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Recognizing and Avoiding MS Triggers to Prevent Exacerbations

Recognizing and Avoiding MS Triggers to Prevent Exacerbations

I remember the feeling of having a terrible cold or flu before I had multiple sclerosis (MS). The stuffy nose that made breathing nearly impossible. That elusive tickle in the back of my throat combined with a hacking cough.

Cold and flu season is a miserable time, and I never would have imagined it could become worse. But add MS in the mix and it becomes an entirely different ballgame.

I always know when I am getting an illness because my MS symptoms gradually become more intense. My already difficult walking becomes more labored and my legs seem heavier. The spasticity in my arms and legs elevates to a new height, and my brain fog gets even thicker.

Last week, I had a terrible cold, the kind where it’s hard to move or even get out of bed. It was an MS cold, and I felt its effects in every inch of my body. The cold virus sent my MS into a full-blown exacerbation. My body was fighting dual enemies — the MS and the virus — and I could feel every attack.

“What can I do to stop the triggers that bring me such pain?” That question sent me in search of answers. What I found were things to avoid and precautions to take — common sense antidotes that we probably all are aware of, yet occasionally need reminding of.

Connect with other patients and share tips on how to manage MS in our forums!

The Cleveland Clinic reminds us to keep our stress under control, as it is a major trigger that can cause a flare-up at any time. Other exacerbation risk factors include smoking, heat, certain medicines, taking too many medicines, and stopping MS medications. The triggers that stood out to me the most on the list were fatigue and infection.
I have a lot of MS-related fatigue, but I never thought of it as being a flare-up trigger. The clinic notes that because MS patients have such low energy already, not getting enough sleep can trigger an exacerbation. According to the clinic’s website, “You have to eat a nutritious diet, get some exercise every day and get plenty of sleep every night to counter that MS fatigue.”
Another trigger is infection. The clinic says that nearly one-third of MS exacerbations are caused by infections. This is a high-risk category due to frequent bladder issues and urinary tract infections that can come with MS. Colds and the flu also are potential catalysts for flare-ups, and frequent hand-washing, avoiding sick people, and getting an annual flu shot are recommended.
One thing I found very interesting was the statement that, “Minor symptoms such as fatigue, tingling or slight confusion usually disappear on their own, once you remove the trigger.” For larger issues, treatment by a doctor is recommended.
It is always best to be aware of what triggers an MS exacerbation so that you can work on avoiding or removing the problem at its source.
What have you discovered about your triggers? Join us in the MS forums to discuss this topic further.


Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.

Debi is a retired admissions and marketing director residing in Oregon. She is a mother of three grown children and has three grandchildren. She was diagnosed with PPMS in 2010. With her column, “Faith of the Mustard Seed,” she hopes to help and inspire others who are also dealing with MS.
Debi is a retired admissions and marketing director residing in Oregon. She is a mother of three grown children and has three grandchildren. She was diagnosed with PPMS in 2010. With her column, “Faith of the Mustard Seed,” she hopes to help and inspire others who are also dealing with MS.
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  1. Martin Matko says:

    When the cause of so called Multiple Sclerosis is eliminated the need for preventing exacerbations will be gone!!!!! #CCSVI

  2. R Doll says:

    I’ve read similar accounts and have to ask clarifying questions…are you speaking of “pseudo-exacerbation” which are effectively the onset and intensification of underlying issues/symptoms brought about by inflammation and/or Uthoff’s phenomenon-related heat intolerance…or are you speaking of demylination of nerves brought about by your body attacking itself; leading to permanent, irreversible damage in the classic definition?

    I ask this as when I have any fever or infection or even just not feeling well in that my internal core body temperature is elevated, my symptoms intensify. The damage is there, but without inflammation, symptoms are less severe.

    The most serious example for me, and terrifying in many ways, was a nighttime fever I had a couple of years ago. I was in my upper 40’s and woke up to a fever slightly over 100 and getting worse…my wife wanted me to go to the ER and I told her that if she did, to call an ambulance because at that time, I could no longer stand much less walk. Several Ibuprofen and a couple of hours later, I was recovered and went in to work that morning…a most bizarre experience and I really don’t know what triggered the fever…it came and went. During the height of the fever, I was all but incapacitated.

    Inflammation is the key for what I now know as “pseudo exacerbation” and I am very susceptible to Uthoff’s. As time has progressed, my disability has progressed too…often without the dramatic flare ups though I have not transitioned to secondary progressive…and hopefully won’t. Much to understand and learn. Diet is key to managing inflammation as well though like most people, managing a healthy diet is difficult at best and most serious to me, as disability increases, exercise decreases which compounds the struggle.

    • Debi Wilson says:

      Hi R.Doll,
      All of the examples you mentioned would classify. Anything that sets off an MS exacerbationis is considered a trigger. Thanks for your questions and comments! Debi

          • Jennifer Bodurtha says:

            I have had MS for 30 years and have minimal disability. I credit diet and vitamin D. Read and follow Dr IRA Swank’s MS diet book.Talk to your neurologist first. I took too much D and it effected creation of a kidney stone. Don’t feel it, tho, but believe that the cure will include vitamin D somehow!

  3. Jennifer says:

    I sent a comment earlier and perhaps is being evaluated. Anyway, another key is keeping saturated fat to under 10 grams/day. Very doable!

  4. itasara says:

    I was dx’d 12+ years ago. I have been on Copaxone only for all that time. I don’t have flu symptoms and other than occasional site itching, and unfortunate skin atrophy which will never go away, I don’t have any other side effects from medications. I do take a LOT of supplements b/c I try to follow a low carb lifestyle and not sure I get all the nutrients from diet. I don’t worry about saturated fat too much; I don’t eat all that much fat put it has 0 calories so in my book it doesn’t count. I did lose a lot of weight and I keep it off by watching carbs. I eat Eggs, dairy, vegetables. Due to silent acid reflux I’ve been told to avoid certain foods which really puts a cramp in my style! Most all the articles I read say that diet has little if anything to do with MS but a health diet is good for everyone. It is my theory (and I may be wrong) and I’ve read this in a couple of places that there may actually be different types of MS mild, for example, that is am entity in itself so that it won’t become another form like progressive. I can only hope that is true for me. Maybe it would have made no difference had I not spent thousands of dollars on medications, but then I wasn’t willing to take that chance. I’m 70 now and I can only hope I won’t get worse. Time will tell.

    • Debi Wilson says:

      Hi Itasara!

      Thank-you for your comments! I too agree that diet is very important for MS and it’s symptoms! Best to you, Debi

  5. Michelle says:

    I think you need to be more careful and clear in your language choices and this is so critical for the whole community as it perpetuates the confusion that’s out there. For example, you say “the cold sent my MS into a full blown exacerbation”. Exacerbation, flares, relapses – without clear and consistent usage of these terms we won’t help others. After reading your article several times I still don’t know if you’re talking about a pseudo relapse where old symptoms flare and you feel bad but it won’t hurt you long term , or an actual relapse, where a cold triggers immune response and then triggers disease progression with further and new demyelination? The latter is much more serious and requires steroids and other intervention as well as has the potential for permanent disability.
    This is what scares many most about catching a cold – the risk of the illness triggering further disease progression . While a temporary increase in symptoms obviously feels terrible and disrupts quality of life temporarily, it’s not cause for WORRY.
    I know I would appreciate it if you clarify and hope that you as well as others be more careful with language in this area.

  6. Debi Wilson says:

    Hi Michelle,
    I understand what you are saying and I will clarify my position. This is how the National Multiple Sclerosis Society (NMSS) classifies exacerbations, attack’s flare-ups and relapses. “An exacerbation of MS (also known as a relapse, attack or flare-up) causes new symptoms or the worsening of old symptoms. It can be very mild, or severe enough to interfere with a person’s ability to function at home and at work. No two exacerbations are alike, and symptoms vary from person to person and from one exacerbation to another.”
    It is very clearly stated, that exacerbations, flare-ups, attacks, and relapses are all words used to describe the same occurrence. The difference is in the severity of each occurrence and each is different from person-to-person. You are correct that I could of stressed more about the different severity levels of exacerbations. I also could have added that my enhanced MS symptoms lasted more than 24 hours. Which on one site suggested a real MS flare-up.

    I wrote my article about my experience, I described how my body felt and reacted to an attack from an outside source. That was the main focus of my article, to be aware and avoid the triggers that can send MS into an exacerbation (flare-up, attack or relapse).
    There is no way of knowing if my relapse caused my body more damage, not without a comparison MRI.
    I always look for more ways to be more helpful to my readers, so I truly appreciate your comments. Best to you,Debi

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