The doctor says you're just stressed. But could it be more sinister
00:32 GMT, 9 October 2012
Patronised: Victoria Saxton was even prescribed an antidepressant to help her cope with migraines
Victoria Saxton had just handed in her first essay at Cambridge University when she suddenly developed a stabbing pain in the back of her head. ‘I felt like I had a dagger plunged in the left side of my head,’ she recalls.
‘The pain was radiating across into my eye socket — it felt like my eyeball was being pulled out. I honestly had no idea what was happening to me.’
Paracetamol and ibuprofen failed to touch the pain. Victoria, who was in her first term at university studying theology, had to lie down for three days, relying on friends to bring her food and water.
‘After a few days, I went to see a GP. He said it was muscle tension from the stress of studying — but this diagnosis totally went against personality type for me. I had never been headache-prone, and usually thrived on pressure. I was head girl at my school, and loved responsibility.’
The muscle relaxant the doctor prescribed had no effect, and Victoria’s headaches became progressively debilitating. Sometimes she would have no choice but to spend days at a time in bed.
She was referred to a neurologist, who diagnosed migraine triggered by stress. Over the next five years, she struggled to find a treatment that had any effect on the headaches, with every expert she saw coming to the same conclusion: stress was the cause of the problem.
At one stage, she was even prescribed the antidepressant Prozac to help her cope with it.
‘I found their attitude incredibly patronising, because I would get migraines when I had absolutely nothing to worry about, and had no pressure,’ she says. ‘I’d even get them when I was on holiday.’
Eventually she found a specialist centre and was prescribed drugs that made some difference.
But it wasn’t until last year — 12 years after her symptoms started — that she finally got to the bottom of things after mentioning to her physiotherapist that she’d been suffering numbness in her shoulder and left arm.
An X-ray and CT scan revealed Victoria had damage to vertebrae and discs in her neck and upper back, including a minor spinal fracture. The damage was from a car accident just before her A-levels, but had never been diagnosed.
‘My doctors now believe it was this physical injury that triggered the start of my migraines,’ says Victoria, who lives in Kew, South-West London.
While stress is undoubtedly a factor in exacerbating some illnesses, patients like Victoria feel increasingly frustrated that it is sometimes given as a catch-all diagnosis, when they actually have a very real underlying medical condition that requires proper treatment and medication.
As a result, they can suffer for months or years with the wrong treatment, says Dr Giles Elrington, a consultant neurologist at Barts and the Royal London Hospital, and director of the National Migraine Centre in London.
‘If I had a pound for every patient I see who is told their headache is down to stress, I’d be a rich man,’ he says. ‘Saying headaches are just down to stress won’t do.
‘While stress, or the let-down period after stress, can trigger migraine attacks, it occurs in only 10 per cent of cases.
‘The reality is that there are lots of other triggers, including dehydration, skipping meals, lack of sleep, disruptions to the body clock, poor posture and hormone changes — yet these are often overlooked.’
The problem is by no means limited to migraines. Heart rhythm problems such as atrial fibrillation, diabetes, overactive thyroid, fibromyalgia (a chronic pain condition) and even cancer are among other conditions that can be mistaken as stress, as Lisa Moss was to discover.
When she started suffering sudden tummy pain, diarrhoea and wind, her GP diagnosed irritable bowel syndrome. He advised her to avoid stress — a known trigger for the condition. But her symptoms continued and she lost a stone in a few months, despite eating well. Again, her doctor said the weight loss was likely linked to stress.
‘I was told to persevere with the IBS treatments,’ says Lisa, 49, who lives with her husband Nick and two sons in Southampton.
It was only after her symptoms worsened, a couple of months later, that Lisa was finally sent for an internal investigation — and was devastated to be told that she had bowel cancer.
The lower section of her bowel was removed and she had six months of chemotherapy.
An X-ray and CT scan revealed Victoria had damage to vertebrae and discs in her neck and upper back
‘It meant I had wasted six months fruitlessly treating IBS, when I really had bowel cancer,’ says Lisa, who still undergoes regular check-ups. Dr Martin Johnson, pain specialist for the Royal College of General Practitioners and a trustee of the Patients Association, says: ‘We’re seeing more patients suffering from stress in our surgeries, and in all the millions we see there are inevitably some who will slip through the net and get given the wrong label.
‘The problem is the interaction between stress and pain is massive. If you look at the area of the brain responsible for stress, anxiety and depression, it is very close to the area responsible for pain. One feeds off the other. For instance, when you’re stressed, your body naturally produces more adrenaline, and this causes physical symptoms such as palpitations and dry mouth.’
Dr David Jones, consultant in rheumatology at the London Bridge Hospital and a specialist in chronic musculo-skeletal pain conditions, including fibromyalgia, agrees that if a patient has complex symptoms that don’t point to an obvious diagnosis, then doctors can wrongly conclude they’re being caused by stress. ‘In my practice, I see patients who have come to a specialist late because they have been all round the houses with their doctor.
‘Their doctors have concentrated on the peripheral symptoms, such as stress and anxiety, without investigating what is making them feel this way.
‘These patients may appear stressed — but they can be stressed because they are coping with the pain of an underlying physical illness.
‘This is partly because there are certain conditions — such as fibromyalgia and migraines, for instance — which can’t be diagnosed with tests or scans, and rely on the patient describing their symptoms.
‘There is still a tendency among some doctors to attribute medically unexplained symptoms to stress, because blood tests and imaging results are normal.’
He says the key to distinguishing between stress and an underlying medical condition is a thorough consultation where the patient describes all their symptoms and gives a timeline of when they started.
When Ann Robinson developed Crohn’s disease — an inflammatory bowel disease — doctors told her it was stress brought on by her mother’s death.
‘I started having constant diarrhoea and my weight dropped from 10 st 5 lb to less than 9 st in eight months,’ says Ann, 61, who is divorced and from Easington, Yorkshire. ‘My GP said it was the effect of my bereavement and I believed him — and put up with it for years.’
Seven years after her symptoms started, she was rushed to hospital with excruciating stomach pains, and it was discovered that her bowel was diseased. She had to have three bouts of surgery to remove sections of intestine which were blocked, and is still prone to flare-ups.
‘I feel that if Crohn’s disease had been diagnosed earlier and not dismissed as stress, these blockages and the surgery needed afterwards might have been avoided,’ she says.
Sometimes, though, it’s patients who convince themselves their symptoms are stress-related — as 51-year-old Jade Smith discovered.
‘I did have the symptoms of stress, such as irritability, exhaustion, lack of concentration and depression. But, looking back, it was always more than that — I was literally in pain from my head to my toes. I wasn’t able to sit up, let alone stand, for more than half an hour a day. I couldn’t bear noise and my legs kept going into spasm.’
Jade, from Mytholmroyd, West Yorkshire, saw her GP and was offered antidepressants. She was forced to give up her job as a social worker because of her ill health.
Finally, after many years of pain and fatigue, her GP diagnosed her with fibromyalgia — a condition which causes pain in the muscles, tendons and ligaments, and affects an estimated 1.76 million people.
‘Until that point, I’d believed it was all caused by stress,’ says Jade, who is now in a wheelchair. ‘Stress can be a factor, but fibromyalgia is also a physical illness in its own right. I think too many women are just told they’re stressed and accept it, and it’s not properly investigated.’
Victoria Saxton finally has her migraines under control, with weekly physiotherapy and regular nerve block injections and a prescription for the epilepsy drug Topamax, which is commonly used to treat migraines, too.
‘Finding the right treatment has taken a long time, but now I finally know the underlying physical cause, it’s easier to manage,’ she says. ‘I suspect there are lots of people, like me, who just end up being labelled stressed-out and neurotic, when they actually have a real physical illness.’
Visit migrainemonologues.com and migraineclinic.org.uk