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7 Common MS Triggers and How to Avoid Them

By Beth W. Orenstein
Reviewed by Dana Cooper, M.D.
May 13, 2024
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If you have relapsing-remitting multiple sclerosis (RRMS), you’re probably well aware that symptoms can come and go. People can have relapses and periods of remission. Even during periods of remission, pseudo-relapses can occur.

A relapse is a new attack of inflammation that occurs somewhere in your nervous system, says Michael Kornberg, M.D., a board-certified neurologist at Johns Hopkins Medicine, in Baltimore. The goal of disease-modifying drugs is to reduce new attacks of inflammation, so work with your doctor to determine the best treatment for you and your symptoms. Then, stick with that regimen, checking in regularly with your doctor to see whether it needs tweaks now and then, Kornberg says.

Even if you’re on disease-modifying medication, you may develop new symptoms (relapse) or a worsening of your preexisting symptoms (pseudo-relapse). While some flares don't have a clear cause, others can be triggered by certain environmental and lifestyle factors. To help prevent or reduce the symptoms of future flare-ups, here are common MS triggers to watch out for.

1. Lack of Sleep

When you have multiple sclerosis, it’s important to get plenty of good rest. Being overtired is an MS trigger because your immune system has to work harder, which could lead to a relapse. Poor sleep can also lead to more noticeable pain, fatigue, anxiety, and cognitive dysfunction in people with MS.

Here’s how to set yourself up for better sleep:

  • Establish sleep and wake routines. Go to bed around the same time every night. Set the alarm for the same time every morning, even days off.
  • Clear your head. Before plopping into bed, write down your worries and leave them on the paper next to your bed until morning.
  • Avoid stimulants. Abstain from caffeine and alcohol during the four to six hours before bedtime.
  • Limit fluids. Don’t drink anything in the hour or two before bed so you’re not traipsing to the bathroom at all hours of the night.
  • Don’t toss and turn. If you can’t fall asleep within 20 minutes, get up and find an activity that will help you to relax, such as reading, listening to soothing music, or watching an old movie.

If you’re consistently having trouble sleeping or are always waking up exhausted, talk to your doctor about testing for sleep disorders such as obstructive sleep apnea. If you’re interested in medication, talk to your doctor about what options may be right for you. Sleeping pills are sometimes better used as a last resort, since they can lose their effectiveness over time and you could become dependent on them.

2. Poor Diet

It’s important to watch your diet and maintain a healthy weight, as poor nutrition and weight gain can make it more difficult for some people to control their symptoms, Kornberg says. And while there’s no single get-well diet to sidestep this MS trigger, an overall healthy diet is important for everyone—especially those with a disease such as multiple sclerosis.

The National Multiple Sclerosis Society (NMSS) recommends a diet rich in colorful fruits and vegetables and whole grains, and low in processed and sugary foods. Getting plenty of vitamin D also may be helpful. While research is still ongoing, some findings suggest that higher levels of vitamin D in the blood may be associated with less disease activity.

Good food sources of vitamin D include:

  • Oily fish, such as rainbow trout, herring, tilapia, and sardines
  • Dairy and vitamin-D fortified options such as soy beverages, fat-free milk, kefir, and American cheese
  • Certain fruits and vegetables such as raw mushrooms and fortified orange juice

Getting enough vitamin D from your diet alone can be difficult, however, so your doctor may recommend that you take a supplement if they’re concerned about a vitamin D deficiency.

3. Overdoing It

Overtaxing yourself physically can put stress on your body that can cause symptoms to flare, Kornberg says. Don’t be afraid to ask for help with everyday tasks so you can avoid overdoing it.

Work with a physical therapist or occupational therapist who can teach you stretching and strengthening exercises that can help make physical activities easier. They can also offer devices to use that can make it easier for you to perform tasks like folding laundry and preparing meals. Don’t be afraid of using mobility aids to prevent problems with your gait if that’s an issue for you when symptoms act up.

4. Getting Sick

“Anything that activates the immune system can trigger an MS flare,” says David Irani, M.D., a board-certified neurologist, professor of neurology at the University of Michigan Medical School, and director of the Multiple Sclerosis Clinic at University of Michigan Health in Ann Arbor.

While a true MS relapse is defined by new neurologic symptoms that are not related to fever or infection, an infection may trigger an immune response and result in a relapse. Pseudo-relapses can also be directly linked to infections. A sinus infection, a bladder infection, a cold, or the flu—“any of these can tax your system and can cause dormant symptoms to be unmasked,” says Meghan Beier, Ph.D., a neuropsychologist at Johns Hopkins Medicine who treats people with MS.

Irani says that even though immunizations can occasionally precede a new relapse, it’s critical that people with MS keep up with their vaccinations, too. That includes an annual flu shot and the coronavirus vaccines, Irani says. Don’t forget other mainstays of avoiding common illnesses: washing your hands frequently, avoiding close contact with others who are sick, and getting adequate sleep.

5. Getting Overheated

Lots of people with MS find their symptoms worsen, at least temporarily, when in hot and humid environments. According to the NMSS, even a slight rise in temperature—a quarter- to a half-degree—can be an MS trigger that causes symptoms to worsen. Most people will find their symptoms ease once they cool down, Kornberg says.

Use these strategies to help avoid overheating:

  • Stay where it’s cool. Take advantage of air conditioning and fans. Don’t go outside in the middle of the afternoon or if it’s really hot and humid. If you must go out, go when it’s cooler, usually in the early morning and evening.
  • Use products designed to keep you cool. These include cooling vests, neck wraps, and bandanas, especially when exercising or being active outdoors.
  • Drink up. Stay hydrated and sip iced drinks or suck on some popsicles.

Note: Some people with MS may also be sensitive to cold extremes. If you’re one of them, try to avoid going out when it’s extremely cold, too.

6. Smoking and Secondhand Smoke

Smoking can trigger the progression of MS for some people. People with MS who smoke tend to have more disease activity and increased disability, Kornberg says. Breathing in secondhand smoke also can cause symptoms to worsen. Smoking or exposure to secondhand smoke may disrupt your body’s ability to process certain MS medications, which could make them less effective, according to the NMSS.

If you smoke, do your best to quit. If you need help, reach out to resources such as your doctor,, or the quitline at 800-QUIT-NOW (800-784-8669).

7. Emotional Stress

Another common MS trigger is stress. Like fatigue, it can cause symptoms to worsen for some people. Tips for overcoming stress include:

  • Practicing yoga, deep breathing, or meditation, which can help relax your body and mind
  • Getting ample exercise, which can help release endorphins (feel-good hormones)
  • Setting priorities and practicing time management to avoid becoming overwhelmed
  • Spending time with your friends and loved ones
  • Making time for hobbies you enjoy

Find what works best for you. Beier also suggests working with a mental health provider if stress becomes overwhelming. Family counseling and/or individual therapy can help you figure out what stresses you out—and ways to avoid those things. Cognitive behavioral therapy (CBT) can also help some people to work through stress, Beier says.

Identifying Your MS Triggers

While these seven triggers are the most common, it’s important to remember that your own MS triggers may vary. Keep a diary to help you identify your triggers, if necessary. Once you have, try your best to avoid or manage those things that tend to make your MS symptoms worse.

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