These subtle symptoms can be easy to brush off but could signal everything from heart disease to cancer.
When you’re in pain, you know about it. From a broken ankle to a nasty burn, you will remember exactly where you were and what you were doing when it started.
“Aches, however, are different,” says Dr Wendy White, an NHS GP based in Surrey, England. “They tend to come on a bit more innocuously.” Many will put off seeking help until it begins to interfere with their daily activities. But just because an issue is rumbling in the background rather than seriously impacting your life, it doesn’t mean it isn’t important to get it checked out.
“I remember one patient in her 50s who had a nagging ache in her side,” says White. “She put up with it for months as it wasn’t really stopping her from doing anything. When she eventually did come in, she also had very high blood pressure and traces of blood in her urine. It turned out that she had a kidney tumour.
“Nine times out of 10, that ache won’t be something serious like cancer, but any unexplained symptom that persists warrants a discussion with your doctor,” she advises.
Here, White explains the four aches she wishes her patients didn’t ignore and what they could mean.
1. Headaches
Headaches are a common issue, and while they’re usually caused by dehydration, poor sleep, stress, eye strain or a hangover, if you have a persistent ache that doesn’t go away with simple painkillers, then it’s worth asking questions, says White.
Obstructive sleep apnoea
“Patients often present with a headache that starts right from the moment they open their eyes in the morning, but because it clears within a couple of hours, they have allowed the issue to go unchecked for ages. This type of headache can be due to obstructive sleep apnoea [OSA], where the throat muscles relax and block the airway during sleep. If they admit to snoring, waking with a dry throat or daytime sleepiness, then further investigation at a sleep clinic can check for OSA.
“OSA increases your risk of cardiovascular disease and stroke in the longer term as it raises the stress hormone cortisol and spikes blood pressure,” White explains.
Sleeping on your side, using a CPAP machine at night or losing weight can help. “It’s even one of the qualifying conditions for GLP-1 weight loss injections if clinically appropriate,” she adds.
Arteritis
If you have a headache only on one side, it could be temporal arteritis, a sight-threatening condition also known as giant cell arteritis, says White.
“Patients complain of a headache on one side and say their temple is tender to touch, it hurts to brush their hair or they have an ache in the jaw when chewing,” White explains. “In advanced cases, there’s also blurred vision. It’s caused by inflammation in the arteries on the temples and can be treated with steroids, but needs urgent treatment as it comes with a risk of permanent sight loss if it compromises blood flow to the optic nerve.”
High blood pressure
Having ongoing, throbbing headaches might mean it’s time for an urgent blood pressure review. “For the vast majority, high blood pressure does not come with symptoms, but sometimes very raised blood pressure may trigger headaches, particularly during physical activity,” says White.
2. Stomach aches
Stomach aches can be caused by all sorts of common issues, from food poisoning to constipation. “But there are persistent stomach aches that require medical attention,” says White.
Gastritis
“If you have an ache or a feeling of fullness at the top of the stomach between your ribs that is usually worse after you’ve eaten or lain down in the evening, then it could be gastritis,” says White.
This is inflammation of the lining of the stomach and can be brought on by taking anti-inflammatory medication such as aspirin or ibuprofen, or by bacterial infections such as Helicobacter pylori (H. pylori). Alcohol can also cause gastritis, while spicy or fatty foods can aggravate symptoms.
“One patient knew he got terrible gastritis when he ate fried fish, and wasn’t very happy when I suggested the solution might be to stop eating it,” recalls White. “But no amount of medicine will fix the fact your body doesn’t like that particular food.”
If you leave gastritis untreated, it can worsen and may lead to a stomach ulcer. In severe cases, ulcers can cause potentially life-threatening bleeding, so it’s important to get advice from your GP if these symptoms apply to you, says White.
Coeliac disease and IBS
Other issues that might initially present as stomach aches are coeliac disease – an autoimmune condition in which the immune system reacts to gluten, damaging the lining of the small intestine – and irritable bowel syndrome (IBS).
“It can be very difficult to tell simply by the symptoms which of those two might be the issue,” says White. “They’re not usually severe right from the outset, but come on gradually with a range of complaints from stomach ache to wind, cramping, diarrhoea or constipation. Some patients will tell you their stools look grey and greasy – this can occur with coeliac disease – and this can be one way to tell the difference, before referring for further tests.”
Cancer
Ovarian cancer can be difficult to spot because its symptoms are often vague and can be mistaken for more common conditions. One possible symptom is an ache in the abdomen or pelvis, says White.
“Quite often, women will also complain that they feel bloated and put that down to things like water retention or menopause. They may describe needing to urinate more frequently or notice a change in their bowel habits because a mass on your ovary occupies that same space as those organs.”
Finally, “if you experience a stomach ache that persists for three weeks that you don’t have a cause for, it really does need investigation, particularly if it is accompanied by a change in bowel habit, weight loss, fatigue or blood in your stools,” says White. “These could all indicate bowel cancer. Don’t let fear or embarrassment be the reason you miss out on what is often a very effective treatment when we catch things early.”
3. Chest ache
Chronic chest pain can sometimes be linked to indigestion or anxiety, but it could also signal something more serious.
Heart attack
Nobody says “I’ve got a chest ache”, but it’s a phrase White says many patients – particularly women – will use to describe the sensation of having a heart attack. “They don’t quite realise what an emergency this is, so they arrive at the surgery and instead of saying they’re in pain, they describe an ache,” she says.
“While men tend to describe crushing central chest pain, women may have a more vague set of symptoms, and may complain of having an ache or a heaviness in their chest, sometimes accompanied by difficulty breathing, nausea or vomiting, sweating or jaw and back pain. This needs urgent medical attention.”
Angina
Angina is also often described as an ache rather than a pain. It is often caused by coronary heart disease, which occurs when fatty deposits narrow the arteries, limiting the blood supply to the heart.
“Somebody might be digging in the garden, or running around with their grandkids and get an ache in the chest which might stop them in their tracks, but wears off after five or 10 minutes of rest,” says White. “They assume they overdid it a little, or blame indigestion, but it’s important to always have coronary heart disease in the back of your mind when someone talks about an achy chest.”
4. Backaches
While backache is often put down to poor posture or simply getting older, there are certain types that need medical attention.
Arthritis
If you have a long-standing achy pain in the spine, then arthritis is probably your No 1 cause, says White. “And if that suddenly gets worse in one spot, sometimes without you doing anything major, then it’s important to see your GP to rule out compression fractures, also known as ‘wedge fractures’. These can result from osteoporosis of the spine and people don’t always know they have it.”
Nerve problems
There are two types of more general backache that should have you seeking medical advice straight away.
“A low backache that niggles, and sometimes radiates through the buttocks and down the legs, can suggest nerve irritation. Often caused by pressure from an intervertebral disc, it can develop into something called cauda equina syndrome [CES], where the nerves at the bottom of the spinal cord become compressed. This warrants an urgent trip to your doctor or even the emergency department,” says White. “The red flag symptoms that accompany the backache are a loss of sensation in the inner thighs, buttocks and genitals – called saddle anaesthesia – and changes in bowel and bladder function.
“CES usually requires emergency surgery and, if untreated, can cause permanent paralysis or long-term loss of bladder and bowel control.”
Cancer
Finally, a constant, worsening backache could be a sign of metastatic cancer, a secondary cancer that has spread from its point of origin. “Prostate, breast and lung cancer are the big three that spread to the spine – but not the only ones,” says White. “A bit like a toothache, this backache can wake you from sleep and doesn’t get better with a change in position. You can’t wriggle your way out of it.
“If you have a history of cancer, even if it’s been treated years ago, or if your backache is accompanied by other symptoms such as weight loss or fatigue, don’t ignore it. Any ache that is new, persistent or getting worse is worthy of a discussion with your GP.”