Once diagnosed, symptoms of myasthenia gravis (MG) often fluctuate. There may be times when you have only minor symptoms or no symptoms at all. At other times, severe muscle weakness can make it difficult to carry on with daily activities. Chest muscle weakness can become so bad it interferes with breathing and requires emergency care (called a myasthenic crisis). 

After living with myasthenia gravis for a while, many people begin to recognize triggers that seem to make their MG symptoms worse. Knowing what exacerbates your MG can help you limit exposure to those factors. It is important to note that not all MG triggers are known. 

Some of the more common MG triggers include:

• Stress, either physical or psychological (such as overexertion, surgery, emotional upset, or work-related anxiety);

• Fatigue or not getting enough sleep;

• Infections, including colds and flu and viral infections like Epstein-Barr;

• Worsening or flare-ups of co-existing illnesses, such as lupus or other autoimmune conditions;

• Hormonal changes related to menstruation, pregnancy, or the postpartum period (for women);

• Extreme temperatures (including hot or cold weather);

• Certain medications, including antibiotics (eg, fluoroquinolones and aminoglycosides), corticosteroids, statins, antihypertensive medications, quinine and related drugs, botulinum toxin, anesthesia, and others; 

• Medication changes, such as a starting a new medication or reducing the dose of an immunosuppressant drug.