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Is there hope for leg cramp sufferers?

February 14, 2017

Despite the lack of a universally recognized therapy for nighttime leg cramps, a few approaches may be worth trying.

leg cramp sufferers
Image: Monkey Business Images/Thinkstock

Few things are more jarring to a night's sleep than shooting calf pains. If you have nocturnal leg cramps, you have lots of company. Although they can strike people at any time of life, they become more common with age. Among people over 60, almost half report having leg cramps, a third say they are awakened by cramps at night, and 15% report weekly episodes.

What causes leg cramps?

Preventing cramps

There are no FDA-approved medications for leg cramps, and the U.S. Preventive Services Task Force hasn't issued guidelines for treating them. However, the American Academy of Neurology (AAN) has issued the following advice on common therapies, based on scientific evidence of effectiveness.

Stretching exercises. The AAN says that there are not enough data to say for sure that stretching helps reduce the frequency of muscle cramps. That doesn't mean that the exercises are ineffective or harmful, and doing them can help contribute to the flexibility of your legs.

Quinine. There is solid evidence that quinine and quinine derivatives are effective in reducing the frequency of muscle cramps, although the magnitude of benefit is small. However, quinine is out-of-bounds for most people. The FDA has issued repeated warnings against using quinine (which is approved only to treat certain types of malaria) to prevent or treat leg cramps because it may cause serious side effects, including bleeding and kidney damage. Although doctors can still prescribe quinine, it is recommended only when cramps are disabling and when the person can be carefully monitored for side effects.

Vitamin B complex. There is some evidence that taking a daily capsule containing eight B vitamins—B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6, B7 (biotin), B9 (folate), and B12—may prevent cramps.

Calcium-channel blockers. Evidence indicates that one calcium-channel blocker—diltiazem (Cardizem, Dilacor XR)—is possibly effective.

Ineffective therapies. The AAN found enough evidence to indicate that magnesium supplements and gabapentin (Neurontin) aren't likely to help.

Other remedies

In situations like nighttime leg cramps, where there are no widely accepted treatments, unproven remedies may be worth a try. The following are low-risk and have enthusiastic proponents.

  • Soap. If you don't mind sharing the bed with a bar of soap, you might want to try securing one under the bottom sheet near where your legs usually rest. Despite scores of testimonials to its effectiveness in letters to news media and comments on websites, no one has offered a hypothesis for how soap might work. Yet it's inexpensive and harmless.

  • Mustard or pickle juice. Swallowing a teaspoon of mustard or an ounce of pickle juice before bedtime also has enthusiastic advocates. In fact, the pickle juice preventive has become a staple among athletes who want to avoid being sidelined by cramps. However, if you have gastroesophageal reflux disorder or are trying to cut back on salt, you might want to check with your doctor before trying this approach. Scientists think the foods might stimulate ion channels in the mouth, esophagus, and stomach to send signals to the central nervous system that inactivate overexcited neurons.

  • HotShot . This 1.7-ounce dose of cinnamon, ginger, lime juice, sweeteners, and capsaicin (the active compound in chili peppers) was developed by Dr. Bean and Dr. Rod MacKinnon, a Nobel Laureate in Chemistry at Rockefeller University, as a remedy for cramping during rigorous exercise. It works along the same principle as mustard and pickle juice, but has longer-lasting effects. It is currently available commercially as a sports beverage. "Although I am aware of people using it for nocturnal leg cramps, it has not yet been formally tested for that use," Dr. Bean says.

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