Ms triggers: 12 MS Triggers to Avoid: Stress, Heat, and More
12 MS Triggers to Avoid: Stress, Heat, and More
Multiple sclerosis (MS) triggers include anything that worsens your symptoms or causes a relapse. You can often avoid MS triggers by simply knowing what they are and trying to sidestep them. If you can’t avoid certain triggers, you may find other approaches helpful, including a healthy lifestyle, regular exercise, and a balanced diet.
Just as no two people will have the same experience with MS, no two people will likely have the same MS triggers. You may have some triggers in common with others who have MS, as well as some that are unique to you.
Over time, you and your doctor may be able to identify triggers that make your symptoms worse. Keeping a journal of your symptoms, when they occur, and what you were doing beforehand can help you identify potential triggers.
Here are some of the most common triggers you may experience with MS and tips to avoid them.
Having a chronic disease like MS can establish a new source of stress. But stress can stem from other sources, including work, personal relationships, or financial worries. Too much stress may worsen your MS symptoms.
How to avoid: Find a relaxing, stress-reducing activity that you enjoy. Yoga, meditation, and breathing exercises are all practices that may help reduce stress and eliminate the risk of making symptoms worse.
The heat from the sun, as well as artificially heated saunas and hot tubs, may be too intense for people with MS. They can often lead to a period of exacerbated symptoms.
How to avoid: Skip high-heat environments like saunas, hot yoga studios, and hot tubs. Keep your home cool and run extra fans if necessary. On hot days, avoid direct sunlight, wear loose, light-colored clothes, and stay in the shade as much as possible.
Pregnant people with MS may experience a relapse after delivering their baby. About 20 to 40 percent of women may have a flare-up in the period just after giving birth.
How to avoid: You may not be able to prevent a flare after childbirth, but you can take steps to reduce its severity and impact. In the immediate days after giving birth, let friends and family members help you with your new baby so that you can get rest and care for yourself. This will help your body recover more efficiently.
According to limited research, breastfeeding may have a potential protective effect against postpartum flare-ups, but the evidence isn’t clear. If you’re taking disease-modifying medication, you may be unable to breastfeed. Talk with your OB-GYN and neurologist about your post-birth options.
Infections can cause MS flare-ups, and MS is also more likely to cause certain types of infection. For example, people with reduced bladder function are more likely to develop urinary tract infections. The infection may exacerbate other MS symptoms. Infections like the flu or common cold can worsen MS symptoms.
How to avoid: A healthy lifestyle is an important part of treatment for MS. Plus, it helps prevent other diseases and infections. Wash your hands during cold and flu season. Avoid people who are ill when you’re experiencing a flare. See your doctor if you think you’re getting sick.
Vaccines are generally safe — and recommended — for people with MS. Certain vaccines that contain live pathogens can potentially exacerbate symptoms. If you’re experiencing a relapse or taking certain medications, your doctor may also recommend you postpone vaccination.
How to avoid: Talk with your neurologist about any vaccine you’re considering. Some vaccines, like the flu vaccine, may help you prevent a future flare-up. Your doctor can help you determine which are safest for you.
One study found that people with lower vitamin D levels have a higher risk of flare-ups than those with adequate vitamin D levels. There is increasing evidence that vitamin D can protect against developing MS. Still, more research on how this vitamin affects the disease course is needed.
How to avoid: To help prevent this, your doctor may monitor your vitamin D levels regularly. Supplements, food, and safe sun exposure may help. Be sure to talk with your doctor about your safest supplement options before trying any.
Sleep is vital for your health. Your body uses sleep as an opportunity to repair your brain and heal other areas of damage. If you aren’t getting enough sleep, your body doesn’t have this downtime. Excess fatigue can trigger symptoms or make them worse.
MS can also make sleep more difficult and less restful. Muscle spasms, pain, and tingling may make it difficult to fall asleep. Some common MS medications may also interrupt your sleep cycle, preventing you from getting shut-eye when you feel tired.
How to avoid: Talk with your doctor about any sleep problems you may have. Sleep is vital to your overall health, so this is an important area of treatment and observation for your doctor. They can rule out other conditions and give you tips for managing fatigue.
A balanced diet and regular exercise can go a long way to helping you avoid a flare-up and ease MS symptoms. A diet high in processed foods is unlikely to provide you with the high quality nutrition it needs.
How to avoid: Work with a dietitian to develop an eating plan you can stick to. Focus on good sources of protein, healthy fats, and carbohydrates. While research isn’t yet clear on the best diet for people with MS, studies do suggest eating healthy foods can have a positive effect.
Cigarettes and other tobacco products can increase your symptoms and make progression happen more quickly. Likewise, smoking is a risk factor for several medical conditions that can worsen your overall health, including lung disease and heart disease.
One study found that tobacco smoking is associated with more severe MS. It also may speed up disability and disease progression.
How to avoid: Quitting smoking, even after your diagnosis, can improve your outcome with MS. If you smoke, talk with your doctor about effective smoking cessation options.
Certain medications have the potential to worsen your MS symptoms. Your neurologist will work closely with all of your doctors to make sure you don’t take medications that may trigger a flare-up.
At the same time, your neurologist may closely watch the number of medications you’re taking. Medications can interact with one another, which can cause side effects. These side effects could trigger an MS relapse or make symptoms worse.
How to avoid: Report all medications you take to your doctor, including supplements and over-the-counter drugs. They can help you narrow down your list to the necessities so you can prevent problems.
Sometimes, MS medications can cause side effects. They may also not seem as effective as you’d hope. But this doesn’t mean you should stop taking the medications without your doctor’s approval. Stopping them can increase your risk of flare-ups or relapses.
How to avoid: Don’t stop taking your medications without talking with your doctor. Though you may not realize it, these treatments are often working to prevent damage, reduce relapses, and stop new lesion development.
Fatigue is a common symptom of MS. If you have MS and push yourself to go without sleep or overexert yourself physically or mentally, you may experience flare-ups. Exertion and fatigue can trigger a relapse or make flares last longer.
How to avoid: Take it easy on yourself and listen to your body’s cues. Slow down when you’re feeling tired. Rest as long as you have to. Pushing yourself to the point of exhaustion will only make recovery more difficult.
When you have MS, you may need to make a few lifestyle changes to prevent relapses and reduce your symptoms. You may be able to easily avoid some triggers, but others may require more work. Talk with your doctor if you’re having difficulty managing your MS symptoms.
Symptoms, Triggers, Prevention, and Treatment
Written by WebMD Editorial Contributors
Medically Reviewed by Jabeen Begum, MD on February 23, 2023
- MS Flare-Up
- What Are the Symptoms of a Flare-Up?
- What Causes Flare-Ups?
- How to Prevent Flare-Ups
- Ways to Treat a Flare-Up
- What to Do After a Flare-Up
If you feel fine for weeks or months but then your multiple sclerosis (MS) symptoms happen again, you probably have what doctors call a relapse or flare-up. The good news is there are ways to treat or prevent them.
Everyone’s flare-ups are different. Some are mild. Others are severe.
During a flare-up, you may have new symptoms or symptoms you already may get worse.
You may have one or more of these:
- Balance problems
- Blurred vision or blindness in one eye
- Pins-and-needles feeling
They can happen when inflammation in your nervous system damages the layer that covers and protects your nerve cells. This slows or stops nerve cell signals from getting to the parts of your body where they need to go.
If you have relapsing-remitting MS, you may have flare-ups followed by symptom-free periods called remissions. To be a true relapse, your symptoms must start at least 30 days after your last flare-up and stick around for at least 24 hours.
The exact mechanism that leads to a relapse is unknown, but it’s thought to be related to an increased overall immune response. There’s some evidence that systemic infection (viral or bacterial), postpartum period, stress, and assisted reproduction (infertility treatment) can be associated with a flare-up. That can lead to more brain cell damage and demyelination.
MS flare-ups are different from pseudo-flares. Those are a temporary worsening of symptoms brought on by external factors. Unlike flare-ups, pseudo-flares aren’t linked to new damage from your MS. They usually last less than 24 hours. Typical triggers for pseudo-flares include high body temperature from fever, infection, too much exercise, or activity; getting your period; new medications; and stress. Usually, removing the underlying stressor can help resolve a pseudo-flare.
But it can be hard to tell the difference between flare-ups and pseudo-flares, so talk to your doctor about any new or worsening symptoms.
MS flare-ups can be caused by:
- Eating poorly
- Skipping medication
- Lack of sleep
To try to prevent a flare-up from happening:
Take meds as directed. The drugs your doctor prescribes help slow your MS from getting worse and help prevent relapses. If you have side effects, don’t just stop taking them. One study found about 25% of MS patients who stopped taking their meds had a relapse. Certain meds for Crohn’s disease or rheumatoid arthritis may cause MS-like symptoms. So can drug interactions. Check with your doctor to see if there are meds you’re taking that could be interacting with one another, and if your current meds are right for you.
Stay healthy. A bout of cold or flu can set off your MS symptoms. A bladder infection can trigger either a flare or a pseudo-flare, so the same advice applies. In fact, infections cause a third of MS flare-ups. Wash your hands with warm water and soap during the day, get your yearly flu shot, and avoid people who look sick. Stay hydrated. Try to avoid anyone who is sick. Make sure your food is cooked properly. Practice safe sex.Ask your doctor for other ways to avoid bladder infections, including vaccinations. Try to avoid anyone who is sick. Make sure your food is cooked properly. Practice safe sex.
Relax. In some people with MS, stress can bring on flare-ups. Find calmness with meditation, yoga, counseling, or anything else that’s good for you and helps you unwind. In one study, MS patients reported their stress level was cut nearly in half after 6 weeks of yoga.
Rest. You won’t feel well when you’re worn out. Sleep problems are common in people with MS. Symptoms like pain and muscle spasms can keep you up at night. Some of the meds that treat MS interrupt sleep, too. Work with your doctor to get your symptoms under control so you can sleep. Adjust your meds if they keep you awake. Aim for 7 to 8 hours of sleep per night.
Stay cool. High temps may trigger a flare-up. If you’re affected negatively by warm surroundings, you should skip saunas, hot tubs, and hot showers and baths. Most of the time hot weather causes fatigue. Also, do what you can to avoid being outdoors on hot days. Take cool baths and/or run air conditioning. Try a hat or clothes that hold ice packs or frozen gel packs to stay comfortable. If you have an exercise goal, divide the time you exercise into smaller segments, with rest after each one.
Eat well. Eat foods rich in omega-3 fatty acids. They’re believed to fight inflammation. Also, get plenty of fiber and stay away from foods with saturated and trans fats. A healthy diet helps keep your immune system strong.
Steer clear of smoking. This is a major risk factor for flare-ups, and it can make your symptoms worse. If you smoke, your doctor can help you make a plan to stop.
Your symptoms might go away on their own if they’re mild. Even so, let your doctor know what’s going on.
Treating symptoms can shorten your flare-ups and help you recover faster. The goal is to bring down the inflammation that caused your symptoms.
Your doctor will likely prescribe a steroid drug. Steroids curb inflammation and can help you get over a relapse faster. But they can’t undo the damage that’s been done or slow your disease. Methylprednisolone is the most common steroid used for this. You might take it as tablets or get it through an IV in a hospital or your doctor’s office.
Some people can’t take steroids. Others are bothered by side effects, which include weight gain, mood changes, trouble sleeping, and upset stomach. Another option may be ACTH gel (Acthar gel). It’s injected into your muscle or under your skin. It triggers your adrenal gland to release hormones that bring down inflammation.
For a severe flare-up that doesn’t get better with steroids, you might try plasma exchange. First, a health care professional will take some of your blood. The liquid part, called plasma, is taken out. It’s replaced with a substitute plasma fluid or with plasma from a donor. Then, the blood is returned to your body. Talk to your doctor about whether this would help you.
You can also treat a flare-up by using the same tips in the section above for preventing them. For instance, get plenty of rest and make sure to eat well.
You can recover fully after a relapse, but it might take weeks or months to get over all your symptoms. If you had a lot of nerve damage, some symptoms might not fully go away.
You may need extra help to get back to your normal life. A rehab program can put you back on track. Your rehab team will help you with:
- Dressing and personal care
- Home chores
- Problems with thinking and memory
If you also see a neurologist (a doctor who specializes in problems with your brain, spinal cord, or nerves) for your MS, let them know about your flare-up. It could affect which meds they prescribe for you.
is a synchronous two-stage
trigger with static
management. Schematically it
is executed on two flip-flops: M(master –
main) and S(slave –
auxiliary). M-trigger perceives
input information, and S-trigger
captures the state of the trigger as a whole.
In this case, both triggers can be
the same type, for example RS-
or D flip-flops,
or different. Control link between
M-trigger and S-trigger
carried out by two synchronization series, or
by means of a inhibiting inverter.
Scheme of a synchronous two-stage RS flip-flop
with static control, performed
according to the MS-trigger scheme,
where as an M-trigger
and S-flip-flop is used
synchronous static RS flip-flop looks like this
has one information input (D-input)
and input for synchronizing
impulse (Fig. 2.4). Main
assigning a D flip-flop
is the delay of the signal applied to the input.
Like an RS flip-flop, it can be built
on different logic elements.
It can be seen that at С = 0 the change in the input
the signal does not affect the state
trigger, and only when C = 1 trigger
takes on a state determined by
D-flip-flop is a DV-flip-flop that
in addition to the D-input has a control
V-inlet (in Fig. 2.4, to shown
dotted line). With V = 1 trigger
works similarly to a D-trigger,
and for V =
0 keeps initial state regardless
from a signal change at the D-input
application in construction practice
digital devices find D-flip-flops
with dynamic control (155TM2 564TM2).
They respond to information signals
only when the signal changes to
C-input 0 to 1 (direct dynamic
input) or 1 to 0 (inverted dynamic
2.4. D-trigger (DV-trigger if available)
V-input): and –
functional diagram; b –
state table; to –
D flip-flop circuit
with direct dynamic control (Fig.
2.5) consists of three asynchronous RS triggers.
Two of them, built on elements 1,
2 and 3, 4 are called commuting, and the third
elements 5, 6 are output. Signals on
switching trigger outputs
control the state of the output trigger.
signal C = 0 at the outputs q2 and q3 is formed
neutral for output trigger
combination and it is in mode
storage. Change of information
signal during this period of time causes
signal change at outputs q 4 and
q 1 .
Elements 2, 3 are ready to accept these
signals as soon as permission appears
signal C = 1. At the time of its appearance
the levels at the outputs q2 and q3 change and
set the output trigger to new
state corresponding to the information
signal at the D-input in the previous cycle.
information signal change
will occur during the establishment
states of the output trigger, switching
triggers won’t miss it because
zero level at the output of element 2
blocks the inputs of elements 1 and 3. Thus
Thus, the appointment of switching
triggers is to receive information,
passing it to the output trigger at the moment
signal drop at the C-input from 0 to 1 and
implementation from that moment
self-locking against impact
dynamic control is not possible
call it two-stage in accepted m
earlier sense, since it does not have that
push-pull transmission mechanism
information from inputs to outputs
is clearly expressed in
two stage trigger. Therefore, in
convention for such triggers
one letter T is provided.
with dynamic control can be
used as a T-trigger, for
it needs information input
D connect with inverted output (fig.
2.5, g ).
2.5. D flip-flop
with dynamic control: a
(flip-flop with even input T) is
flip-flop with one input that changes its
state with the arrival of each input
implementation of the T-trigger on potential
logical elements in the basis can
be put a two-stage RS flip-flop,
because it provides the required
for the operation of the T-flip-flop, the delay in transmission
information from inputs to outputs; C-entrance
acts as a T-input, and S-
R inputs must be connected
trigger outputs (Fig. 2.6).
2.6. T-trigger (TV-trigger
with V-inlet): a
T-trigger is a TV trigger having
additional control input V (on
rice. 2.6, and shown
dotted line). With a signal V = 1 TV-trigger
works according to the rules of the T-trigger.
With signal V =
0 trigger saves its state
MS type trigger. Lecture 11
Memory. Triggers and Latches
triggers. Schemes of the simplest triggers
Synchronous or clocked triggers. JK – triggers
triggers. Asynchronous and synchronous triggers
triggers. RS – trigger,
Trigger (trigger system)
Trigger type MS
Trigger with two bistable cells, one of which is
master and the other slave.
It is often necessary that the read information is not transmitted directly to the
output, but appears there when the circuit inputs are already
locked. This can be done using the master-slave scheme, it is made by
of two static RS – flip-flops, which are controlled by one clock signal
C. The signal is supplied to the input of the second trigger in antiphase.
the clock pulse voltage exceeds
level a, then the slave trigger is disconnected from
When the clock signal rises to level b, the information supplied to the input will be written to the master trigger
. To avoid direct receipt of information
to the output without intermediate storage, the response threshold for the logical
units in the inverter is made less than in the NAND elements at the input.
When level C is reached, the master trigger is again disconnected from the inputs
of the circuit.
When level d is reached, the information will be written to the slave trigger and
will be set at the trigger outputs. Changing the output state of this circuit
is only possible on the negative edge of the clock pulse.
Since the master trigger repeats the state of the inputs of the circuit while C=1, only the input signal that occurred
before the negative edge of the clock pulse is transmitted to the
input of the slave trigger.
MS type flip-flop can be converted into a frequency divider
Divider timing diagram.
The pulse frequency at the output of
is half the clock frequency.
JK – triggers.
If the input elements AND-NOT have additional inputs, then when
feedback is closed
, a JK-type MS type flip-flop is obtained from the counting flip-flop
With J=K=1, the trigger state changes with each negative
edge of the clock pulse.
The switching table of the JK flip-flop is the same as the switching table of the
RS flip-flop. Input J acts as set input, K-reset. The difference is in the absence of
In contrast to the RS flip-flop, only one JK flip-flop can be overturned
times, since one of the two input elements is always blocked by the feedback
JK flip-flop switching table.
A D flip-flop can be obtained from a JK flip-flop.
Dynamic D – trigger.
A flip-flop in which there is no pass-through signal from the input to the
output can be obtained by blocking the inputs at the moment when the information read by the
is transmitted to the output. Such schemes are called flip-flops with
dynamic action on the synchronization input. Some of them work
on the leading edge, others on the trailing edge. The most common are D-flip-flops.
Dynamic D-flip-flop controlled by a rising positive edge.
Operating procedure: If C=0, then always X2=X3=1. In this case, the output trigger
operates in the information storage mode: Х1=
. This means that always
one of the two auxiliary flip-flops has both outputs equal to 1.
This abnormal state disappears when clock signal C=1.
The steady-state output signal is determined by another auxiliary
trigger that is in the correct state.
If D=0, X3 stays at 1, X2 goes to 0. The signal that takes
zero value determines the output state of the flip-flop. During the occurrence
of the rising edge of the clock pulse, the equation Q=D is fulfilled.
Locking inputs: after the transfer of information, both auxiliary flip-flops
are in the correct state. But in this case they are blocking each other
. All subsequent changes in the signal D do not cause any reaction.
New information will be written only when, at C=0, one of the two
auxiliary triggers goes into the wrong state.
When the value of signal C exceeds
, the input signal will be
accepted and transmitted to the output
of the circuit.