What to Do When Cold Weather Worsens MS Symptoms

Overheating during hot weather or in a hot bath is known to magnify symptoms in many people with multiple sclerosis (MS).

But for some, cold weather can be just as problematic. No one knows this better than Barbara Appelbaum, a retired motivational speaker and wellness coach who spent much of her life enduring the unforgiving winters of Chicago. She now relocates to the California desert during the most frigid months of the year.

Appelbaum felt certain symptoms of her MS appear or worsen on “bitterly cold” days. “I would get increased fatigue and also experience occasional shooting pains, primarily in my feet,” she says.

It’s more common for people with MS to experience symptoms due to heat rather than the cold, says Scott Ireland Otallah, MD, a neurologist who specializes in multiple sclerosis at Atrium Health at Wake Forest Baptist in Winston-Salem, North Carolina. But cold temperatures can affect MS symptoms, too.

According to Dr. Otallah, “Cold weather’s impact on MS is a little less understood. It doesn’t seem to have the same impact as heat because it doesn’t cause conduction block [which is the failure of a nerve impulse to pass through a certain point in the nerve fiber] in the same way.”

A temporary worsening of neurological function due to an increase in core body temperature, known as Uhthoff’s phenomenon, happens in about 60 to 80 percent of MS patients, Otallah says.

There isn’t a lot of research on how and why some people with MS can have symptoms related to the cold, says Otallah. “I have observed people who have certain pain-related symptoms due to a demyelinating event of MS. A common example of that would be trigeminal neuralgia.”

Trigeminal neuralgia is a chronic pain disorder that typically causes severe, shock-like pain in the face, and it’s more common in people with MS. “If there is a lesion [affecting the trigeminal nerve], then this can often be provoked by cold,” Otallah says.

Still, cold is a trigger for trigeminal neuralgia in people without MS. So it’s not clear why cold affects MS symptoms in some people.

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• tizanidine (Zanaflex)
• diazepam (Valium)
• Clonazepam (Klonopin)

Stretching and doing yoga can be beneficial for increasing mobility and reducing muscle stiffness, says Otallah.

“Going to a physical therapist — even just a one-time visit — could also help with symptoms exacerbated by cold weather. A physical therapist can assess what you need to work on and provide in-depth recommendations on exercise for you,” he says. A physical therapist can also provide you with energy conservation strategies to help with fatigue.

Often when people are talking about cold exacerbations in MS, they’re talking about feeling worse during the winter, says Otallah. “That’s tricky, because there are a variety of things that can make everyone — with or without MS — feel worse in the winter, but the issues can be even more problematic when you do have MS,” he says.

“For example, when the days are shorter and we’re getting less exercise, it is easier for our mood to get down and for our sleep to be disturbed, which causes us to feel more fatigued because we’re being less active and not sleeping as well,” he says. A lot of gray matter symptoms like fatigue and “brain fog” are worsened by changes in mood or poor sleep, he adds.

“Even healthy individuals can have more problems with cognitive and processing abilities during the winter months, but they can affect people with MS quite significantly,” says Otallah.

“If the worsening symptoms are more cognitive and include trouble with sleep, we would want to make sure you’re getting as much sun as you can and remaining as active as you can. This can help with sleep at night and may help improve your mood,” Otallah says. He recommends talking with your provider about any symptoms that get worse in the winter, in part because there may be an underlying condition that needs to be treated.

Relatively simple fixes can sometimes make a big difference. “For example, practicing yoga or using a light therapy box can help with seasonal affective disorder (SAD),” Otallah says.

If your mood is more significantly impacted, counseling or medication may be recommended, he adds.

The way to work around MS issues caused by cold weather depends on the type of symptom that you’re having in the cold, says Otallah. “If it’s pain, then you might truly need to avoid the cold; you don’t want to go out in a really cold place.”

And if you can’t avoid going out, you may want to put a scarf around your face and really bundle up, he says.

Appelbaum also recommends to:

• Dress in layers, both to stay warm and so that you can quickly remove one if you begin to get too hot.
• Preheat the car before setting out. If you’re in the market for a new car, consider a heated steering wheel to keep your hands warm while driving. You can also find a variety of heated steering wheel covers for purchase online.
• Practice restorative yoga, which, she says, allows her to warm up her body without overheating, enabling her to avoid the dizziness and weakness she experiences when her body temperature is too high. In restorative yoga, instead of flowing quickly from one pose to the next, sessions are built around fewer poses held for a longer time, with the goal of deepening the stretch, clearing your mind, and focusing on your breath.

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• Cold weather can worsen symptoms of MS for some individuals, especially impacting fatigue and muscle spasticity.
• About 10 to 15 percent of people with MS experience increased symptoms due to cold, and it’s important to address these changes for better quality of life.
• Strategies like dressing warmly in layers, preheating your car, and practicing restorative yoga can help manage symptoms during colder months.
• Communicating with your healthcare provider about worsening symptoms can help identify potential underlying issues and refine your symptom management plan.