The October Slide: Why Chronic Illness Symptoms Flare When the Seasons Change

The October Slide is the informal name that many of us in the chronic illness community call the worsening of symptoms as fall arrives. It is commonly reported among people with hEDS/HSD, POTS, MCAS, Long COVID, and other conditions.

It’s not an official diagnosis or medical term, and research is limited. No one has studied “the October Slide” directly, but weather swings, shorter days, and seasonal stress have each been looked at on their own, with mixed results.

For this post, we asked The Zebra Club community about their experiences with the October Slide and how they manage it.

Some describe flares or flare-ups in fatigue, pain, migraines, POTS symptoms, and even MCAS reactions. If you experience this in the fall, you are not alone!

Here’s what they told us — and what might help.

What Is the October Slide?

The October slide is the term describing an increase in fatigue, instability, and pain that many people notice as the seasons change and summer turns to fall. It’s a term, not a diagnosis, and not everyone experiences it. Some people even feel better in cooler weather, while others tend to feel worse.

If you’re in the southern hemisphere, the same pattern may show up around March instead, as your own autumn begins. It’s the seasonal shift itself, not a specific month, that seems to matter most for many people.

Why Is October Harder for Chronic Illness?

October can be harder for many of us because several potential triggers arrive at the same time: fast-changing weather and barometric pressure shifts, shortening days, busier routines, and the start of cold and flu season.

Scientific evidence for each is mixed, and researchers tend to describe weather as one contributing factor, rather than a single cause.

Weather and pressure swings

Barometric pressure is a measure of the weight of air pressing on the Earth’s surface. It rises and falls in a given area as weather systems move through. Weather instability happens when there is a pattern of frequent (and sometimes large) swings in barometric pressure and/or temperature over a short period of time.

“I feel our hEDS bodies are weather detectors – we would be amazing at predicting storms,” one member joked.

There is some research to back up that feeling, though it may be more complicated than just an internal barometer.

In a large study in the UK following 13,000 people with chronic pain (not specific to hEDS), they found that high pain days were more common when pressure was lower than normal, humidity was higher, there was more rain, and wind was stronger (1).

Migraines have also been linked to changes in weather. It is also estimated that anywhere from 40-75% of people with hypermobility conditions experience migraines compared to 14% of the general population (2).

A 2025 systematic review of migraine research found a similar pattern to the one studying pain, pressure drops and rapid changes in weather were linked to more frequent migraine attacks (3).

Other researchers describe it as a trigger among several, rather than a direct cause. They describe migraine as a combination of factors and a “perfect storm effect” with multiple triggers occurring at once (4,5).

One headache specialist estimates that 30 to 50% of people with migraine identify some kind of weather change as a trigger, making it the most commonly reported one (6).

“My migraines and pain seem to flare when the seasons change – very closely related to barometric pressure fluctuations. Then it seems like it sets off pain flares. Like my nervous system is overwhelmed.” – Katie

Shorter days and less light

Another commonly proposed contributor to the slide is that days get shorter and sunlight decreases. One researcher hypothesizes that summer sun raises serotonin levels and vitamin D (7).

A recent study on nutrient intake in over 400 people with hEDS found very low vitamin D intake, with only 4.5% reaching recommended levels (8). Since most vitamin D comes from sun exposure rather than food, this may mean less of a buffer heading into the lower-light months, though this hasn’t been tested directly.

Joint and muscle pain are already highly prevalent in hEDS/HSD (9). Separately, a 2024 systematic review of 30 studies found that while the overall link between vitamin D levels and chronic musculoskeletal pain was unclear, lower vitamin D was fairly consistently associated with more intense pain (10).

Whether this connects to the October Slide specifically hasn’t been studied, but if you’re concerned about your vitamin D levels, it’s worth raising with your care team, who can test and advise on supplementation if needed.

Cold and flu season

October is also the start of flu season in the US, which typically runs through May according to the CDC. For a body that is already managing chronic symptoms, added infections or sickness may be one more contributing factor alongside weather and routine changes.

Members often tell us recovery from a virus takes longer or is accompanied by more fatigue than it used to before their diagnosis. If that’s you, The Zebra Club’s Post Viral/Illness Recovery class is designed to support exactly that kind of extended recovery.

Stress, routine, and how fast it drops

Along with the fall comes changes in routine, return to school schedules, work demands and the lead-up to the holidays, which can bring stress itself.

This kind of stress may matter more than it first appears. As Jeannie and Leslie Russek, The Zebra Club’s scientific advisor, explain in Nociplastic Pain, Hypermobility, and a Sensitized Nervous System, stress can contribute to sensitization of the nervous system and is anecdotally a common trigger for flares.

Some members also notice the drop itself feels sudden, even if the improvement earlier in the year didn’t.

“The build up of some more energy and less pain and symptoms in spring and summer goes gradually, the sudden drop in October/November is so harsh.” – Helene

Is the October Slide the same for everyone?

The October Slide can vary a lot from person to person. Some people feel better in cooler weather, at least for a while, and the same person can have a different autumn from one year to the next. One large chronic-pain study found weather sensitivity varies by individual, in both strength and direction (11).

Two members described this first hand:

“The first few years after my first Covid infection, I felt like I was cured in fall with the decrease in temps and humidity! I would say it’s roughly 50/50 now whether that happens or I get the October slide. I suspect overdoing it when I feel well and stressors (election season, upcoming holidays) are my big triggers. My symptoms tend to be increased pain and fatigue- six years of Long Covid and I’m only recently diagnosed with hypermobility/suspected hEDS. I no longer meet the diagnostic criteria for POTS- I think that is why I felt so much better in cool weather the first few years.” – Kristen

 

“I used to be worse in the spring and summer I think because of my MCAS which worsens my POTS – but now the damp and cold seems to worsen my joint pain and the cold makes me feel more stiff. … So the extremes of temperature in both summer and autumn/winter seem to trigger symptoms.” – Charlotte

 

“I’m the opposite. I come back to life as soon as the weather drops from 70s to 60s here in New York. I have Orthostatic Hypotension, so summer heat really disables me. October is wonderful! I go for longer walks. I walk faster. I sleep better. It’s kind of misleading because my symptoms start to go the other direction in December. The cold of winter is not kind on my fascia.” – Amber

What Does the October Slide Feel Like?

The October Slide can look different for everyone and could include any combination of increasing symptoms together: stiffer, more painful joints, fatigue, head pressure, brain fog, increased frequency of headaches or migraines, coathanger pain, breathlessness in cold damp air and, for some people, MCAS reactions.

For some, it feels as if the whole nervous system is overloaded rather than one body part struggling.

We asked members of The Zebra Club community what the October Slide feels like for them:

“My body certainly get stiffer takes more effort. Painful joints. The start of the colder damper air makes me a little breathless.” – Ian

 

“I get a head pressure and really painful joints along with fatigue” – Erika

 

“ALL my symptoms ramp up, GI, fatigue, joint instability and pain, headaches, sinuses, MCAS reactions.” – Ash

 

“I didn’t recognize what was happening to me the first years of Long COVID but it hit me like a brick. It was terrible hip pain during and long after a car trip that first November that sent me looking for answers. It took years more for the diagnoses that explain my experiences.” – Jenn

 

“I am really struggling since the weather shifted… I was doing really well this summer and this sudden change is jarring and discouraging.” – Andrea

 

If headaches, migraines, or coathanger pain are part of your pattern, The Zebra Club’s Headache and Migraine Relief and Coathanger Pain classes (in Pain Management) and the Head, Neck, and Shoulders meditation in Calm Your Mind are built for exactly this.

MCAS in Autumn: Temperature Swings and the Trigger Bucket

Mast cell activation syndrome (MCAS) is a condition in which mast cells release histamine and other chemicals too easily. Heat, cold, or sudden temperature changes are among the most common triggers.

MCAS diagnoses are common in people with hEDS, and hEDS is common in people with MCAS, though not everyone with hEDS has MCAS. Read more in EDS and Mast Cell Activation Syndrome (MCAS).

Charlotte, who also has MCAS, noticed a new pattern this year:

“I also now get urticaria from the cold (I typically have always had heat and solar triggered urticaria), but now my urticaria is triggered by cold also.”

Ash has MCAS too:

“My bucket is much fuller this time of year so I work harder to try and eliminate triggers.”

The Zebra Club’s Mast Cell Meditation (in Calm Your Mind) is designed to support nervous-system regulation alongside trigger management.

Working WITH the Slide

Working with the October Slide means preparing for it instead of waiting for it: scaling back before symptoms peak, using better-energy days to set up support, and pacing movement and rest to what your nervous system can handle that day.

It can also mean having compassion with yourself, knowing that you are doing your best. It may help to keep your sleep, meals, and routine as consistent as you can.

When joints stiffen and pain increases, moving less often happens on its own. But for a body that stiffens with rest, moving less can make things worse, not better. Generic advice to “move more” doesn’t help if you don’t know how to start safely.

This is where Jeannie’s Integral Movement Method (IMM) comes in: shorter, gentler sessions that work with your nervous system. We have found that working with your baseline and keeping your tissues and fascia hydrated can really help with pain and tension.

The Zebra Club’s Soothe Your Senses for Pain Relief meditation (Calm Your Mind) is a good starting point for this kind of nervous-system work. For an ongoing pattern, the Pain & Flare Recovery Structured Pathway offers more structured support, and the Overload & Recovery Structured Pathway is built specifically around breaking the cycle of pushing through good days and paying for it later.

Here is how some of our members manage:

“I intentionally try to slow down from the middle of October – middle of November. I know this is when people usually ramp up activities, but I need to scale back. I mentally prepare myself several weeks in advance by reminding myself that I may need to give myself extra grace, and time, and I may need to rest more or take it slower.” – Ash

 

“I do change my approach to movement shorter classes and a slower approach.” – Ian

 

“Now, I get a brief respite of energy and ease in my body after the oppressive heat of summer and before the stiffness of autumn settles in. I use it to organize my home for the next phase, one when I will be bundled up again, tending to my body with nervous system work, sleep support, and regular movement so that I don’t freeze up like the Tin Man.” – Jenn

Practical Fall Prep

Practical fall prep means supporting your body before symptoms peak. A few things that can help:

• Keep sleep, meals, and your daily schedule as consistent as you can (5)
• Check the weather forecast to prepare for changes, without letting it dictate your day (5)
• If you have POTS, some people find hydration and compression garments helpful — worth discussing with your care team
• Some members have tried WeatherX earplugs for barometric pressure changes, with mixed results — some find them helpful, others don’t notice a difference
• Layer clothing so you can adjust to swings through the day
• Get outside for natural light, even on grey days
• Prepare freezer meals or “ingredients” in batches for low-energy days

Here’s how our members put it into practice:

“In addition to The Zebra Club’s classes Getting outdoors for 20-30 minutes daily, usually for a walk and sometimes just sitting on a bench with a hot drink and a good book. I find that even on a grey day here in the UK there is still a beneficial amount of natural light and it makes a difference to both my mood and energy levels.” – Savitri

“Getting a bit more sleep, preferably by going to bed half an hour earlier but when that isn’t possible I set my alarm for half an hour later.” – Savitri

The Zebra Club’s Rest & Restore class (Sleep and Fatigue) is built around exactly this kind of pacing.

“I’m looking forward to layering up in my favourite woollies. So much better to be able to control temperature with layers.” – Helene

“I incorporate more cozy things, like soft flannels and fleeces, tea, soups, etc., and am able to batch cook a little more — I do more “ingredients”, like rice, beans, stews, soups, etc., that I can freeze for the times I have less energy.” -Mischa

Loving Fall, Even With the October Slide

The October Slide is real for many people, and so is the love of the season, so is loving the season anyway.

“I love the smell of the crisp air in the autumn, however, I definitely need to take things more slowly, and rest more since the days get shorter and the temps get colder.” – Mischa

“But I love the Autumn 🍂 colours, the smell of Autumn, the warm glow of a sunrises aswell, sometimes the clear night skys bright moon are great to see.” – Ian

“It’s hard because I love this season.” -Ash

“I love all seasons. And I love that it’s getting cooler.” – Helene

Whatever fall looks like for you this year, we have resources for you. Inside The Zebra Club, you’ll find a community of people who understand exactly what you’re describing, along with classes and support built for days like these.

[Join The Zebra Club]

Works Cited

1. Schultz DM et al. Weather Patterns Associated with Pain in Chronic-Pain Sufferers. Bull Am Meteorol Soc. 2020;101(5):E555–E566.
2. Mehta et al. (2024). Headache disorders in patients with Ehlers-Danlos syndromes and hypermobility spectrum disorders.  Neurol. 2024;15:1460352.
3. Farah A, et al. Impact of Barometric Pressure Changes on the Severity, Frequency, and Duration of Migraine Attacks: A Systematic Review of the Literature. Cureus. 2025;17(11):e96821.
4. Denney, D. E., Lee, J., & Joshi, S. (2024).Whether weather matters with migraine. Current Pain and Headache Reports, 28(3), 181–187. 
5. The Migraine Trust. (2023, September).Can weather changes trigger a migraine attack?
6. Wilhour, D. (2025, July 13).A neurologist explains how weather changes can trigger migraines. PBS NewsHour. (Originally published in The Conversation, July 10, 2025.)
7. Di Carlo et al. (2025).Seasonal variation influences fibromyalgia severity in terms of widespread pain among female patients: Data from a large national registry. Clinical Rheumatology, 44, 4671–4679.
8. Topan et al. (2026).Nutrient intake, dietary patterns and relationship to symptoms and comorbidities in hypermobile Ehlers-Danlos syndrome.Clinical Nutrition, 56, Article 106538.
9. Gensemer et al. (2021).Hypermobile Ehlers-Danlos syndromes: Complex phenotypes, challenging diagnoses, and poorly understood causes. Developmental Dynamics, 250(3), 318–344. 
10. Alonso-Pérez et al. (2024).Relationship between serum vitamin D levels and chronic musculoskeletal pain in adults: A systematic review. Nutrients, 16(23), 4061. 
11. Yimer et al.(2022).Heterogeneity in the association between weather and pain severity among patients with chronic pain: A Bayesian multilevel regression analysis. PAIN Reports, 7(1), e963.