A multiple sclerosis (MS) relapse happens when you experience worsening or new symptoms that last at least 24 hours and meet certain medical criteria. Flare-ups are common in relapsing forms of MS, such as:

• Relapsing-remitting MS (RRMS)
• Clinically isolated syndrome
• Active secondary progressive MS (SPMS)

Primary progressive MS doesn’t usually involve these flare-ups.

Because MS flare symptoms can vary, MS relapses — also known as exacerbations — aren’t the same for everyone. Relapses can involve one or multiple symptoms at the same time. Some relapses are short, while others last longer.

Some members of MyMSTeam have shared that they find it hard to tell when they’re having a relapse. As one member put it, “Is what I’m feeling a relapse, or is it just Tuesday?”

“My relapses sort of creep up on me slowly, making it difficult to know if it’s a relapse or not,” another member said.

A third shared, “It appears that when your memory and cognition are affected by a relapse, you don’t realize you are having one until it’s over.”

MS flare-up symptoms can affect any part of the central nervous system (which includes the brain, spinal cord, and optic nerve). Because of this, almost any body function can be affected.

Some of the most common symptoms include:

• Spasticity (muscle stiffness or tightness)
• Muscle weakness
• Trouble thinking
• Fatigue
• Pain
• Unusual sensations (which can including tingling, numbness, and others)

Sometimes, symptoms may get worse temporarily because of things like fever or a urinary tract infection. These are called pseudoexacerbations. Unlike true flares, pseudoexacerbations don’t involve new inflammation or damage in the nervous system. Once the trigger is gone, symptoms usually improve.

It’s not always easy to tell if you’re having a relapse. Signs may not be visible to others, even when you’re feeling off. As one MyMSTeam member wrote, “Relapses are weird, confusing, and peppered with INSANITY.”

Here are some ways members of MyMSTeam have described their MS relapses.

Numbness and Muscle Spasms

Sensory changes, like numbness and the sensation of pins and needles, often get worse during a relapse.

One member of MyMSTeam asked, “Just curious. … My first MS relapse was numbness on the right side of my body. I haven’t had a relapse since then. What has everyone else’s relapses been like?”

Another responded, “I just had my second relapse. My legs are so stiff with pins and needles, and my walking is worse. The spasms are so bad.”

“I’m experiencing a rough relapse with eye problems, cramping, and weakness."

— A MyMSTeam member

Sometimes, symptoms can be very severe. One member wrote, “Just got home after spending a week in the hospital with a flare-up. Scary. Lost the use of my legs.”

For some people, symptoms go away after a flare. For others, the problems may not fully go away. While others may not notice when you’re having mild symptoms (like pins and needles), having trouble walking or moving can make it clear that something is wrong.

Vision Problems

Eye issues are another common sign of an MS relapse. One type is optic neuritis (inflammation of the optic nerve). It can lead to pain and vision loss. “I’m experiencing a pretty rough relapse with eye problems (optic neuritis) that the eye doctor confirmed. It’s a new and nasty pain that includes cramping and weakness. Also, my immune system is going haywire,” explained one MyMSTeam member.

Another shared, “It hasn’t been a good week so far. I had a relapse with left eye inflammation, and I have blurred vision.”

Optic neuritis usually affects just one eye. It can cause:

• Eye pain
• Changes in color vision
• Trouble seeing contrast

One member shared that they found relief from their optic neuritis symptoms with treatment: “I had a month of double vision. MRI changes led my MS neurologist to start IV corticosteroids. It cleared up after a week.”

Insomnia

Unfortunately, many people have trouble sleeping during an MS relapse. Symptoms of multiple sclerosis like pain, discomfort, or unusual sensations may keep them up at night. This can lead to daytime drowsiness, and signs of tiredness like yawning, dozing off, or dark undereye circles.

One MyMSTeam member described a relapse they experienced: “I was feeling a constant buzzing sensation down one side of my body. I couldn’t sleep and was in a lot of pain, even though I was numb.”

Another member said, “I had total insomnia for the second night in a row, plus a migraine. 😪😴🤕🤧 Does anyone else get insomnia directly from MS or relapses?”

Lack of sleep is a common symptom of MS, and not getting enough sleep can make other symptoms worse — creating a cycle that’s hard to break. Other potential causes of sleep problems in people with MS include vitamin D deficiency or side effects from MS medications.

Following a relaxing bedtime ritual, keeping a regular sleep schedule, and limiting alcohol and caffeine may help. Let your doctor know if you’re struggling with sleep issues.

Vertigo and Balance Issues

A flare-up can also cause coordination problems, imbalance, and even dangerous falls. One member of MyMSTeam wrote, “I woke up with vertigo worse than ever, for no apparent reason. I couldn’t walk very well from the dizziness. I had to stay in bed. I couldn’t read or watch TV, and even moving my head gave me nausea. Maybe the start of a severe relapse?”

”My vestibular system has been affected, making vertigo worse. ... A recent episode involved fainting due to my autonomic nervous system failing and my blood pressure dropping.”

— A MyMSTeam member

Another member explained the range of symptoms they experienced during a relapse: “I’ve been having tough relapses that have challenged me in several ways. My vestibular system has been affected, making vertigo worse. I lost feeling on my right side. A recent episode involved fainting due to my autonomic nervous system failing and my blood pressure dropping.”

If balance problems are putting you at risk of injury, your doctor may recommend using different shoes, a cane, or even a wheelchair for safety. If you need to change the way you walk or use assistive devices, it may be a sign you’re having an MS exacerbation.

What You Can Do About MS Flare Symptoms

It’s normal to feel nervous or uncertain during an MS attack. Symptoms can be unpredictable and difficult to manage. You may worry about what others think if you don’t look or act quite like your usual self. In some cases MS flare symptoms may be so severe that you need to go to the emergency room right away.

New or worsening symptoms may also be a sign that your disease-modifying therapy (DMT) isn’t working or needs to be modified. Talk to your neurologist about any change in your condition. Keeping a detailed log of your multiple sclerosis symptoms, including when they started and how they’ve progressed, can help your doctor better understand your MS and help with managing relapses. If you’ve been having more relapses, it may be time to discuss your treatment options with your doctor.

Remember, you’re not alone. Connecting with others who understand what you’re going through — whether it’s an online support group, your family and friends, or your healthcare professional — can help you cope with the challenges of MS flare-ups.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Have you experienced MS flare symptoms since you were diagnosed with MS? How do relapses feel for you? Do you have advice for others going through an MS flare-up? Share your thoughts in the comments below, or start a conversation by posting to your Activities feed.