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RENEE MONTAGNE, host:

A charley horse is one muscle pain that's excruciating. People tend to get them during strenuous exercise. For older people, muscle cramps can be unlike any they've ever had before.

NPR's Patti Neighmond explains why and what people might do about it.

PATTI NEIGHMOND: For 71-year-old Ken Holladay, muscle cramps started off mild and irregular, once every few weeks, but then they started to get more frequent. Eventually, they occurred every single night, often twice, between 2 and 6 in the morning.

Mr. KEN HOLLADAY: It was like a charley horse, only these were in my feet or my toes or somewhere, muscles that I didn't know I had. They would make my toes stand straight up.

NEIGHMOND: Yes, he said straight up.

Mr. HOLLADAY: The big toe was at 90 degrees to the bottom of the foot; put your foot on the floor, and this big toe would be pointing straight up toward the ceiling; and I don't believe you can voluntarily pull a big toe that high.

NEIGHMOND: Not likely. But turns out, your muscles can, all on their own.

Mr. HOLLADAY: One time the toe would actually curl down, and I leapt out of bed to try and get rid of the pain and landed on that toe and broke the toe, broke a bone underneath the big toe, broke the toenail off. And it was terrible.

NEIGHMOND: Screeching pain, says Holladay, making it impossible to get a good night's sleep or feel well-rested during the day. But that wasn't what drove him to seek treatment.

Mr. HOLLADAY: The big thing that scared me was if I was bedridden as I got older and things were to happen potentially, or even some injury that would keep me bedridden, I had no way of stopping them.

NEIGHMOND: It was too scary a thought. So Holladay went searching for help. His doctor determined that the spasms were not an indicator of any other disease, so he tried acupuncture; it didnt work. Prescription quinine didnt work either, and now it's off the market anyway because of side effects.

Finally, Holladay drove over an hour to see Dr. Yuen So, a neurologist who specializes in muscle cramps at Stanford University. Dr. So had just finished his own research for treatments, and there were some promising things: a blood pressure medication and even Vitamin B, but nothing that worked for everyone. In Ken Holladay's case, it was an anti-seizure medication that ultimately worked.

Mr. HOLLADAY: After a week or two, no cramps. After a month or two, no cramps, so this stuff was really working for me.

NEIGHMOND: UCSF neurologist Robert Miller says older people are at greater risk for cramps. Like everything else, nerves suffer wear and tear, and cramps occur at the place where nerves meet muscle.

Dr. ROBERT MILLER (Neurologist, UCSF School of Medicine): The signal does have to cross through those tiny little, we call them nerve twigs or nerve terminals. And excessive signaling, excessive irritability coming out of those little nerve terminals, seems to be the generator for cramping.

NEIGHMOND: At 68, Miller's a candidate himself for cramps, but he keeps them at bay, he says, by eating a banana a day and drinking lots of water. And every day, Miller bikes back and forth to work, two hours a day of calf stretching while riding up and down San Francisco hills. Turns out a stretched muscle is less likely to cramp.

Patti Neighmond, NPR News.

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