Ouch! Nocturnal Leg Cramps—and How to Stop Them

You've likely experienced the random, sleep-interrupting pain of muscle cramps. Beat those nocturnal leg cramps with these simple strategies.

nocturnal leg cramps

Taking a vitamin B complex supplement substantially improved nocturnal leg cramps in a group of elderly patients with high blood pressure in a double-blind trial.

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Up to 60 percent of adults have had nocturnal leg cramps.[1] These recurrent, painful cramps usually strike the calf muscles and can cause frequent awakenings and severe insomnia. They are more common in people aged 50 years and older. If you’ve suffered through them, read on to learn how to lower your risk and get a good night’s sleep.

Causes and Risk Factors

Exactly what causes cramping is unknown, but cramps are probably caused by muscle fatigue, nerve dysfunction, and/or electrolyte abnormalities (chemical imbalances in calcium, potassium, and magnesium).

Other risk factors include:

Conventional Treatments for Nocturnal Leg Cramps

When you tell your healthcare practitioner about leg cramps, it’s important that he or she takes a thorough history and physical examination, and orders tests, if necessary, to rule out other conditions that can cause leg pain, such as restless legs syndrome, claudication, myositis, and peripheral neuropathy.

Conventional treatment for nocturnal leg cramps uses prescription medications.[2] Quinine used to be the gold standard, but is no longer commonly recommended due to a considerable risk of birth defects and serious adverse effects.[1] Calcium channel blockers and antiepileptics are considered potential alternatives to quinine, but they can have considerable side effects of their own and their effectiveness for cramps has not been extensively studied.

Natural Treatments for Nocturnal Leg Cramps

A better approach is to try these natural strategies.

To stop a calf cramp while it’s happening, stretch the calf by pulling the toes closer to the shin while keeping the knee as straight as possible and simultaneously massaging the calf muscles. Doing this has been shown to help relieve pain quickly during a cramping episode.

To help prevent nocturnal leg cramps and reduce their frequency and severity, a simple three-minute stretching routine before bed has been found to be helpful. A study in 80 adults found that a six-week long stretching program significantly decreased the frequency and severity of cramps.[4]

Magnesium for Nocturnal Leg Cramps

Magnesium is one of the most commonly recommended natural treatments for muscle cramps. While not many people have serum magnesium levels low enough to be abnormal on standard blood testing, less severe magnesium deficiency and insufficient magnesium status is relatively common.[5]

In the United States, around half the population consumes less than the required amount of magnesium.[5] This is likely because of the reliance on heavily processed convenience foods at the expense of the green leafy vegetables, nuts and seeds, and legumes that are among the best food sources of the mineral.

A number of studies have looked at magnesium supplements as a therapy and the results are conflicting. On average, magnesium leads to only small improvements, if any, over placebo.[6,7]
Yet, in a double-blind study, 64 patients took either 366 mg per day of magnesium or placebo for four weeks. Seventy-five percent of the patients taking magnesium reported symptomatic improvement.[8] The evidence is particularly strong for magnesium’s effectiveness as a treatment for pregnancy-related nocturnal leg cramps.[6]

Given magnesium’s good safety record and its great importance for health, a trial of magnesium supplementation is warranted for anyone with nocturnal leg cramps. Take around 400 mg of elemental magnesium in the form of a chelated magnesium supplement such as magnesium citrate, malate, aspartate, or glycinate.[8]

Meanwhile, make sure you’re also eating a nutrient-dense diet containing plenty of magnesium-rich foods, including pumpkin, sesame, and sunflower seeds; black and navy beans; spinach and Swiss chard; and quinoa.

You can also take an Epsom salt bath before bed. Pour a couple of cups of Epsom salts into running water and soak with your legs fully immersed for twenty minutes or so.

Vitamin B12 and Vitamin B Complex

Another safe and natural therapy is supplementation with a vitamin B complex or high dose of vitamin B12 (or both).

Taking a vitamin B complex supplement substantially improved nocturnal leg cramps in a group of elderly patients with high blood pressure in a double-blind trial.[9] Patients took one capsule three times per day of either a placebo or a vitamin B-complex containing 250 mcg of vitamin B12 (as hydroxocobalamin), 30 mg of vitamin B6 (as pyridoxal phosphate), 50 mg vitamin B1 (thiamin, as fursultiamine), and 5 mg of vitamin B2 (riboflavin) per capsule.

The average pain score decreased in the B-complex group, with almost 30 percent of the group reporting their leg cramps were completely gone and another 57 percent reporting significant improvement.

Other published cases and uncontrolled studies have reported that vitamin B12 administered by intramuscular injections or nasal spray can relieve chronic nocturnal leg cramps in elderly people.[8] While these forms of B12 are not available without a prescription, there is evidence that sublingual forms of vitamin B12 can be as effective as injections.

If you have no success with a magnesium or a B-complex supplement, try a high dose (2,000 micrograms) of sublingual vitamin B12 (as hydroxycobalamin or methylcobalamin) daily.

What to Try First

To help reduce nocturnal leg cramps, start with these steps:

  • Stay hydrated by drinking plenty of water throughout the day.
  • Limit your consumption of refined, packaged, and processed foods while increasing your consumption of magnesium-rich foods like dark leafy greens.
  • Next, try a regular stretching program during the day and just before going to bed as described above.
  • If these measures don’t relieve your leg cramps, try magnesium as magnesium glycinate, citrate, malate, or aspartate, 400 mg in divided doses throughout the day. At the same time, take a vitamin B-complex supplement three times daily.
  • If you still find no relief, add 2000 micrograms of vitamin B12 under the tongue.

Together, these steps can help ease leg cramps so you can get a good night’s sleep.


For related reading, visit these posts:

Originally published in 2015, this post is regularly updated by the editors of University Health News.

1. Amer Fam Phys. 2012;86(4):350-355.
2. Consult Pharm. 2008 Feb;23(2):141-56.
3. BMJ. 1995;310:13.
4. J Physiother. 2012;58(1):17-22.
5. Nutr Rev. 2012 Mar;70(3):153-64.
6. Family Practice (2014) 31 (1): 7-19.
7. Cochrane Database Syst Rev. 2012 Sep 12;9:CD009402.
8. IMCJ. 2007 Dec;6(6):20-23.
9. J Clin Pharmacol. 1998 Dec;38(12):1151-4.

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Kathleen Jade, ND

Dr. Kathleen Jade is a naturopathic physician and served for many years as the Medical Director and Editor-In-Chief of Natural Health Advisory Institute. She has been licensed as a primary … Read More

View all posts by Kathleen Jade, ND

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  • Hello I’m having some issues with really bad muscle cramps but I’m very active and I drink alot of water I eat green leafy veggies alot and I also take a B12 vitamin so what can possibly be causing these terrible pains in my body legs back face stomach everywhere please help me

  • I was surprised that although potassium was in boldface type at first mention, the article didn’t discuss its use in treatment. I went through a period of frequent bouts of leg cramps, and in reading about them, found potassium deficiency to be frequently mentioned, along with advice to eat more foods containing plenty of potassium. I started eating more bananas and potatoes, drinking more vegetable juices high in potassium (Trader Joe’s “Garden Patch” is one particularly high in potassium), molasses tea (the Wholesome Sweeteners brand of organic molasses is also particularly high in potassium), and other things like orange juice that are less rich in the mineral, but still useful sources. The liquids were helpful to prevent recurrence of cramps when I’d get waked up by them.

    Eventually I found that my cramps were the result of malnutrition stemming from untreated celiac disease. Once I went on the gluten-free diet and my intestines healed a little, the cramps went away.

  • My wife had leg cramps every other night. We placed lavender-scented soap under the bed covers near her legs and the cramps were reduced to twice a month.

  • My cramps mainly observed in the nights in bed. The cramps will start in one leg and then migrate to another. Sometimes my ankle and toes are so stiff ; they cannot move without excruciating pains. I try massage and walking as best as I can; it takes a long to get relief. I am over 50 but I have been having these cramps even when I was pregnant. I don’t believe my doctors (GP) take me very seriously so here I am taking me seriously. Do I need to see a specialist ?
    Like a Vascular doctor ?

  • If cramping is migrating, you may have nerve issues in the lower back, the ‘small’ of the back. There’s a huge network of nerves like group of hairs in the lower back, and arthritis or a bulging disc can press on them. Even retaining water can cause minor muscle swelling and press on them, causing all sorts of symptoms, from tingling, pain, cramps. If you can see a vascular specialist, it’d be good to rule out any blockages, yes, IMO.

  • Excellent and accurate article. Very helpful. I have training in herbal and naturopathic approaches to health. Your article offers the consumer a variety of safe and natural treatments, with risk of harm. Good work!

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