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Top Multiple Sclerosis Triggers In the Community

While every person experiences multiple sclerosis (MS) differently, those living with the disease may share some common ground on what triggers their symptoms and how they cope.

We conducted our 2020 Multiple Sclerosis In America survey to learn more about what causes MS symptoms to flare up or worsen, or even leads to a relapse or exacerbation. Survey responses provided insight into the most common triggers and how people living with MS manage them.

Triggers are experienced by most people with MS

Nearly 93 percent of survey respondents were able to identify at least 1 trigger for their MS symptoms. Respondents named some external triggers that they have no control over, while other triggers seem to be manageable through lifestyle and behavioral changes.

Temperature and weather sensitivity are the most common triggers

The vast majority of respondents named heat as a trigger. Those living with MS say changes in weather and change in body temperature cause symptoms. To manage, respondents try to avoid heat while utilizing air conditioning, cooling towels, and cold showers. Although not as common as heat, cold was also recognized as a trigger.

  • 74 percent identify heat as a trigger
  • 30 percent identify cold as a trigger
  • Air conditioning, cooling towels, and cold showers are used to beat heat

High humidity and fluctuations in weather and barometric pressure were also noted as triggers by some survey respondents.

Stress and strong emotions also bring on MS symptoms

Managing stress and having an emotional outlet are important for the MS community, as more than 60 percent of respondents say stress and strong emotions provoke a worsening of their symptoms.

To stay ahead of their trigger(s), people with MS eliminate unnecessary stressors and make use of stress management tools. Stress management tools include:

  • Breathing exercises
  • Prayer
  • Meditation
  • Complementary therapies like CBD and cannabis
  • Medication
  • Avoidance of stressful situations

Lack of sleep and exhaustion are triggers for many

Getting enough sleep can be challenging, but it is necessary for those with MS. Fatigue and lack of sleep are common triggers in the MS community. 61 percent say lack of sleep or fatigue prompts symptoms. To stay well-rested and energized, those with MS:

  • Take naps
  • Prioritize relaxation time
  • Use medication
  • Exercise in moderation


Finding the right balance of movement and rest is not always easy. Sometimes pushing too hard can cause a flare-up. About 60 percent of survey respondents shared that over-exertion/physical activity causes symptoms.

Sickness and infection lead to symptoms flares

Warding off germs and staying healthy is one way people manage MS symptoms. Just over 40 percent say that getting the flu, a cold, or some type of infection sets off a flare-up. Survey respondents say they stay healthy by:

  • Getting enough rest
  • Diet and exercise
  • Practicing stress management

Noise and crowd control are triggers for some

Some people living with MS experience sensitivity to sound. Loud noises and large crowds can be overwhelming for those with a compromised central nervous system. A loud or sudden noise that is quickly forgotten by most can be painfully aggravating for those with MS, much like the sensation of nails on a chalkboard.

  • 20 percent say loud or sudden noises trigger symptoms
  • 26 percent say large crowds trigger symptoms

To keep symptoms at bay, survey respondents shared that they avoid large crowds and limit their activities.

Managing diet and vitamin D levels to avoid triggers

As scientists continue to research the link between Vitamin D and multiple sclerosis, some already living with the disease find value in maintaining their vitamin D levels. Eating a healthy diet full of nutritious foods can help those with MS stay healthy and live well. There is no “MS diet,” but experts suggest those with MS eat whole and unprocessed foods for energy and nutrients.1

Some survey respondents shared that they have been able to identify that their diet and vitamin D levels can trigger symptoms.

  • 14 percent say Vitamin D deficiency triggers symptoms
  • 13 percent say their diet triggers symptoms

The link between medications and triggers

The right medicine can be life-changing for people living with multiple sclerosis, but drugs are not a 1-size-fits-all solution. Drug interactions, stopping a medicine, and certain types of medicines all have the potential to cause a flare-up. About 10 percent of survey respondents identify medication as a trigger.

Less common triggers and the unknown

A smaller portion of survey respondents identified less common triggers, like alcohol or menstruation. Others are still unsure about the causes of their triggers. 7 percent have not identified any triggers.

Living well with multiple sclerosis

Common everyday occurrences, from subtle changes in temperature to lack of sleep, can provoke MS symptoms. By avoiding and managing exposure to triggers, those with MS can take some control over their disease, lessening the risk of a flare-up. Survey participants use the following strategies to keep triggers in check:

  • Exercise
  • Medication
  • Complementary therapy like CBD oil and cannabis
  • Diet
  • Stress management
  • Rest and relaxation

The 2020 Multiple Sclerosis In America survey was held online between March and July 2020. 5,023 people completed the survey.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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