While Lyme Disease symptoms are depressingly diverse in their expression and severity, a few occur in nearly all patients.

Girl with closed eyes and hands on head thinking about Lyme Disease Symptoms

Lyme disease symptoms include headaches and other flu-like symptoms

One of the biggest obstacles to acquiring a Lyme Disease diagnosis is the fact that Lyme Disease symptoms are incredibly variable. Worse, each case is different, and the common symptoms occur during different stages of the disease; that is, some appear when the infection is new, others when it’s chronic.

The various symptoms that present during the various stages of Lyme Disease could fill a book; and indeed they have, more than one. But in this article, we’ll take a look at the four most common.

Lyme Fatigue

Fatigue is the single most common symptom of Lyme Disease, and seems to be characteristic of all stages of the illness. Its severity increases from the early stages through to the late, disseminated stage, when it becomes chronic and particularly damaging.

It begins as a general lack of energy during the early localized infection, advancing to unexplained tiredness in later stages until it becomes a pervasive, crushing fatigue so debilitating that some patients just can’t get out of bed.

Yet even the most profound fatigue isn’t immediately diagnostic of Lyme Disease, according to the stringent guidelines most doctors labor under. Often, they only take it into consideration if the diagnostic erythema migrans (EM) rash, Lyme arthritis, and positive laboratory tests also occur.

Lyme Arthritis

A remitting and relapsing arthritis, characterized by redness, joint swelling, and fluid build-up, is one of the most recognizable symptoms of Lyme Disease — though it can be mistaken for normal arthritis or other problems. In some patients, an odd, migrating pain that travels from one joint to another may accompany it.

Typically, Lyme arthritis isn’t permanent, which is one way to distinguish it from regular arthritis. However, the episodes are painful, and may last for six months or more. Sometimes, it disappears from one group of joints only to appear in another.

While Lyme arthritis usually responds to antibiotic treatment, it doesn’t always. This has led to speculation that some cases are due to an autoimmune dysfunction left over after the actual Lyme infection has gone away.

Erythema Migrans (EM)

Aside from positive results in two unreliable laboratory tests, the medical powers-that-be consider the erythema migrans “bulls-eye” rash to be the only truly diagnostic symptom of Lyme Disease. Even then, some doctors will dismiss it if they don’t believe Lyme Disease occurs in your area, no matter how textbook the rash is.

The EM is a red rash with a central clearing that gradually expands from the site of a bite, though it can spontaneously recur elsewhere on the body as the infection spreads. It appears mostly during the early localized infection of the first four weeks, but can recur as much as four months later.

Unfortunately, the EM rash fails to appear in at least 40% of infected individuals, and when it does, it may occur in an area that’s not obvious. Worse, it’s hard to see on dark-skinned individuals, because it resembles a simple bruise.

Flu-Like Symptoms

This is a symptom set rather than a single symptom, but it’s characteristic of early Lyme infections. Headaches, muscle aches, fever and transient joint pain may all occur, but are often ignored and/or misinterpreted because they’re typical of other, more common (and more expected) illnesses.

Associated symptoms like stiff neck, chills, and swollen lymph nodes can accompany this basic suite of symptoms, and again, may mask a new Lyme Disease infection. They do respond to antibiotic treatment, but then, these symptoms tend to, whatever causes them.

The only way to be absolutely sure that these are Lyme Disease symptoms is to observe them in concert with other accepted symptoms and clinical markers.