Restless legs syndrome (RLS) causes an overwhelming urge to move the legs, often with uncomfortable sensations that worsen at rest and disrupt sleep. Many people wonder whether magnesium for restless legs might offer relief. Magnesium plays a vital role in nerve and muscle function, and deficiency has been proposed as a potential contributor to RLS symptoms. However, current evidence for magnesium supplementation remains limited and inconclusive. This article examines the scientific basis for using magnesium in RLS, practical guidance on supplementation, and evidence-based treatment options recommended by NICE and UK clinical guidelines.

What Is Restless Legs Syndrome and How Does It Affect You?

Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a neurological condition characterised by an overwhelming urge to move the legs, typically accompanied by uncomfortable sensations. These sensations are often described as crawling, tingling, burning, or aching deep within the leg muscles. The condition predominantly affects the lower limbs, though arms can occasionally be involved.

Symptoms typically worsen during periods of rest or inactivity, particularly in the evening and at night. This circadian pattern can severely disrupt sleep quality, leading to daytime fatigue, reduced concentration, and impaired quality of life. Many patients report that movement—such as walking, stretching, or rubbing the legs—provides temporary relief, though symptoms return once movement stops.

Key features of RLS include:

• An urge to move the legs, usually accompanied by uncomfortable sensations

• Symptoms that begin or worsen during rest

• Partial or complete relief with movement

• Worsening of symptoms in the evening or night

Up to 7–10% of the UK population report RLS symptoms, with moderate to severe cases affecting approximately 2–3%. Women are twice as likely to develop the condition as men. Primary RLS has no identifiable cause and often runs in families, whilst secondary RLS may be associated with iron deficiency, pregnancy, chronic kidney disease, or certain medications.

It's important to distinguish RLS from other conditions that cause leg discomfort, such as night cramps, peripheral neuropathy, or vascular disease. Seek prompt medical advice if you experience marked asymmetry of symptoms, severe pain, muscle weakness, swelling, or other neurological symptoms, as these may indicate a different condition requiring specific treatment.

Can Magnesium Help with Restless Legs Syndrome?

Magnesium is an essential mineral involved in over 300 enzymatic reactions in the body, including nerve transmission, muscle contraction, and neurotransmitter regulation. The theoretical basis for magnesium supplementation in RLS stems from its role in modulating neuronal excitability and muscle relaxation. Magnesium deficiency has been proposed as a potential contributing factor in some cases of RLS, though there is no official link definitively established between low magnesium levels and restless legs syndrome.

The current evidence base for magnesium supplementation in RLS remains limited and inconclusive. Small observational studies and case reports have suggested potential benefit in some individuals, particularly those with documented magnesium deficiency. However, large-scale, high-quality randomised controlled trials are lacking. Systematic reviews of complementary therapies for RLS have found insufficient evidence to recommend magnesium as a standard treatment.

NICE guidance and the NICE Clinical Knowledge Summary (CKS) for restless legs syndrome do not currently include magnesium supplementation as a recommended intervention. The evidence is considered too weak to support routine use. That said, some clinicians may consider a trial of magnesium supplementation in selected patients, particularly when:

• Serum magnesium levels are low or borderline

• Conventional treatments are contraindicated or poorly tolerated

• Symptoms are mild and the patient prefers to try non-pharmacological approaches first

If you are pregnant or breastfeeding and experiencing RLS symptoms, consult your midwife or GP before taking any supplements, including magnesium. It is important to note that any perceived benefit may be due to placebo effect, and magnesium supplementation should not delay appropriate investigation (particularly for iron deficiency) or evidence-based treatment for moderate to severe RLS.

How to Use Magnesium for Restless Legs: Dosage and Forms

If you and your healthcare provider decide to trial magnesium supplementation for restless legs, several formulations are available, each with different absorption characteristics and tolerability profiles. Magnesium citrate, magnesium glycinate, and magnesium malate are generally better absorbed than magnesium oxide, which has lower bioavailability and is more likely to cause gastrointestinal side effects.

Typical supplementation doses range from 200–400 mg of elemental magnesium daily, usually taken in the evening given the nocturnal nature of RLS symptoms. The UK Expert Group on Vitamins and Minerals sets a safe upper level for supplemental magnesium at 400 mg per day of elemental magnesium. It is essential to check the elemental magnesium content on supplement labels, as different formulations contain varying amounts. The elemental magnesium content varies significantly between products and formulations.

Forms of magnesium supplementation:

• Oral tablets or capsules: Most convenient and widely available

• Magnesium-rich foods: Dark leafy greens, nuts, seeds, whole grains, legumes, and dark chocolate

• Topical magnesium: Oils or creams applied to the skin, though scientific evidence for transdermal absorption is limited

• Epsom salt baths: Contain magnesium sulphate; anecdotal reports suggest benefit, but clinical evidence is lacking

Important safety considerations: Magnesium supplementation is generally well tolerated, but excessive intake can cause diarrhoea, nausea, and abdominal cramping. Start at a lower dose if you're sensitive to these effects. Individuals with chronic kidney disease should avoid magnesium supplements without medical supervision, as impaired renal function can lead to dangerous magnesium accumulation (hypermagnesaemia).

Magnesium can interact with certain medications. Take magnesium supplements at least 2–4 hours apart from:

• Bisphosphonates (osteoporosis medications)

• Certain antibiotics (tetracyclines, quinolones)

• Diuretics

• Levothyroxine

• Oral iron supplements

If you are pregnant or breastfeeding, consult your midwife or GP before taking magnesium supplements. Before starting supplementation, consult your GP or pharmacist, particularly if you have existing medical conditions or take regular medications. If symptoms do not improve after 4–6 weeks of supplementation, or if they worsen, seek medical review for alternative management strategies.

Report any suspected side effects from medicines or supplements via the MHRA Yellow Card scheme.

Other Treatment Options for Restless Legs Syndrome

Management of RLS should be individualised based on symptom severity, frequency, and impact on quality of life. NICE recommends a stepwise approach, beginning with identification and correction of contributing factors before considering pharmacological interventions.

Non-pharmacological measures form the foundation of RLS management and should be tried first for mild symptoms:

• Sleep hygiene: Maintain regular sleep-wake times and create a comfortable sleep environment

• Moderate exercise: Regular physical activity, particularly in the afternoon or early evening, may reduce symptoms

• Avoidance of triggers: Caffeine, alcohol, and nicotine can exacerbate RLS

• Leg massage and stretching: May provide temporary symptomatic relief

• Hot or cold compresses: Some patients find these helpful

• Mental alertness activities: Engaging the mind during periods of rest (e.g., puzzles, reading) may reduce symptom awareness

Investigation and treatment of underlying causes is essential. According to NICE CKS, all patients with RLS should have serum ferritin checked, as iron deficiency is a common and treatable contributor. NICE CKS recommends considering oral iron supplementation if ferritin is ≤75 micrograms/L. For ferritin levels between 75-100 micrograms/L, transferrin saturation may be considered. Review of current medications is also important, as certain drugs (including some antidepressants, antihistamines, and antipsychotics) can worsen RLS.

Pharmacological treatment is reserved for moderate to severe symptoms that significantly impact quality of life and have not responded to non-pharmacological measures. UK-licensed options include:

• Dopamine agonists (pramipexole, ropinirole, rotigotine): Licensed for moderate to severe primary RLS but carry risks of impulse control disorders and augmentation (worsening of symptoms with long-term use)

Other medications used (off-label) include:

• Alpha-2-delta ligands (gabapentin, pregabalin): Used off-label for RLS in the UK. The MHRA has issued safety warnings about respiratory depression, misuse/dependence risk, and CNS depression with these medications

When to contact your GP:

• Symptoms significantly interfere with sleep or daily activities

• Self-management strategies have been ineffective

• You experience sudden worsening of symptoms

• You develop new neurological symptoms

• You experience side effects from medications

Referral to a neurologist or sleep specialist may be appropriate for diagnostic uncertainty, atypical features, refractory symptoms despite optimised therapy, significant augmentation, or complex comorbidities. Regular follow-up is important to monitor treatment response and adjust management as needed.

Frequently Asked Questions