Best Evidence Review: Muscle Cramps -- Painful, Common, and Neglected

Charles P. Vega, MD


August 03, 2010

Best Evidence Reference

Katzberg HD, Khan AH, So YT. Assessment: symptomatic treatment for muscle cramps (an evidence-based review). Neurology 2010; 74: 691-96.


This study was selected from Medscape Best Evidence, which uses the McMaster Online Rating of Evidence System. Of a possible top score of 7, this study was ranked as 5 for newsworthiness and6 for relevance by clinicians who used this system.


Although quinine sulfate and its derivatives were considered first-line therapy for idiopathic muscle cramps in adults for many years, the United States Food and Drug Administration warned against this off-label use several years ago. Was this warning warranted? And do satisfactory treatment alternatives exist? The current evidence-based review seeks to answer these questions.


Muscle cramps are common and are seen by physicians in a number of specialties. They can be very frustrating for patient and physician alike. In a study of patients in a general practice register, the overall prevalence of cramps at rest was 37%.[1]Forty percent of respondents had cramp symptoms more than 3 times per week, and 21% of participants described their symptoms as very distressing.

This study also found that muscle cramps were more common among older adults. In a study of 365 patients with a mean age of 78.5 years, the prevalence of leg cramps was 50%.[2] Women were more likely to report cramps compared with men (56% vs 40%). Cramps were most prevalent at night, and were frequently long-standing in duration. Factors associated with a higher risk of leg cramps included peripheral vascular disease, arthritis, and being female.

The diagnostic approach to the patient with leg cramps can be confusing, in part because most cases of nocturnal leg cramps are idiopathic.[3] The physical examination should include an assessment for possible peripheral neuropathy and peripheral vascular disease. The laboratory workup can include serum electrolytes, iron studies, thyroid function tests, blood urea nitrogen, and creatinine. Imaging studies or sleep studies are recommended only when the physician clearly suspects illness such as peripheral vascular disease or periodic limb movement disorders.

Despite the long duration of leg cramps for many patients--or perhaps because individuals had become resigned to life with these symptoms -- only 40% of participants in one study had reported their leg cramps to their practitioner.[2] However, most of the patients who had received treatment for leg cramps reported a therapeutic benefit.

Quinine has traditionally been the first-line therapy for muscle cramps. However, its safety has been called into question, prompting consideration of other therapies which can help patients with this bothersome and sometimes debilitating symptom. The current evidence-based review describes the body of research into the treatment of muscle cramps.


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