Annoying Muscle Twitch? When to Seek Help

Why muscle twitches — or fasciculations — are rarely a cause for concern

Do you ever have a muscle that seems to have a mind of its own, causing an uncontrollable twitch or spasm in your eyelid, leg or other part of your body? If so, you’re in good company.

These spontaneous movements — called fasciculations — can affect as many as 70% of the population at any time in their lives. In many cases, these twitches can be blamed on behaviors like having too much caffeine, not drinking enough fluids, catching too little sleep or even lifting heavy weights.

Most of the time, muscle twitches aren’t cause for concern, says Ryan Jacobson, MD, a neuromuscular specialist at RUSH University Medical Center. But because fasciculations can be a sign of more serious issues, seeing a doctor may be a smart move.

Benign fasciculation syndrome

Although occasional muscle twitches are common, for a smaller subset of people, fasciculations can become especially persistent and bothersome, sometimes with no clear trigger. These individuals may be diagnosed with what is known as benign fasciculation syndrome.

People with this syndrome may have twitches in large muscles in their calves. Or they might experience twitches in smaller muscles, like those in their eyelids or other parts of the face. But really any part of the body can develop twitches. “Oftentimes, people will seek medical attention because they might notice twitches affecting unusual parts of the body, like the chest wall or abdomen, which can be frightening,” Jacobson says.

As the term “benign” implies, these fasciculations aren’t cause for concern, even if they can be distressing. “There is no muscle and nerve damage occurring underneath, and the symptoms, while bothersome, are ultimately not worrisome or progressive,” he adds.

Twitches coupled with cramps are common

Another frequent symptom in people with benign fasciculation syndrome is muscle cramping. “The cramping can range from occasional twinges of muscle pain to severe charley horses,” Jacobson says.

Like the muscle twitches, the cramps may affect just one part of the body or several areas. People also may experience tingling along with the twitches and cramps.

Doctors believe these persistent symptoms are caused by irritated nerves and not the muscles themselves, Jacobson says. Potential triggers include a recent infection, hormone abnormalities, vitamin deficiencies or electrolyte imbalances, Jacobson says. Sometimes, prescription and over-the-counter medications may be the culprits.

Is twitching a sign of ALS?

So, how do you know if your twitches and cramps are truly nothing to worry about, as they are for most people? The best way is to see your primary care doctor or a neurologist, Jacobson says. Getting medical care is especially important if you also have significant muscle weakness along with twitches, which together can be the sign of something more serious.

“Frequently, patients who present to the clinic with fasciculations are specifically worried about neurological conditions like amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease,” Jacobson says. “In most cases, a history of presenting symptoms and a good neurological exam can identify whether the symptoms are benign or whether there could be an underlying, concerning problem.”

In fact, a neurological exam and simple bloodwork may be all that is needed to rule out ALS or another progressive condition. Sometimes, a doctor may recommend electromyography (EMG), an electrical test for the nerves and muscles. In people with benign fasciculation syndrome, EMG tests are usually normal, Jacobson says.

Treating twitches

To ease benign fasciculations, Jacobson typically helps patients work on better habits, such as getting more sleep and drinking more fluids (but not caffeine).

If the symptoms are especially bothersome, he may recommend that a patient take a prescription medicine called gabapentin that can reduce nerve irritability. An over-the-counter magnesium supplement also may reduce symptoms in some people.

Over time, muscles twitches and cramps may ultimately fade away on their own. “In many patients, these neuromuscular symptoms seem to wax and wane,” Jacobson says. “And the prognosis is generally good for the symptoms to become less prominent and less bothersome over time.”

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