Feeling cold can make your multiple sclerosis (MS) symptoms worse. As temperatures drop in the winter months, many people with MS begin to brace for cold sensitivity. “It’s brutal on my multiple sclerosis symptoms,” shared one MyMSTeam member. “Hurry up, summer temperatures!”

For some people with MS, it can be hard to shake the feeling of being cold all the time. “My toes are so cold. I have been sitting at home for the last two hours, under several blankets, and yet my toes feel ice cold,” a member shared.

Read on to learn more about how cold affects some common symptoms of MS and what steps you can take to manage the effects of cold sensitivity.

People with MS commonly experience temperature sensitivity, which involves worsening of symptoms during temperature changes. As one member put it, “I can’t take real cold or real hot temperatures.”

Although many people with MS experience heat sensitivity (heat intolerance), the effects of cold can also affect quality of life for some people with the condition. This may come as a surprise to people who are newly diagnosed with relapsing-remitting MS (RRMS) as well as those who’ve been living with the condition for a while.

Cold sensitivity can even occur when it’s warm outside but you get wet in a rainstorm, feel a light breeze, or are chilled by air conditioning. “Does anyone feel cold all the time?” one member asked. “My husband is like an oven, and he looks at me like I’m crazy for being cold — cold all over, not just hands and feet.”

A 2022 study found that 58 percent of people with MS reported heat sensitivity, 29 percent experienced both heat and cold sensitivity, and 13 percent reported sensitivity only to cold. In general, the study found that the effects of temperature extremes worsened their MS symptoms, especially fatigue.

People with MS usually have a normal body temperature, so scientists aren’t sure why some are more sensitive to cold than others. However, one theory is that people with MS may develop cold sensitivity as a neurological (nerve-related) symptom due to problems with their neurons, or nerve cells.

In MS, a person’s immune system attacks the protective myelin sheath that surrounds their nerves. This leads to damage known as demyelination. The damaged areas, called lesions, cause nerves to send signals much slower than they should. People with RRMS experience periods of worsening symptoms known as relapses, flares, or exacerbations, followed by periods of remission (when symptoms improve or go away).

A 2022 study found that the effects of temperature extremes worsened participants’ MS symptoms, especially fatigue.

Lesions in the hypothalamus — a key area of the brain that regulates body temperature — likely play the largest role in cold sensitivity. If damaged, this part of the brain may not be able to effectively control a person’s core body temperature. Lesions may slow down or halt brain-controlled processes that regulate temperature and normally help keep the body warm, such as shivering.

Changes in internal body temperature can also affect the central nervous system (CNS), which includes the brain and spinal cord. If your CNS cools down too much, it may not send or receive signals efficiently. Keeping your internal temperature within an ideal range allows cells to function properly. When a person with MS is exposed to colder temperatures, their CNS has to work harder to control their body temperature and keep their body functioning appropriately, which may lead to worsening symptoms.

No matter the season or the weather, it’s important to talk to your MS specialist about your symptoms and how best to manage them. Be prepared for your next neurologist appointment with these customized questions about your symptoms and self-care.

If you have MS and cold sensitivity, you may notice your symptoms respond to even the slightest drop in temperature. You may experience cold hands and feet, chills, stiffening muscles, and generalized pain. These symptoms may persist until the environment becomes warm again. While your body is undergoing this cold stress, your typical symptoms of MS may feel worse than usual.

One MyMSTeam member stated, “When the temperature is too warm— above 72 degrees or so and humid — the fatigue, weakness, and nerve pain ramp up. When the temperature is too cold, below 55 degrees or so, I get stiff with muscle pain.”

Cold sensitivity may worsen various MS symptoms, including the following.

Fatigue

In the 2022 study, respondents reported that fatigue was the most common symptom to worsen from cold sensitivity. Some MyMSTeam members have this experience as well. One member shared, “It’s cold here in west central Wisconsin. Friday, I couldn’t stand or get dressed. Saturday, I couldn’t get to my walker to get to the bathroom. I didn’t have the strength to crawl, either.”

“When the temperature is too cold, below 55 degrees or so, I get stiff with muscle pain.”

— A MyMSTeam member

“This year, the cold has just drained me,” wrote another member. “My body seems no longer able to regulate my internal temperature.”

Muscle Spasms

Cold sensitivity may cause muscle stiffness or cramping, ranging from mildly tight muscles to severe cramps or spasticity. Cold weather is a common cause of worsening spasticity in MS.

Cold sensitivity “makes my hands and legs really stiff, and I shiver at 65 degrees,” said one MyMSTeam member. Another member agreed, saying, “When I get cold, I start to spasm all over and can’t stop.”

Worsened Walking

Cold weather can impair mobility by causing increased weakness and balance difficulties. One MyMSTeam member described this effect: “My leg doesn’t even like to cooperate, let alone walk, in cold weather!”

Pain

Cold sensitivity can be painful in and of itself. It may also make existing nerve or muscle pain worse. “I get so cold, I feel it in my bones,” wrote one member. Another said, “I still have a bad time in the winter. Even my pain levels go way up. When the warmer weather comes, my body does much better.”

Numbness and Tingling

Cold sensitivity can cause varying degrees of numbness and tingling in people with MS. These sensory symptoms may include:

• Paresthesias — Pins-and-needles feeling
• Dysesthesias — Burning or stabbing sensations
• Anesthesia — Complete numbness

One MyMSTeam member commented, “My feet have been ‘cold’ all my life! Now they’re not just cold, they’re numb!”

Cognitive Changes and Depression

Cognitive symptoms, including difficulties with attention, memory, and language, commonly worsen in people with MS when the temperature changes. Many MyMSTeam members note an increase in depressive symptoms during the colder winter months. “I have decided that winter depression on top of MS depression really sucks,” one member wrote.

Feeling cold can severely affect your quality of life if you’re living with MS. Some MyMSTeam members have relocated to avoid cold weather. “I had to finally move away from the cold, damp weather,” one member shared. “It was terribly hard to keep warm. My core temp has come up a little, but I even have to keep the heat in my room near 80 just to keep warm, or use my electric blanket.”

If you have any new or worsening symptoms, be sure to reach out to your neurology health care team. They can help determine the cause of your symptoms and how best to manage them. Severely cold temperatures can put you at risk of hypothermia, a dangerous condition in which the core body temperature drops below 95 degrees Fahrenheit.

The following tips can help you manage worsening MS symptoms from cold sensitivity.

Keep Your Body Moving

Moving your body regularly is one of the best ways to help with cold sensitivity. Movement generates internal heat, which may help return your body to a temperature that will relieve your symptoms.

Even simple movements, such as stretching your arms or making circles with your wrists and ankles, can increase circulation and reduce stiffness. Walking is also a beneficial low-intensity exercise that can help raise body temperature.

Plan Ahead

Watch the weather forecast and prepare yourself for colder periods. When leaving the house, bring items that can easily help warm you up, such as:

• Extra clothes
• Warm compresses
• Hot water bottles
• A flask of hot tea to sip
• Emergency blankets

Find out ways to keep safe and comfortable while traveling with MS.

Bundle Up and Layer

Wearing warmer clothes is a simple preventive way to maintain a comfortable body temperature. Putting on extra layers — especially on the head, hands, and feet — can help prevent the effects of heat loss through the extremities. Electric blankets can be cozy and provide extra warmth when needed.

Warm Up From the Inside Out

Eat and drink warm foods and beverages to help feel more comfortable. You may want to try nourishing soups or stews as well as herbal teas.

Keep Temperatures Consistent

You may experience worsened symptoms from both cold and heat, so it’s important to find the temperature that’s right for you. Keep your home thermostat at a temperature that doesn’t worsen your symptoms. It may also help to avoid dramatic shifts in temperature, such as cold showers or gusts of wind.

If you want to use a heating pad or hot bath to warm up, start at a lower temperature and gradually raise the heat if necessary.

In a similar vein, avoid cranking up the thermostat or quickly piling on layers of clothes when you get cold. This can lead to heat sensitivity or Uhthoff’s phenomenon (worsening of MS symptoms when the body is overheated). Instead, make gradual changes. Likewise, if you want to use a heating pad or hot bath to warm up, start at a lower temperature and gradually raise the heat if necessary.

On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 218,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Does feeling cold affect your MS symptoms? Do you have a tip to share on warming up? Share your thoughts in the comments below, or start a conversation by posting to your Activities page.