Past medical history should include any disorders that can cause cramps. A complete history of medication and other substance use eg, alcohol is taken. read more , nonpitting edema or loss of eyebrow hair suggesting hypothyroidism , and changes in skin moisture or turgor.

read more , including deep tendon reflexes, is done. Pulses should be palpated, and blood pressure measured in all extremities. A weak pulse or low ankle:brachial blood pressure ratio in an affected limb may indicate ischemia. Focal cramps suggest benign idiopathic leg cramps, exercise-associated muscle cramping, musculoskeletal abnormalities, peripheral nervous system causes, or an early degenerative disorder that can be asymmetric, such as a motor neuron disorder.

read more , a motor neuron disorder Amyotrophic Lateral Sclerosis ALS and Other Motor Neuron Diseases MNDs Amyotrophic lateral sclerosis and other motor neuron diseases are characterized by steady, relentless, progressive degeneration of corticospinal tracts, anterior horn cells, bulbar motor nuclei read more , or a drug, although effects on deep tendon reflexes can vary by drug.

Generalized hyporeflexia can suggest hypothyroidism Hypothyroidism Hypothyroidism is thyroid hormone deficiency. read more and sometimes alcohol use disorder or be a normal finding, particularly in older patients. A normal examination and compatible history suggests benign idiopathic leg cramps or exercise-associated muscle cramping.

Blood glucose, renal function tests, and electrolyte levels, including calcium and magnesium , should be measured if patients have diffuse cramps of unknown cause, particularly if hyperreflexia is present.

Ionized calcium and arterial blood gases ABGs to confirm respiratory alkalosis are measured if patients have tetany. MRI of the brain and often spinal cord is done if muscle weakness or neurologic signs indicate that the central nervous system is involved.

If a cramp occurs, stretching the affected muscles often relieves the cramp. For example, to relieve a calf cramp, patients can use their hand to pull the toes and foot upward dorsiflexion. Applying heat eg, using a warm towel or heating pad, taking a warm bath or shower or cold eg, massaging the affected muscle with ice may help ease pain.

Drinking plenty of fluids particularly beverages that contain potassium after exercise. Not consuming stimulants eg, caffeine , nicotine , ephedrine , pseudoephedrine.

The hands can be placed on the wall for balance. Both heels remain on the floor. The knee of the front leg is bent further until a stretch is felt along the back of the other leg. The greater the distance between the two feet and the more the front knee is bent, the greater the stretch.

The stretch is held for 30 seconds and repeated 5 times. The set of stretches is repeated on the other side. Most of the medications often prescribed to prevent cramps eg, calcium supplements, quinine , magnesium, benzodiazepines are not recommended. Most have no demonstrated efficacy.

Quinine has been effective in some trials but is no longer recommended because of occasional serious adverse effects eg, arrhythmias, thrombocytopenia, thrombotic thrombocytopenic purpura [TTP] and hemolytic-uremic syndrome [HUS], severe allergic reactions [ 1 Prevention references A muscle cramp charley horse is a sudden, brief, involuntary, painful contraction of a muscle or group of muscles.

Cramps commonly occur in healthy people usually middle-aged and older adults read more ]. Mexiletine sometimes helps Prevention references A muscle cramp charley horse is a sudden, brief, involuntary, painful contraction of a muscle or group of muscles.

read more ] , but whether using it is worth the risk of adverse effects is unclear. These effects include nausea, vomiting, heartburn, dizziness, tremor, and possibly seizures. El-Tawil S, Al Musa T, Haseeb Valli H, et al : Quinine for muscle cramps. Br J Gen Pract. Food and Drug Administration.

Qualaquin quinine sulfate : new risk evaluation and mitigation strategy—risk of serious hematological reactions. Accessed August 3, 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.

Serrao M, Rossi P, Cardinali P, Valente G, Parisi L, Pierelli F. Gabapentin treatment for muscle cramps: an open-label trial. Clin Neuropharmacol. Guay DR. Are there alternatives to the use of quinine to treat nocturnal leg cramps?. Consult Pharm. Roffe C, Sills S, Crome P, Jones P.

Randomised, crossover, placebo controlled trial of magnesium citrate in the treatment of chronic persistent leg cramps. Med Sci Monit. Garrison SR, Birmingham CL, Koehler BE, McCollom RA, Khan KM. The effect of magnesium infusion on rest cramps: randomized controlled trial.

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search close. PREV Aug 15, NEXT. C 7 Passive stretching and deep tissue massage may be suggested as a therapeutic trial for nocturnal leg cramps. C 19 , 20 Quinine should not be used to treat nocturnal leg cramps.

C 11 , 21 Carisoprodol Soma , diltiazem, gabapentin Neurontin , magnesium, orphenadrine Norflex , verapamil, and vitamin B 12 complex may be useful in some patients with nocturnal leg cramps.

Clinical Features. Pathophysiology and Etiology. Diagnostic Evaluation. RICHARD E. ALLEN, MD, is program director of the St.

Mark's Family Medicine Residency in Salt Lake City, Utah. KIRBY, MD, is a faculty member at the St. Mark's Family Medicine Residency. Allen, MD, Utah Healthcare Institute, East South, Ste.

Weiner IH, Weiner HL. Nocturnal leg muscle cramps. Steiner I, Siegal T. Muscle cramps in cancer patients. Daniell HW. Simple cure for nocturnal leg cramps. N Engl J Med. Continue Reading. More in AFP. More in Pubmed. Copyright © by the American Academy of Family Physicians. Copyright © American Academy of Family Physicians.

All Rights Reserved. Patient history should be used to diagnose nocturnal leg cramps; routine laboratory tests, such as electrolyte levels, are unnecessary.

Passive stretching and deep tissue massage may be suggested as a therapeutic trial for nocturnal leg cramps. Carisoprodol Soma , diltiazem, gabapentin Neurontin , magnesium, orphenadrine Norflex , verapamil, and vitamin B 12 complex may be useful in some patients with nocturnal leg cramps.

Bromocriptine Parlodel , bupropion Wellbutrin , celecoxib Celebrex , cetirizine Zyrtec , chromium, cinacalcet Sensipar , ciprofloxacin Cipro , citalopram Celexa , clonazepam Klonopin , donepezil Aricept , eszopiclone Lunesta , fluoxetine Prozac , gabapentin Neurontin , lansoprazole Prevacid , rivastigmine Exelon , sertraline Zoloft , telmisartan Micardis , zolpidem Ambien.

Aching, sometimes cramping, deep pain brought on by exercise; relieved with rest. History Atherosclerotic risk factors Ankle-brachial index Radiographic studies.

Risk factor modification Graded exercise Invasive interventions. Painful cramps during or immediately after exercise Palpable muscle tightening.

Graded exercise and stretching. Sudden involuntary jerking at the onset of sleep May awaken the patient. History from bed partner. Deep, aching pain unrelated to exertion Weakness and poor exercise tolerance Often occurs in legs, but can affect any muscle.

History Elevated creatinine kinase levels myositis Statin use Evaluation for polymyositis and dermatomyositis. Mononeuropathies: Isolated numbness of the hands brought on by excessive keyboard work may be identified as carpal tunnel syndrome, also a treatable problem.

Ulnar neuropathies are also included as a type of mononeuropathy. Radiculopathies Small fiber neuropathies Occupational neuropathies: Industrial and athletic injuries to nerves such as the stinger in football result in arm weakness and tingling.

Symptoms Peripheral neuropathy produces symptoms such as weakness, muscle cramps, twitching, pain, numbness, burning, and tingling often in the feet and hands.

Diagnosis Neuropathy can be a difficult condition to diagnose. To begin, your doctor will take a full medical history and perform a physical and neurologic exam that may include checking your Tendon reflexes Muscle strength and tone Ability to feel certain sensations, and Posture and coordination Your doctor also may request one or more of the following: Blood tests to check your level of vitamin B A urinalysis Thyroid function tests and, often Electromyography EMG a test that measures the electrical discharges produced in your muscles A nerve conduction study, which measures how quickly your nerves carry electrical signals.

A nerve conduction study is often used to diagnose carpal tunnel syndrome and other peripheral nerve disorders Your doctor may recommend a nerve biopsy, a procedure in which a small portion of a nerve is removed and examined for abnormalities. Risk Factors Returning to the example of hitting your elbow, tingling in your hands is caused by injury to the sensory nerve.

Peripheral neuropathy can result from: Diabetes Nerve compression or entrapment Trauma Penetrating injuries Fracture or dislocated bones Tumor Intraneural hemorrhage Exposure to cold or radiation Rarely, certain medicines or toxic substances Vascular or collagen disorders such as atherosclerosis, lupus, scleroderma, sarcoidosis, and rheumatoid arthritis.

Treatments Neuropathy does not usually clear up unless the underlying problem is relieved or removed. Medical Approaches Depending on the cause, neuropathy may be relieved by medications, vitamin supplements, physical or occupational therapy, splinting, or surgery.

If you have diabetes, you and your doctor can work together to keep your blood sugar level as close to normal as possible. Maintaining normal blood sugar levels helps protect your nerves.

Vitamin deficiency. If your neuropathy is the result of a vitamin deficiency, your doctor may recommend injections of vitamin B daily for a few days, then once a month.

Autoimmune disorder. If caused by an inflammatory or autoimmune process, your neuropathy treatment will be aimed at modulating your immune response. Nerve pressure. Treatment will likely focus on adding ergonomic chairs, desks or keyboards to your home or office, changing the way you hold tools or instruments, or taking a break from certain hobbies or sports.

Only in extreme cases of nerve compression will you need surgery to correct the problem. Toxic substances or medications. Surgery Peripheral nerve disorders caused by tumors and traumatic and compressive conditions can sometimes be treated surgically.

Treatment options for Peripheral Nerve Disorders. Nerve Graft Repair. Nerve Biopsy.

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When idiopathic cramps occur in patients more than age 65—primarily nocturnally in the calves—the term nocturnal leg cramps of the elderly NLCE has been used. The most common is dehydration, in which electrolyte loss disrupts neuromuscular junction function and membrane stability.

Other physiologic stressors include unusually prolonged or strenuous exercise, particularly in a deconditioned state in which muscle tendon shortening is common. Pathologic states that disrupt the homeostatic environment or structural integrity of the neuromuscular axis or spinal connections also lead to muscle cramps.

People with medical conditions in which fluid shifts occur eg, cirrhosis or renal failure are especially vulnerable to muscle cramps.

For individuals who are dehydrated or malnourished, muscle cramps may arise from electrolyte loss or vitamin B or D deficiency. Neurologic conditions in which peripheral nerve is affected are particularly prone to muscle cramps as a positive motor symptom.

This includes motor neuron diseases, such as amyotrophic lateral sclerosis ALS , where muscles cramps are an early and common symptom that may eventually fade as denervation becomes advanced.

A high proportion of individuals with nonneuromuscular neurologic conditions eg, stroke, multiple sclerosis, and movement disorders experience muscle cramps. Although the mechanism for this association is unclear, it could result from a combination of spinal or cortical dysfunction, deconditioning, increased age, or medications.

The most common disorders of lipid metabolism are carnitine deficiency and CPT 2 deficiency, in which symptoms manifest with prolonged exercise usually after 45 minutes.

Investigation can be directed when muscle cramps are particularly bothersome, severe, or frequent. A practical approach is to consider first whether cramps are neurogenic or myogenic.

Nerve conduction studies and needle EMG can be helpful in differentiating neurogenic from myogenic cramps. Serum creatine kinase CK levels may also be helpful as CK is often elevated over, IU per L in myopathy; however, it should be noted that CK can also be elevated, particularly mildly elevated, in neurogenic processes and situations in which cramps are common see also HyperCKemia in this issue.

Evaluation should be directed toward potential etiology. Spinal MRI should be ordered if cervical or lumbosacral radiculopathy is suspected. Reccomended laboratory tests include a complete blood count CBC , creatinine and urea, liver enzymes, albumin, extended electrolytes, serum B-vitamin levels including B 12 and B 6 levels, 2-hour glucose tolerance test, hemoglobin A1C, thyroid-stimulating hormone TSH , and serum protein electrophoresis.

If immune motor neuropathy is suspected, antiganglioside GM1 antibody testing should be done. For myogenic cramps, investigations should be tailored to diagnose underlying metabolic myopathies. Forearm ischemic exercise testing can be used to diagnose disorders of glycolysis.

The normal result is elevated lactate and ammonia times baseline levels. In contrast, in myoadenylate deaminase deficiency, lactate levels rise, but ammonia levels do not. When neither ammonia nor lactate levels increase, the test is inconclusive and indicates muscles were not adequately exercised.

In myopathies due to lipid metabolism disorders, forearm ischemic exercise testing results are normal. If lipid metabolism disorder is suspected, order genetic testing for CPT2 deficiency, and if negative, again consider muscle biopsy with metabolic assay.

If cramps are found to be an isolated finding not associated with any identifiable neurogenic, myogenic, or metabolic source, they can be labelled as idiopathic and treated as such. There is no evidence that recurrent muscle cramps lead to significant long-lasting damage to muscles, and serious harm from muscle cramps eg, tendon ruptures is rare.

If treatment is needed, the avoidance of the offending agent or appropriate electrolyte and vitamin replacement to treat the root cause are warranted.

There is level B evidence that vitamin B-complex supplementation can reduce cramp frequency in people who experience at least 6 cramps per week. This also includes cannabinoids, where the limited high-quality evidence available to date has not shown a clear treatment effect.

In individuals with prominent dehydration eg, athletes, malnourished individuals, or members of vulnerable populations , care must be taken to ensure adequate electrolyte-rich solutions, particularly high-salt formulations.

In pregnant women, there is ample evidence that magnesium replacement is helpful in managing muscle cramps. People with dialysis disequilibrium syndrome during hemodialysis usually have improvement in muscle cramps when dialysates and dialysis rates are adjusted to prevent fluid shifts.

If cramps remain frequent, severe, and disabling, pharmacologic prescription level intervention should be considered Table 2. Given a current lack of a validated and comprehensive cramp scale, the prescribing clinician and patient are encouraged to choose a clear goal in mind when considering treatment eg, cramp frequency or intensity reduction until more comprehensive and validated outcome measures become available.

Quinine sulphate is the most studied medication for treatment of muscle cramps. Although there is level 1 evidence that quinine may be effective for treating muscle cramps, there are concerns about hematologic and cardiac adverse effects, including thrombocytopenia and QT prolongation in addition to visual disturbances and cinchonism.

Quinine, however, is still prescribed with special precautions in some parts of the world. In 2 independent studies in this population, safety and efficacy for reducing severity and frequency of muscle cramps was seen, which offers an alternative for those with ALS or other neuromuscular conditions with prominent muscle cramps.

Mexiletine is also proven effective for treating nondystrophic myotonia. As such, these can be tried in individuals with muscle cramps and coexisting neuropathic pain; however, if there is no effect on muscle cramps once the maximal effective dose for pain is reached, add-on medications for the cramps should be considered.

Cramps are an under-recognized treatable painful symptom that affects a large number of people across normal physiologic and neuromuscular, neurologic, and medical disease states. Clinical judgement should be used to fully evaluate possible treatable causes.

A rational treatment plan includes pharmacologic and nonpharmacologic options. Additional research into a reliable and validated outcome measure and new treatments for muscle cramps are areas of unmet need.

Jansen PH, Gabreels FJ, van Engelen BG. Diagnosis and differential diagnosis of muscle cramps: a clinical approach. J Clin Neuromuscul Dis. Layzer RB. The origin of muscle fasciculations and cramps. Muscle Nerve. Jansen PH, Joosten EM, Vingerhoets HM.

Muscle cramp: main theories as to aetiology. Eur Arch Psychiatry Neurol Sci. Sawlani K, Katirji B. Peripheral nerve hyperexcitability syndromes. Continuum Minneap Minn. Matzner O, Devor M. J Neurophysiol. Mense S. Group III and IV receptors in skeletal muscle: are they specific or polymodal?

Prog Brain Res. Baldissera F, Cavallari P, Dworzak F. Graven-Nielsen T, Mense S. The peripheral apparatus of muscle pain: evidence from animal and human studies. Clin J Pain. Obi T, Mizoguchi K, Matsuoka H, Takatsu M, Nishimura Y.

Muscle cramp as the result of impaired GABA function— an electrophysiological and pharmacological observation. Jentsch TJ, Stein V, Weinreich F, Zdebik AA. Molecular structure and physiological function of chloride channels.

Physiol Rev. Conte Camerino D, Tricarico D, Pierno S, et al. Taurine and skeletal muscle disorders. Neurochem Res. Gospe SM, Lazaro RP, Lava NS, et al. Familial X-¬linked myalgia and cramps. Harrison TB, Benatar M. Accuracy of repetitive nerve stimulation for diagnosis of the cramp-fasciculation syndrome.

Examination findings may indicate a potential underlying medical cause, such as peripheral vascular disease. Appropriate examination includes inspection of the legs and feet, palpation of pulses, and evaluation of touch and pinprick sensation, strength, and deep tendon reflexes.

Blood pressure should be measured to assess cardiac and vascular risk factors. Neurologic disease may also manifest as tremor, gait disturbance, or asymmetry. Routine blood tests are not helpful in the diagnosis because leg cramps have no proven association with electrolyte abnormalities, anemia, glucose levels, thyroid function, or kidney disease.

Similarly, other diagnostic studies such as nerve conduction studies, ultrasonography, and angiography are not necessary unless indicated to confirm specific medical conditions. No current treatments for leg cramps have been proven both safe and effective.

Passive stretching and deep tissue massage are harmless, patient-controlled maneuvers that may be suggested as a therapeutic trial despite limited proof of effectiveness. One randomized study of patients discontinuing quinine showed no effect from stretching; however, gastrocnemius stretching has long been recommended to prevent leg cramps.

Anecdotal evidence suggests that mild exercise, such as a few minutes on a stationary bicycle or treadmill before bedtime, can relieve nocturnal leg cramps. Quinine has shown some effectiveness for nocturnal leg cramps but is no longer recommended. In , the U.

Food and Drug Administration issued a warning about multiple drug interactions with quinine, and stated that the potential for serious adverse effects outweighs the modest benefit of the drug. Cardiac arrhythmias, cinchonism causing headache, tinnitus, and dizziness , and hemolytic uremic syndrome can occur from toxic levels of quinine.

Small studies have shown some benefit from other medications. Because of the low quality of evidence, no medication can be recommended for routine treatment of leg cramps; however, carisoprodol Soma , diltiazem, gabapentin, orphenadrine Norflex , verapamil, and vitamin B 12 complex may be considered in some patients.

There is no research on how treating underlying medical conditions impacts the symptom of leg cramps. Differentiating leg cramps from restless legs syndrome may be challenging, 17 and a trial of dopaminergic drugs is a reasonable approach for a patient with mixed symptoms.

Figure 1 is an algorithm for the evaluation and treatment of nocturnal leg cramps. Data Sources: We searched PubMed using the search term leg cramps. We examined clinical trials, randomized clinical trials, meta-analyses, and review articles, as well as the bibliographies of selected articles.

Cochrane and Essential Evidence Plus were also searched. Search dates: September and October Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly: prevalence, drug and disease associations. Int J Clin Pract. Oboler SK, Prochazka AV, Meyer TJ.

Leg symptoms in outpatient veterans. West J Med. Leung AK, Wong BE, Chan PY, Cho HY. Nocturnal leg cramps in children: incidence and clinical characteristics. J Natl Med Assoc. Olney RK, Aminoff MJ. Weakness, myalgias, disorders of movement, and imbalance. In: Harrison TR, Braunwald E, et al.

Harrison's Principles of Internal Medicine. New York, NY: McGraw-Hill; Sontag SJ, Wanner JN. The cause of leg cramps and knee pains: an hypothesis and effective treatment. Med Hypotheses. Schwellnus MP, Nicol J, Laubscher R, Noakes TD. Serum electrolyte concentrations and hydration status are not associated with exercise associated muscle cramping EAMC in distance runners.

Br J Sports Med. Sulzer NU, Schwellnus MP, Noakes TD. Serum electrolytes in Ironman triathletes with exercise-associated muscle cramping. Med Sci Sports Exerc.

Noordzij M, Boeschoten EW, Bos WJ, et al. Disturbed mineral metabolism is associated with muscle and skin complaints in a prospective cohort of dialysis patients. Nephrol Dial Transplant.

Baskol M, Ozbakir O, Coskun R, Baskol G, Saraymen R, Yucesoy M. The role of serum zinc and other factors on the prevalence of muscle cramps in non-alcoholic cirrhotic patients.

J Clin Gastroenterol. Clinical pharmacology. Elsevier gold standard. com password required. Accessed June 23, Garrison SR, Dormuth CR, Morrow RL, Carney GA, Khan KM.

Nocturnal leg cramps and prescription use that precedes them: a sequence symmetry analysis. Arch Intern Med. Matsumoto M, Watanabe K, Tsuji T, et al. Nocturnal leg cramps: a common complaint in patients with lumbar spinal canal stenosis.

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Financial Assistance Documents — Arizona. Financial Assistance Documents — Florida. Financial Assistance Documents — Minnesota. In some cases, neuropathy is caused by heredity, vitamin deficiency, infection, and kidney disease.

Neuropathy does not usually clear up unless the underlying problem is relieved or removed. Controlling a chronic condition may not eliminate your neuropathy, but it can play a key role in managing it.

Depending on the cause, neuropathy may be relieved by medications, vitamin supplements, physical or occupational therapy, splinting, or surgery.

Peripheral nerve disorders caused by tumors and traumatic and compressive conditions can sometimes be treated surgically. With regards to diabetic neuropathy, surgeons may consider placing a spinal cord stimulator if a patient has medically refractory pain.

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Related Specialties. Peripheral Nerve Disorders. Examples of peripheral nerve disorders include: Guillain-Barre´ Strohl Syndrome: Since the polio vaccine came into widespread use, GBS has become the most common remaining cause of acute neuromuscular paralysis.

An acute, ascending, and progressive neuropathy characterized by weakness, paresthesias, and hyporeflexia. In the early s, Guillain, Barre´, and Strohl first described the syndrome in 2 patients who spontaneously recovered from a progressive ascending motor weakness with areflexia, paresthesias, sensory loss, and an elevated level of cerebrospinal fluid CSF protein.

Chronic inflammatory demyelinating polyneuropathy CIPD Polyneuropathies Diabetic neuropathies: Tingling in the feet may be caused by a peripheral neuropathy. Early evaluation with laboratory studies may uncover potentially treatable disease such as diabetes and vitamin B12 deficiency.

Mononeuropathies: Isolated numbness of the hands brought on by excessive keyboard work may be identified as carpal tunnel syndrome, also a treatable problem. Ulnar neuropathies are also included as a type of mononeuropathy.

Radiculopathies Small fiber neuropathies Occupational neuropathies: Industrial and athletic injuries to nerves such as the stinger in football result in arm weakness and tingling.

Symptoms Peripheral neuropathy produces symptoms such as weakness, muscle cramps, twitching, pain, numbness, burning, and tingling often in the feet and hands. Diagnosis Neuropathy can be a difficult condition to diagnose. To begin, your doctor will take a full medical history and perform a physical and neurologic exam that may include checking your Tendon reflexes Muscle strength and tone Ability to feel certain sensations, and Posture and coordination Your doctor also may request one or more of the following: Blood tests to check your level of vitamin B A urinalysis Thyroid function tests and, often Electromyography EMG a test that measures the electrical discharges produced in your muscles A nerve conduction study, which measures how quickly your nerves carry electrical signals.

A nerve conduction study is often used to diagnose carpal tunnel syndrome and other peripheral nerve disorders Your doctor may recommend a nerve biopsy, a procedure in which a small portion of a nerve is removed and examined for abnormalities. Most often, doctors use the term peripheral arterial disease to describe poor circulation read more commonly called hardening of the arteries in the legs may cause calf pain claudication Symptoms during physical activity such as walking.

This pain is due to inadequate blood flow to muscles, not to muscle contraction as occurs with cramps. The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation. In people with muscle cramps, the following symptoms and characteristics are of particular concern:.

Signs of alcohol use disorder Alcohol Use Alcohol ethanol is a depressant it slows down brain and nervous system functioning. Consuming large amounts rapidly or regularly can cause health problems, including organ damage, coma, read more , such as a history of consuming large amounts of alcohol, spider veins, and red palms.

If people have cramps in the arms or trunk or muscle twitching, the cause is more likely to be a disorder such as an electrolyte or hormonal disorder or a medication or drug than benign leg cramps or exercise-related muscle cramps.

People with muscle cramps should consult a doctor as soon as possible if they also have alcohol use disorder, sudden weakness or loss of sensation, or severe symptoms or if they have lost body fluids for example, through vomiting, diarrhea, or excessive sweating.

Otherwise, people should call their doctor to discuss how soon the doctor needs to see them. Doctors first ask questions about the person's symptoms and medical history Medical History in Neurologic Disorders Before doing a physical examination, doctors interview the person to obtain information about the person's current and past health medical history.

The history is the most important part of read more and then does a physical examination. What doctors find during the history and physical examination often suggests a cause and the tests that may need to be done. Lack of menstrual periods or menstrual irregularities—symptoms that suggest pregnancy-related leg cramps.

Vomiting, diarrhea, use of diuretics, excessive exercise, and sweating—symptoms that suggest loss of body fluids or electrolytes. Difficulty tolerating cold, weight gain, and coarse, thick skin—symptoms that may indicate hypothyroidism.

The person is also asked about use of medications and alcohol, recent dialysis treatment, and any association between past dialysis treatments and muscle cramps. The physical examination focuses first on the nervous system neurologic examination Neurologic Examination When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the different parts of the nervous system.

read more , including assessment of muscles and reflexes. Alcohol use disorder such as spider veins, red palms, and, in men, changes in the pattern of genital hair. No tests are routinely done. Instead, testing is done based on the history and results of the physical examination.

If cramping is widespread, particularly if reflexes are overactive, doctors measure levels of blood sugar and electrolytes including calcium and magnesium and do blood tests to check for kidney malfunction which can cause levels of calcium and magnesium to be abnormal.

If the cramped muscles are also weak, electromyography Electromyography and Nerve Conduction Studies Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Imaging tests commonly used to diagnose nervous system neurologic disorders read more may be done.

For this test, a small needle is inserted into a muscle to record the electrical activity of the muscle when the muscle is at rest and when it is contracting. If muscle weakness Weakness Weakness refers to loss of muscle strength. That is, people cannot move a muscle normally despite trying as hard as they can.

However, the term is often misused. Many people with normal muscle read more is widespread and doctors think that it is related to a problem with the nervous system, magnetic resonance imaging Magnetic Resonance Imaging MRI Magnetic resonance imaging MRI is a type of medical imaging that uses a strong magnetic field and very high frequency radio waves to produce highly detailed images.

During an MRI, a computer read more MRI of the brain and spinal cord is done. Drinking plenty of fluids particularly sports beverages that contain potassium after exercise.

Not consuming caffeine for example, in coffee or chocolate. Avoiding stimulants, such as caffeine , nicotine , ephedrine , or pseudoephedrine a decongestant contained in many products that do not require a prescription but are available only behind the pharmacy counter.

Stretching makes muscles and tendons more flexible and less likely to contract involuntarily. The runner's gastrocnemius stretch is the best stretch for preventing calf cramps. A person stands with one leg forward and bent at the knee and the other leg behind with the knee straight—a lunge position.

The hands can be placed on the wall for balance. Both heels remain on the floor.