What It Means When You Have an MS Flare-Up

When you’re living with multiple sclerosis (MS), you probably already know that some days will feel better than others.

Unfortunately, part of living with MS is experiencing what healthcare providers call relapses and symptom fluctuations. Or what you might call MS flare-ups.

Often, people talk about MS flare-ups as if they’re one thing. But in reality, MS flare-ups can have different causes. And that can mean different things for your long-term health.

“Using terms like ‘flare-ups’ can be tricky because it means different things to different people,” says neurologist and MS specialist Robert Bermel, MD. “Some people talk in terms of flare-ups when they’re talking about a new MS symptom that is a sign of MS attacking a new area of the brain or spinal cord. Other people use it to describe good days and bad days with symptoms that come and go. And each of those situations calls for different management approaches.”

Understanding what’s really happening when you experience worsening MS symptoms is important to living well with MS.

Dr. Bermel explains how to know what’s behind your MS flare-up.

Types of MS flare-ups

You’ll typically hear about MS flare-ups described as a worsening of symptoms. That could mean that you experience symptoms where you hadn’t previously been affected. Or you could experience a worsening of your chronic symptoms.

During a flare, you might experience things like:

• Increased weakness or stiffness.
• Vision changes.
• More intense pain or discomfort.
• Numbness or tingling in areas of your body that had previously been unaffected.
• New or more pronounced difficulty with muscle coordination or balance.
• Fatigue.

The reason for your changing symptoms matters. Because some so-called flare-ups are likely to pass quickly. Others may signal that your condition is becoming more severe and that it’s time for a change to your MS management plan.

Dr. Bermel explains two situations that people tend to describe as MS flare-ups.

1. Symptom fluctuations

When people talk about MS flare-ups, they’re sometimes referring to fluctuations in their symptoms. That is, short-lived changes in how you feel and function. Though bothersome, these fluctuations, thankfully, aren’t associated with a change in how MS affects you long term.

“Symptom fluctuations are a worsening of your condition that comes and goes, without being related to new areas of inflammation in the nervous system,” Dr. Bermel explains. “They could last from a few minutes to a few days. But they’re not signaling a change in the severity of your MS.”

MS symptom fluctuations tend to happen in a pattern. Usually, a person with MS can learn what triggers might cause their own specific symptoms to worsen, sometimes in a predictable pattern.

“It’s common for patients to describe that if they are under stress or if they get sick, their MS symptoms worsen. Another example of this could be that someone is walking for exercise and notices that their foot drop worsens at a predictable point in their walk each time. Then, they rest and it improves,” Dr. Bermel illustrates.

Common fluctuation triggers include:

• High levels of stress.
• Overexertion.
• Illnesses, especially with fever.
• Overheating, like spending time in a bath or hot tub.

“Heat causes nerve conduction to slow down a little bit. And that slowing can cause your condition to temporarily worsen. If heat is the cause, symptoms should improve when you return to a normal body temperature,” he continues.

2. MS relapse

Other times when people describe an MS flare, what they’re actually talking about is an MS relapse.

During a relapse, what’s actually happening is that your immune system is actively attacking a new area of your nervous system. That causes a new area of damage and the development of new lesions.

“The term ‘multiple sclerosis’ means ‘multiple scars.’ That means that people with MS have scars, or lesions, in their nervous system,” Dr. Bermel explains. “A person who is having an MS relapse has developed a scar in a new area because their immune system is attacking a new area of the body.”

If you have new or worsening symptoms, especially a symptom that you haven’t had before, that last more than a day and aren’t clearly related to illness, like a fever, you may be experiencing an MS relapse.

“Talk to your MS care team about any new symptom lasting longer than 24 hours,” Dr. Bermel advises. “Relapses are a signal to us that your condition isn’t under adequate control and we need to do something different to better manage your disease.”

MS relapses can leave new scars, or what Dr. Bermel describes as “footprints on your nervous system.” But with proper treatment, relapses can often be well-managed.

It’s rare for MS to require emergency medical treatment. Your MS neurologist should generally be able to handle most needs — including MS relapses — in the office. But it’s probably time to head to the ER if you’re having new difficulties with tasks like walking, eating, drinking or taking care of yourself.

Preventing MS flare-ups

Can you take steps to proactively manage your MS and limit flare-ups? Absolutely.

“We now recognize that wellness is an important contributor to prevent symptom fluctuations and relapses,” Dr. Bermel says.

His best advice? Exercise when you can. And balance activity with adequate rest.

“When you live with MS, you have a certain amount of fuel in your tank. And you need to be sure you’re taking time to refuel,” he adds. “We encourage all patients to exercise. But if on Friday night you’re going to your child's football game, you probably don’t want to exercise immediately before that. You need time to rest before and fuel up.”

Other tips for staying healthy and avoiding flare-ups:

• Don’t smoke.
• Stay hydrated.
• Get adequate sleep.
• Get regular exercise.
• Follow a healthy diet.
• Address other health problems, like high blood pressure, diabetes and high cholesterol — all of which can affect your MS.
• Get regular MRIs to monitor your MS.

“Achieving stability of the disease ― or what is called ‘no evidence of disease activity’ ― is now a realistic treatment goal,” Dr. Bermel says. “While current treatments can’t reverse the damage that’s been done, they can, when coupled with a healthy lifestyle, effectively stop the disease from worsening.”

Knowing what to expect from your MS and what steps you can take to manage it can make a dramatic difference in your life. Taking care of other health issues, reducing stress and knowing when to talk to your MS care team can help keep MS in check and keep you enjoying your life.