Does cold weather trigger an MS flare-up? Experts explain the real risk

Cold weather may amplify existing multiple sclerosis symptoms, but experts say it doesn't trigger new inflammation. Understanding the difference between pseudo-exacerbations and true relapses is key.

Cold mornings, stiff muscles, and sudden dips in energy are familiar winter hurdles, but for people living with MS (multiple sclerosis), the season can feel especially challenging. As temperatures drop, many report worsening symptoms. But does cold weather actually trigger an MS flare-up? Experts emphasise that while the cold can amplify pre-existing symptoms, true relapses are usually linked to infections rather than the weather itself.

 

How do low temperatures amplify MS discomfort?

 

Multiple sclerosis is a chronic neurological condition in which the immune system mistakenly attacks the protective (myelin) covering of nerve fibres, disrupting communication between the brain and body. Cold temperatures can have a noticeable effect on people with MS, largely because their nerve pathways are already damaged. 

“Exposure to low temperatures may worsen mobility, increase stiffness and amplify nerve pain due to impaired signal transmission in already-affected nerves,” explains Dr M V Padma Srivastava, Chairperson, Neurology department, Paras Hospital, Gurgaon.

Shorter daylight hours and winter sleep disruptions also intensify fatigue, one of the most disabling MS symptoms, she adds.

 

Dr Vinit Banga, Director, Neurology, Fortis Hospital, Faridabad, echoes this, "Cold slows nerve conduction, reduces blood flow and heightens muscle rigidity." Muscles tighten and the body spends extra energy maintaining warmth, all of which can worsen pre-existing symptoms.

 

What is the difference between pseudo-exacerbations and true relapses?

 

Both experts emphasise that cold weather itself does not cause true MS relapses.

Low temperatures can trigger pseudo-exacerbations or temporary worsening of symptoms due to slowed nerve signalling. These improve once the body warms up.

 

“True relapses involve new or worsening symptoms driven by underlying inflammation,” says Dr Padma Srivastava. Cold does not spark this inflammation, but infections prevalent during the season can trigger genuine relapses. These flare-ups clear out once the infection is treated with the right medication.

 

Dr Banga adds, “A true exacerbation lasts longer than 24-48 hours, with new or definitely worse neurological deficits, and cannot be explained by cold exposure, infection or fatigue.”

 

When should someone with MS seek medical help?

 

Experts advise watching for:

• Symptoms lasting over 24 hours
• New neurological deficits
• Fever or signs of infection
• Progressive weakness, new vision loss or significant sensory changes

If symptoms clearly improve with warming or rest, they are likely temperature-related rather than a true relapse.

 

How can MS symptoms be managed during winter?

 

Layered, thermal clothing, insulated gloves and moisture-wicking fabrics help maintain stable body temperature. Indoor spaces should be kept uniformly warm.

 

Dr Srivastava recommends measures such as light cardio, dry brushing and warm baths to maintain healthy blood flow. Immediate temperature swings should be avoided.

 

To ease stiffness, Dr Banga suggests gentle stretching, low-impact exercise and warm-up routines. Use of heating pads and adequate hydration can also bring relief.

 

Clinicians may adjust medication, recommend physiotherapy and advise vitamin D supplements if levels dip in winter. Staying consistent with disease-modifying therapies remains crucial to reducing relapse risk year-round.

 

What do experts want people with MS to remember?

 

As winter sets in, experts say the key is understanding that cold weather may intensify symptoms, but it does not directly cause MS flare-ups. With the right precautions, most individuals can stay warm, stable and active through the season.