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

Spasticity is a common symptom in MS, described as tightness, stiffness, or involuntary muscle spasms, according the National Multiple Sclerosis Society. Bouts of spasticity can be painful or painless and range from mild to very severe.

Cold weather is one of the most common triggers for worsening spasticity, per the organization. The “MS hug” — a tightening or constricting sensation caused by muscle spasms surrounding the rib cage — may also get more severe in freezing temperatures, according to the Multiple Sclerosis Foundation.

If your symptoms are interfering with your quality of life, you may want to discuss possible treatment options for spasticity. Per the Cleveland Clinic, oral medications used to treat spasticity include:

Other options include an injection of medication such as Botox in the most affected muscles.

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.

Typical Winter Health Issues May Be Harder for People With MS

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 such as 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 Cold Weather Is Impacting Your MS and Overall Health, Talk With Your Doctor

“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,” he says. Otallah 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.

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

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

Worsening MS symptoms could also be related to an underlying sleep disorder, such as obstructive sleep apnea, says Otallah. “That can occur at an increased rate in people with MS,” he says.

Strategies for Dealing With Cold Weather When You Have MS

The way to work around cold-weather MS issues 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 dressing in layers, both to stay warm and so that you can quickly remove one if you begin to get too hot.

She also recommends preheating the car before setting out and, if you’re in the market for a new car, considering getting a heated steering wheel to keep your hands warm while driving. If you’re not buying a new car soon, you can find a variety of heated steering wheel covers for purchase online.

Finally, Appelbaum combats the cold by practicing 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.

Additional reporting by Tammy Worth.

What to Do When Cold Weather Worsens MS Symptoms