Multiple Sclerosis (MS): 4 Triggers That Can Make Symptoms Worse

Most people living with multiple sclerosis (MS), a condition that affects the central nervous system, experience periods of acute symptoms, called relapses or flares. During an MS flare, existing MS symptoms can worsen or new ones can appear.

Common symptoms of MS can include fatigue, balance problems, vision changes, numbness, and weakness. These episodes are unpredictable and not fully avoidable, but there are ways to lower your risk of having one.

"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," says Devon Conway, MD, a neurologist at the Mellen Center for Multiple Sclerosis at Cleveland Clinic in Ohio.

There’s another category of recurring symptoms known as pseudoexacerbations, which is worsening symptoms that clear up in less than 24 hours. While the flares are real, there is no new damage being done to the central nervous system.

Relapses can vary from mild to severe, and they’re caused by inflammation in the central nervous system. They can be triggered by both medical and environmental factors. At their worst, flare-ups may require hospitalization, but most can be managed at home with support from your healthcare provider.

“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.

MS relapses and stress can have a bidirectional relationship, which means stress may contribute to the development of a relapse and an MS relapse may also cause stress.

“Patients can dismiss stress, but it’s another condition, like high blood pressure or diabetes or obesity; it can impact all aspects of your health and it should be attended to,” Dr. Fox says.

• Open up to friends or family about your worries.
• Stay active.
• Plan ahead and prioritize tasks to make them more manageable.
• Try relaxation or mindfulness techniques, like mediation, yoga, or deep breathing.
• Consider cognitive behavioral therapy.

While no one likes being sleep deprived, it can be an even bigger issue for people with MS, says Dr. Conway. "Most people with MS have a lower reserve of energy," and a lack of sleep can worsen MS symptoms, he says.

In some cases, sleep difficulties for people with multiple sclerosis may be due to an underlying sleep disorder, such as obstructive sleep apnea, says Scott Ireland Otallah, MD, a neurologist who specializes in multiple sclerosis at Atrium Health at Wake Forest Baptist in Winston-Salem, North Carolina. He says if a sleep disorder is suspected, getting it diagnosed and treated will reduce the likelihood of a relapse.

"UTIs are common causes, because some people with MS have reduced bladder function," says Conway. But he says any type of infection that weakens the immune system, like a cold or the flu, can also cause a flare.

"In the old days, a hot-bath test was one of the ways doctors diagnosed MS," says Matthew McCoyd, MD, a neurologist and an associate professor with the Loyola University Health System in Illinois. The person with MS was immersed in hot water, and if their neurological symptoms appeared to worsen, it was considered evidence they had MS.

“Getting into air-conditioning, taking a cool shower, or wearing a vest filled with cooled water usually helps reduce heat symptoms,” says Otallah.

Not all these symptoms may be caused by MS. If you experience symptoms that concern you for any reason, discuss it with your doctor to help find a solution.

The Takeaway

• Multiple sclerosis relapses, also known as flare-ups, are new or worsening neurological symptoms that last for at least 24 hours. They can’t be completely prevented, but there are situations that may trigger flares and make symptoms worse.
• Triggers can be both medical and environmental and can include balance problems, numbness, and weakness. Stress, lack of sleep, infections, and hot temperatures can all trigger symptoms.
• You can prevent flare-ups by taking steps to avoid these situations. Severe MS symptoms may indicate that you’re having a relapse, and your doctor may treat you with steroids to reduce its duration and severity.