Dear Dr. Roach: Do you have any recommendations to stop restless legs at night? My husband has been to many doctors to find a cause or a solution to stop them. His legs have raised up as much as a foot in the air at night, constantly jumping and causing many sleepless nights. No one seems to have a solution for him.
J.O.
Restless legs syndrome (RLS) is a common condition where people have the urge to move their legs. It’s usually worse at night and associated with an unpleasant sensation that is relieved by movement. People with RLS often have involuntary jerking movements of their legs during sleep, unimaginatively called “periodic limb movements of sleep.”
Your husband may have these periodic limb movements without RLS, which would then be considered periodic limb movement disorder. Treatment recommendations require an exact diagnosis.
I often see his condition misdiagnosed or continue on for years without a diagnosis. The diagnosis is confirmed by a sleep study where the limb movements are recorded and characterized. Once the diagnosis is made, there are a few important considerations:
The first is that this condition often coincides with iron deficiency, which should be looked for and treated, if necessary. (The underlying cause for iron deficiency also needs to be found.) It may take weeks or even months after iron replacement for the leg movements to get better.
Prior to medication treatment, a review of any medicines your husband takes is appropriate, as some can cause similar symptoms. Regular exercise, avoidance of caffeine and alcohol, and good sleep (ironically) can all improve symptoms in some people.
If medicine is needed, medications like pregabalin or pramipexole may be the first-line treatment, depending on the results of the sleep study and how intermittent the symptoms are. A new therapy called neurostimulation is a drug-free approach that has been shown to be effective. One device, the tonic motor activation, was approved by the Food and Drug Administration for RLS and will hopefully be available shortly.
But there are many experts in this condition. He should see a sleep medicine expert.
Dear Dr. Roach: I was wondering if you could give me any information on idiopathic stabbing headaches. I have been having them for three months now. From what I have read, this is a long time for this condition. I can have them anywhere from 3-50 times a day, and sometimes they go away for a day or two. They are extremely painful.
I was prescribed indomethacin, which gives some relief but doesn’t fix the problem. This is a very strong NSAID, and I am tolerating it with minimal side effects. But I don’t want to be on this long-term. Do you have any suggestions that might help me?
L.L.
A stabbing headache is an uncommon headache syndrome. It can be hard to distinguish it from a cluster headache, but a stabbing headache does not have the characteristic eye symptoms (especially tearing) or nose symptoms (especially runny nose). Cluster headaches are seldom greater than eight per day.
There isn’t a lot published on the long-term prognosis of a stabbing headache. As you found, it goes away in many people after several weeks, but some people have intermittent symptoms that last months or sometimes years.
One alternative to indomethacin is melatonin, which is much less likely to damage the stomach and kidneys. A neurologist with expertise in headaches may have other options for you.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
