Photo by Max van den Oetelaar on Unsplash

Worried About MS Flares? 4 Triggers That Can Worsen Your Symptoms

Maintaining healthy habits and being aware of what can trigger a symptom flare can help you better manage your MS. I go out of my way to avoid MS exasperations (a cool word I learned upon diagnosis in 2001), don’t you?

If I surround myself with elements of calm, peace, positive people, and fun, the challenge of living with the MonSter is much easier to accept. Activities that soothe my soul include listening to music, camping, reading, knitting, writing, and watching reality television (so I can laugh at mindless people dealing with mindless issues .)

Unfortunately life often interferes and we cannot always control our surroundings. That’s when we need to pay special attention to what the MonSter has in store.

According to Dr. Devon Conway, a neurologist at the Cleveland Clinic Mellen Center for Multiple Sclerosis, “When a new neurological symptom develops in multiple sclerosis, one that isn’t related to an infection and lasts for more than 24 hours, it is considered to be an MS relapse.” Although a relapse is the result of inflammation in the central nervous system and often followed by remission as the inflammation dies down, not every worsening symptom is a relapse. The Multiple Sclerosis Association of America states “When old symptoms reappear but subside within 24 hours, the episode is referred to as a pseudorelapse or pseudoexacerbation. While the cause of a relapse or pseudoexacerbation may not always be easily identifiable, there are some common triggers of both, says Matthew McCoyd, MD, a neurologist and associate professor with the Loyola University Health System in Illinois.”

Okay, that’s the technical portion of this post. Let’s get to the bones of the matter.

1. Stress

Photo by Anthony Tran on Unsplash

“I don’t know of a single medical condition that is not adversely affected by stress, and there is evidence that stress can worsen the symptoms and the disease of MS,” says Robert Fox, MD, a neurologist at the Mellen Center for Multiple Sclerosis at Cleveland Clinic.

As a member of the Human Race, stress is not an alien concept. We all experience it. At home, in the workplace, in the middle of the dairy aisle at Walmart. In the words of Forest Gump “S**t happens”. It very well may be out of your control, BUT you own your reaction to the situation. Quit blaming others. Stop lingering on the negatives. Some folks exist to be miserable. Don’t be one of them.

Face stress with a deep, cleansing breath, a moment of inner reflection, and a nod to the blessings that surround you.

Be in control.

Hey, I heard that! It IS that easy. Just make up your mind and thumb your nose at stress. It’s your choice.

Look for ways to alleviate stress. Be proactive.

The National MS Society recommends a variety of strategies to help manage stress levels: say no to things you don’t have the time or energy to do, and asking for help when you need it. Practice a relaxation technique such as deep breathing, meditation, or yoga.

2. Lack of Sleep

Photo by Megan te Boekhorst on Unsplash

There are many reasons why restful sleep may be a problem. Remember, we’re talking about a MonSter that sabotages good intentions. “Getting enough restful sleep can be challenging when you have MS. Pain, restless legs, urinary or bowel symptoms, or temperature dysregulation are some of the top symptoms that can interfere with nightly z’s”, according to the National MS Society.

Because most people with multiple sclerosis have a lower reserve of energy, sleep deprivation can be HUGE.

A 2018 review of studies published in Current Neurology and Neuroscience Reports found significant associations between sleep disturbance and cognitive dysfunction in MS. Objective sleep measures (performed at a sleep lab rather than self-reporting) generally predicted objective impairments in processing speed and attention, according to the analysis.

Try keeping a regular bedtime schedule. Limit alcohol consumption. Drink less fluid new bed time inn order to decrease midnight bathroom interruptions. Lifestyle modifications are controllable and free.

I try to read a few pages of whatever before extinguishing my bed side light. That usually helps me grow drowsy.

3. Common Infections

Photo by CDC on Unsplash

Infections can cause an MS symptom flare.

Urinary tract infections (UTIs) are common in for MS Warriors. Our bladders don’t function well. I know, I know, preaching to the choir.

But, it’s true. What is the first service you look for upon entering a new space? Yep, the loo. If I cannot identify bathroom locations I do not visit that space.

Any type of infection that weakens the immune system, like a cold or the flu, can cause a flare. “Some research suggests that relapse occurs in an estimated 30 percent of people with MS after an upper-respiratory infection”, according to a review published in Frontiers in Immunology.

The National MS Society recommends that “people with MS receive influenza and other vaccines according to standard vaccine guidelines. This guidance extends to the COVID-19 vaccine and booster.”

4. Summer Heat

Photo by Pawel Czerwinski on Unsplash

Do you wilt in the sun’s heat?

Increased body heat is a common trigger for MS Warriors, me included. “In the old days, a hot-bath test was one of the ways doctors diagnosed MS,” notes Dr. McCoyd. “The person with MS was immersed in hot water, and if their neurological symptoms appeared to worsen, it was considered evidence they had MS.”

(Kind of sounds like the Salem Witch Trials, doesn’t it? Have you read the history of MS? Welcome to the Coven! Can I interest you in some electrotherapy?)

Temporary worsening of neurological function in MS caused by increased core temperature is commonly called Uhthoff’s phenomenon. An elevation of just half a degree or more of body temperature can make those old MS symptoms come out.

Air-conditioning, taking a cool shower, staying hydrated, or wearing a vest filled with cooled water usually helps reduce heat symptoms.

I know that cold temperatures can also trigger MS symptoms, but that has not been true for me so far. Please feel free to share your own temperature challenges.

When to Treat MS Flares

Not all MS symptoms need to be treated. Tingling, fatigue, and mental fog generally go away on their own once the trigger is removed or an infection clears up.

However, more severe MS symptoms that affect your ability to function normally, such as severe weakness, poor balance, or loss of vision, may indicate that you’re having a relapse, and your doctor may recommend treatment with steroids to shorten the duration and severity of the exacerbation, according to Johns Hopkins Medicine.

And keep in mind that not all symptoms are caused by MS. If you’re experiencing symptoms that are concerning you for any reason, let your doctor know what’s going on. That way, you can figure out together what to do next.

Basically, the MonSter is a unique and individual challenge. We are all different while living with a common truth. We have multiple sclerosis.

As a community of like-minded Warriors, we live day in and day out with this horrible MonSter. Let’s adopt a positive mindset in our collective effort to battle this silent beast.

Take care,

Lisa, Lady With the Cane

20% of all sales is donated to the NMSS



Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store


July 1, 2001, six months after the birth of my only child, I was diagnosed with multiple sclerosis.