Am I Having an MS Relapse?

Criteria For Determining MS Exacerbations

Am I Having A Multiple Sclerosis Relapse?
Am I Having A Multiple Sclerosis Relapse?. AJ_Watts/Getty Images

A relapse (also referred to as an exacerbation, attack, or flare) can be pretty clear when you are having new multiple sclerosis (MS) symptoms that start pretty suddenly and are interfering with daily life.

However, most of you probably have days where something is simply just a little "off." Maybe you feel a touch more disorganized than usual and wonder if it is MS-related cognitive difficulties or just a busy day.

Maybe you get up a couple more times at night to urinate and wonder if it is nocturia or too much to drink close to bedtime. Maybe you feel some pressure in your ribs and wonder if it is it the MS hug or a muscle strain from lifting heavy groceries.

In these situations, the answer to the relapse question can be tricky and only answered definitively by climbing into an MRI tube to look for new lesions. Remember, old lesions often leave damage in the form of scar tissue and can cause residual symptoms, especially when you are fatigued or stressed. But new lesions light up on an MRI scan and cause new symptoms, ones you have not experienced before.

What Is a Relapse?

In technical terms, a relapse occurs when a person experiences one or more new neurological symptoms or worsening of one or more old neurological symptoms for at least 24 hours. In addition, in order for a person to experience a true relapse, their current attack must be separated from a prior attack by at least 30 days.

A Simple Quiz That May Help You Determine If You Are Having a Relapse or Not

You may suspect a relapse if you answer “yes” to the following questions:

  • Am I experiencing new symptoms or worsening of existing MS symptoms?
  • Has this worsening happened over the course of 24 hours to a couple of days?
  • Have these symptoms lasted more than 24 hours?
  • Has it been at least a month since my last relapse? (In other words, had these symptoms been non-existent or stable for at least 30 days before they appeared or got worse?)
  • Am I free of fever or infection?

Signs May Indicate a Relapse Too

It's not just symptoms that signal a relapse, but clinical signs too. A sign is an abnormality that is identified by a doctor during a neurological exam. They may be different than symptoms that the patient reports because they may not be recognizable to the person with MS and are identified when the doctor conducts certain tests.

What Is a Pseudoexacerbation?

Pseudoexacerbations are temporary increases in symptoms caused by external factors, usually heat, which go away after a short period of cooling off. These can also be the result of infections or other forms of physical or emotional stress. Symptoms resolve when that stress is alleviated.

When to Contact Your Doctor

Please contact your doctor if you are ever worried or if symptoms bother you or stick around—even recent onset of vague "fuzzy-headedness" or the fact that you drop things more frequently may signal something that your doctor can identify during a neurological exam. Whether your doctor decides “relapse” or “no relapse,” he may have medications to ease some of your symptoms to make life more comfortable.

When You Talk With Your Doctor

Your doctor will likely inquire whether your symptoms are interfering with activity or causing significant pain or distress. If they aren't, your doctor will probably not put you through an MRI unless he or she plans to follow up with Solu-Medrol, which doctors usually save for severe exacerbations because of the drug's side effects.

Some exceptions to this are:

  • Your doctor may want to give you an MRI scan to see if your ​disease-modifying therapy is working or if there are new (or more) lesions, which may indicate that it's time to consider switching therapies.
  • It has been awhile since your last MRI and your doctor wants to monitor the situation anyway.

    A Word from Verywell

    Don't let MS take over any more than it already has by worrying about relapses with every twinge. Try resting more or staying out of the heat to see if that helps. See a doctor if you are concerned, but try not to let every strange sensation send you into a panic and conjure up visions of increased disability. It may be a relapse and it may not, but the best thing you can do is to stay calm and act rationally.


    Birnbaum, M.D. George. (2013). Multiple Sclerosis: Clinician’s Guide to Diagnosis and Treatment, 2nd Edition. New York, New York. Oxford University Press.

    National MS Society. (2017). Managing Relapses.

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