostic criteria
- DIFFERENTIAL DIAGNOSIS
- Treatment of acute leg cramps
- Prevention of recurrent leg cramps
- - Initial preventive therapies
- - Resistant to initial preventive therapies
- Initial drug therapies
- Resistant to initial drug therapies
- When to refer
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS