Tingling that wakes you at night usually has a simple explanation and a simple first treatment. A free ten-minute check to find out whether yours is one of those.
Tingling, prickling and pins and needles have a medical name — paraesthesia. Most of the time the cause is a squashed nerve, a vitamin deficiency or a medicine, and most of the time it can be sorted out.
The check asks which fingers, which time of day, and one or both sides. Those three answers narrow it down more than any scan.
Tingling or numbness that comes on suddenly and affects the face, arm and leg on the same side is treated as a stroke until proven otherwise.
Source: NHS FAST stroke pathway · NICE NG128
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Carpal tunnel syndrome happens when the median nerve is squeezed at the wrist. The pattern is very recognisable:
The first treatment NICE recommends is a wrist splint worn at night, which keeps the wrist straight while you sleep. It is simple, cheap and works for a lot of people.
It is more common in pregnancy, in an underactive thyroid, in diabetes, and in rheumatoid arthritis — so those get checked too.
Source: NICE CKS Carpal tunnel syndrome — night splinting as first-line
Phalen’s test. You hold the backs of your hands together with your wrists bent for about a minute. If it brings on your tingling, that supports the diagnosis.
Tinel’s test. The neurologist taps over the front of your wrist. A tingling shock into the fingers points the same way.
Both need a clinician’s hands and eyes, so they are part of the in-person appointment.
Before anyone refers you for surgery, nerve conduction studies confirm the diagnosis and show how badly the nerve is compressed. That result determines whether an injection or an operation is the better option.
Source: NICE CKS Carpal tunnel syndrome — nerve conduction studies before surgical referral
Topiramate is used for migraine prevention and for epilepsy. Tingling in the hands and feet is one of its most common side effects, and it is frequently mistaken for carpal tunnel syndrome or nerve damage.
The giveaway is the pattern: both hands and both feet, roughly equally, starting some weeks after the medicine was begun or the dose was raised.
Recognising it avoids a round of scans and nerve tests that were never going to show anything.
Do not stop topiramate on your own — stopping suddenly can trigger a seizure in people taking it for epilepsy. Speak to your prescriber.
Source: BNF (topiramate — paraesthesia) · MHRA Drug Safety Update
When it is symmetrical and it started in the toes, it is more likely to be a general nerve problem than a trapped nerve. The usual causes are low vitamin B12, diabetes, an underactive thyroid, and alcohol.
Low B12 is worth singling out. It is common in people taking metformin or long-term stomach acid tablets, and in people who eat little or no animal food. It is easy to test for and easy to treat, and treating it early prevents lasting damage.
Source: NICE CKS Neuropathy · NICE NG97 (B12 screening)
Lhermitte’s sign. Bending your chin to your chest triggers a brief electric shock feeling down your spine.
Uhthoff’s phenomenon. Your symptoms get worse in the heat — a hot bath, hot weather, or after exercise — and improve when you cool down.
Tingling that affects a whole limb or a band across the trunk, that lasts weeks, or that comes with problems with your vision or your bladder, also points away from a simple trapped nerve.
These are not emergencies, but they are reasons to see a neurologist rather than wait.
Source: NICE NG220 (multiple sclerosis in adults)
We ask about mood, memory, motor skills, and sensory changes to tailor your diagnosis and treatment.
Video appointments start at £399
and include a medication review and blood tests. In-person appointments include Phalen’s and Tinel’s testing, and a night splint is included in the Bronze package.