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What to Do When Your MS Relapses

By Beth W. Orenstein
Reviewed by Dana Cooper, M.D.
July 05, 2022
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When you have multiple sclerosis (MS), you can be feeling pretty good one day, and the next, notice your symptoms starting to flare. As many as 85% of people with MS have what’s known as relapsing-remitting multiple sclerosis (RRMS), according to the National Multiple Sclerosis Society. This is especially common for people early in the course of the disease.

As its name suggests, RRMS is characterized by going from periods of relapse followed by periods of remission and back again. A relapse is when symptoms worsen (or new symptoms appear), and remission is when symptoms improve, either going away completely or partially.

MS relapses are also called exacerbations, attacks, flares, or flare-ups. Most people find that relapses develop slowly over two to three days and reach a peak after several days. To be considered an MS relapse by the medical community, a flare must:

  • Last at least 24 hours
  • Have no other potential causes, such as an infection
  • Take place at least 30 days after the last relapse

Each time you experience an MS flare-up, it can be different. You may experience a single symptom (such as trouble seeing, fatigue, or lack of balance), and sometimes you may experience two or more.

Common MS Relapse Symptoms

While everyone’s symptoms and experience are unique to them, some of the more common symptoms of an MS relapse, according to the Multiple Sclerosis Association of America, are:

  • Muscle weakness, muscle spasms, or stiffness
  • Painful sensations or numbness
  • Vision changes
  • Memory problems or inability to focus
  • Difficulty walking or balance problems
  • Fatigue

What Causes MS Flare-Ups?

“We don’t know for sure [what causes relapses],” says Peter A. Calabresi, M.D., director of the Multiple Sclerosis Center and professor of neurology at the Johns Hopkins School of Medicine. “But infections and stress can possibly be triggers of the immune system,” which is important to note because MS is an autoimmune disease.

An autoimmune disease is when your body mistakes its own cells as an invader and sends out an attack. With MS, the body’s immune system mistakenly attacks myelin, which is the protective coating around nerve fibers in the central nervous system (which includes the brain, spinal cord, and optic nerves).

What to Do First When You’re Relapsing

If you think you’re having a relapse, the first thing you should do is call your neurologist. “You need to be evaluated to confirm that it is a relapse,” says Jacqueline A. Nicholas, M.D., system chief of neuroimmunology and multiple sclerosis at OhioHealth Multiple Sclerosis Center and adjunct assistant professor of neurology at Ohio University College of Medicine and University of Toledo College of Medicine.

“People with MS can sometimes feel they are having a relapse when their chronic symptoms increase in the setting of a fever, infection, or being overheated,” Nicholas says. “It is called a pseudo-relapse when this occurs, and if the offending cause is removed—for example, they get treatment for the infection such as a UTI [urinary tract infection], or they avoid being overheated—then the symptoms resolve.”

Treatments for MS Relapses

If a true relapse is confirmed by a doctor, it may or may not need to be treated. This is often the case if your sensory symptoms are mild. For example, if you develop numbness or changes in sensation, or if you feel fatigued but are still able to carry out your daily activities, it may be more annoying than problematic. In these cases, your doctor may suggest you let these symptoms improve on their own.

However, if your MS exacerbations are severe—for example, you can’t see, or your lack of balance is causing you to fall—you’ll likely need some intervention.

Very often, the solution is a round of high-dose steroids, Nicholas says. “These can be oral or intravenous.” Steroids help to calm the new inflammation and speed up recovery, she explains.

If steroids aren’t helping, the next step could be a treatment called plasmapheresis. “This is where a special machine helps to filter out your plasma [a part of the blood], which contains pro-inflammatory particles to allow for the inflammation to calm down and your body to heal,” Nicholas says. “This treatment is often done every other day for a total of five treatments.”

Another treatment option for MS relapses is the adrenocorticotropic hormone (ACTH), which was approved by the U.S. Food and Drug Administration in the late 1970s as a short-term treatment for acute MS flares.

No studies show that patients respond better to ACTH than they do to corticosteroids, so this treatment option became less popular for some time. However, interest in ACTH was recently renewed, and studies are underway investigating whether it should be used again. Drawbacks are that it’s costly and may be hard to find, but it may be an option for people who can’t tolerate steroids.

It’s important you comply with your MS treatment to minimize symptoms from previous relapses and prevent future ones. That means taking any medications, such as disease-modifying therapies, as your doctor has directed you to.

Rehabilitation for MS Relapses

Many patients find that rehabilitation helps them to restore or maintain functions they had before their flare-up. There’s a wide variety of rehab options for people with MS, depending on the symptoms they’re experiencing.

“Physical, occupational, and even speech therapy can be incredibly important following a relapse to help you adjust to the new neurologic change and work to improve function as much as possible after a relapse,” Nicholas says. Physical therapy also can help to reduce muscle spasms. Talk to your doctor about what rehab and therapy options might be right for you.

Managing MS Relapse Triggers

“Avoiding triggers is essential,” says Nada Abou-Fayssal, M.D., director of the NYU Langone Brooklyn Multiple Sclerosis Center. A trigger is a factor in your life that seems to exacerbate symptoms. Common MS relapse triggers include:


Angela Bradford, 38, of Edmonton, Alberta, Canada, who has been living with RRMS for more than two years, finds lowering stress helps her avoid relapses. “I stay physically active. I go to the gym for a little bit every day,” Angela says. “I do stretching every morning, so that’s been really helpful.”

She says starting her day by waking up early and meditating for 15 minutes, followed by her stretching routine, is calming and enables her to take on the demands of running her own business. To manage stress, you can try some popular techniques like yoga, tai chi, and deep breathing to see if they work for you.

High Temperatures

Warm weather won’t cause a relapse; nevertheless, many people with MS find their existing symptoms worsen when they get overheated. If this is the case for you, you can make an effort to avoid high temperatures and wear cooling scarves or vests when the weather heats up.

Inflammatory Food

“I look after my diet as best I can, as I find I feel better overall when I do," Angela says. She avoids inflammatory foods like sugary desserts, fried foods, and dairy to help keep her symptoms in check. It’s important for your overall health that you eat a nutritious, balanced diet, and you just might find it helps you manage your symptoms, too.

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