Symptoms
Nighttime calf cramps are painful and involuntary muscle contractions of the legs that often occur in the calves and feet. They last only a few minutes but can continue to cause discomfort for hours. They are particularly common in older people over 60 years of age. They are benign complaints. The most important complication is interference with sleep. Patients wake up because of the cramps and may not be able to get back to sleep.
Causes
No cause can be determined for so-called idiopathic nocturnal calf cramps. A common hypothesis describes calf cramps as a result of our sedentary lifestyle. Known causes of secondary calf cramps include:
- Chronic venous insufficiency
- In women, pregnancy (common!)
- Uremia
- Diabetes mellitus
- Poisonings
- Thyroid diseases
- Dialysis
- Electrolyte disorders: Hypomagnesemia, hypocalcemia, hyponatremia, hypokalemia.
- Vascular and neuromuscular diseases.
Some medications such as diuretics, nifedipine, morphine, H2 antihistamines, SERMs, statins, lithium, and beta2-sympathomimetics such as salbutamol have also been associated with muscle spasms. Muscle discomfort is a known adverse effect of inhaled beta2-sympathomimetics (eg, Ventolin, generics).
Diagnosis
Diagnosis should involve medical treatment to determine whether a disease, deficiency, or medication is causing the calf cramps. Diseases that cause similar symptoms should be ruled out (e.g., restless legs syndrome, neuropathies).
Nonpharmacologic treatment
In an acute attack, the foot can be flexed backward toward the shin. Cooling or warming, massaging, and walking around also help. Whether stretching has a reliable preventive effect is controversial. It may relieve discomfort in an acute attack. It has been recommended to sleep so that the foot is at right angles to the leg, as when standing, for example by leaning against the bed frame.
Drug treatment
Before symptomatic therapy is initiated, underlying conditions such as thyroid dysfunction or electrolyte imbalances should be treated with specific agents. Magnesium:
- Magnesium is a commonly used remedy for calf cramps and is usually taken in a dosage of approximately 300 mg per day (adults). It is commercially available, for example, in the form of capsules, effervescent tablets, granules, powders and chewable tablets. Its effectiveness has not been reliably proven scientifically. However, since it is generally well tolerated apart from a possible softening of the stool, the treatment can be tried. Magnesium can inhibit the absorption of some drugs and should therefore not be taken at the same time with other medications.
Painkillers:
- Such as acetaminophen can be taken for a short time before bedtime for symptomatic treatment of pain.
Antimalarials:
- Quinine sulfate may possibly reduce the occurrence of calf cramps at doses of 200 mg or more per day. However, it should not be used at all or should be used with great caution because of the potential for serious adverse effects. It is not suitable for pregnant women because it has fruit-damaging properties. In many countries, quinine sulfate is not approved for this indication and must be used off-label. The antimalarial drug chloroquine is also prescribed by some doctors.
Cooling skin care products:
- Can bring relief during an attack. Applied, for example, vinegar-tartaric alumina solution as a gel.
Other agents mentioned in the literature are verapamil, benzodiazepines and antihistamines; however, they can potentially cause adverse effects. Various alternative medicine agents are commercially available. Finally, placebo is also said to be well effective.
