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Muscle cramps

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of muscle cramps are prepared by our editorial team based on guidelines from the American Academy of Physical Medicine and Rehabilitation (AAPMR 2024), the Canadian Expert Group on Cannabinoids Use in Chronic Pain (CCP-CEG 2023), the Amyotrophic Lateral Sclerosis Society of Canada (ALSSC 2020), the European Academy of Neurology (EAN 2020), ...
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Diagnostic investigations

Initial evaluation, nocturnal leg cramps: as per AAFP 2012 guidelines, elicit patient history to diagnose nocturnal leg cramps. Avoid obtaining routine laboratory tests, such as electrolyte levels.
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  • Initial evaluation (muscle spasticity)

Medical management

Quinine: as per AAFP 2012 guidelines, do not use quinine for nocturnal leg cramps.
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  • Diltiazem

  • Gabapentin

  • Carisoprodol

  • Naftidrofuryl

  • Orphenadrine

  • Magnesium

  • Vitamin B complex

  • Management of muscle spasticity (general principles)

  • Management of muscle spasticity (nonpharmacological interventions)

  • Management of muscle spasticity (oral medications)

  • Management of muscle spasticity (botulinum toxin)

  • Management of muscle spasticity (nerve blocks)

  • Management of muscle spasticity (intrathecal baclofen)

  • Management of muscle spasticity (selective dorsal rhizotomy)

Nonpharmacologic interventions

Physical therapy: as per AAFP 2012 guidelines, consider offering passive stretching and deep tissue massage as a therapeutic trial for nocturnal leg cramps.
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Specific circumstances

Patients with ALS, management of muscle cramps: as per ALSSC 2020 guidelines, differentiate muscle cramps from other causes of pain.
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  • Patients with ALS (management of spasticity, nonpharmacological interventions)

  • Patients with ALS (management of spasticity, pharmacotherapy)

  • Patients with multiple sclerosis (management of spasticity, exercise)

  • Patients with multiple sclerosis (management of spasticity, skeletal muscle relaxants)

  • Patients with multiple sclerosis (management of spasticity, cannabinoids)

  • Patients with multiple sclerosis (management of spasticity, botulinum toxin)

  • Patients with multiple sclerosis (management of spasticity, transcutaneous electrical nerve stimulation)