Cold weather aggravates fatigue and spasticity for some with MS, but that doesn’t mean you have to hibernate all winter.
By Becky Upham — Medically Reviewed by Samuel Mackenzie, MD, PhD
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 59-year-old semiretired 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.
10 to 15 Percent of People With MS Experience Symptoms Due to Cold Weather
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.
Indeed, now that Appelbaum winters in a warmer climate, heat is her winter nemesis. “It causes fatigue, not in a ‘sleepy tired’ way, but rather a fatigue of my muscles and bones, along with a dizziness that occasionally gives me wobbly legs,” she says.
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 in the same way.”
A temporary worsening of neurological function due to an increase in core body temperature, known as Uhthoff phenomenon, happens in about 60 to 80 percent of MS patients, Otallah says.
“Worsening of symptoms due to cold only happens in about 10 to 15 percent of patients, at least in the surveys that have been done,” he adds.
Why Does Cold Weather Cause MS Symptoms to Get Worse?
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.
A small study published in January 2021 in the Korean Journal of Pain found that even though light touch was the most common trigger for trigeminal neuralgia, weather triggers were reported by 12 out of the 60 participants (20 percent). Strong winds, cold temperatures, and cold winds were all cited as causes for a painful episode.
There’s also some speculation that having a demyelinating lesion on the hypothalamus … could make it harder to regulate your own body temperature, says Otallah. “That would explain why cold in general would affect you more, making you feel slowed down and fatigued, and so on,” he says.
Cold Temperatures May Cause Worsening Spasticity
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