What Are The Early Shingles Symptoms? Signs, Treatment, and Avoiding Future Infections

Many people think shingles—a viral infection that causes a painful rash—is something only older people deal with, given that the risk generally increases with age. But Jacquelyn Gill, a professor at the University of Maine, had shingles nine years ago, when she was just 35. Even though health care providers know that younger adults can get the illness, she was initially misdiagnosed with impetigo when she went to urgent care the day her first symptom emerged.

Although Gill wasn’t sure what was going on with her health, she knew something wasn’t right. “I was sitting in a coffee shop on campus grading some papers, and I had what felt like a pimple forming below the corner of my mouth. It was just a little sore, tender spot,” Gill says. “Then I started having this really weird sensation that felt like a zing or buzz on the right side of my face,” she adds, noting that this made her think she was having a stroke or experiencing Bell’s palsy.

Later that week Gill developed a rash along the right side of her face, so she returned to the urgent care center, where a different provider diagnosed her with shingles. Although she was young and healthy, she’d had chicken pox as a child, which put her at risk of developing the infection. “Shingles is caused by the varicella-zoster virus, the same virus that causes chicken pox,” says Shannon Markus, MD, MPH, an emergency physician at Dell Seton Medical Center at the University of Texas at Austin. “After a person recovers from chicken pox, the virus stays dormant in the nerves and can reactivate later in life as shingles,” she adds, noting that the latter illness often appears as a painful, blistering rash on one side of the body. But before anything shows up on the skin, it’s common for people to experience severe pain, burning, throbbing, or itching in an area where a rash eventually forms. This is precisely what happened to Gill. However, these aren’t the only early shingles symptoms that can easily be overlooked or mistaken for another health issue.

The most-overlooked early shingles symptoms

About one third of people in the United States will have shingles at some point in their life, and dermatologists can often diagnose it without even having to do a swab test, mainly because of the rash’s distinct pattern. “Classic shingles, when it happens, is almost like a slam-dunk diagnosis,” says Anthony Rossi, MD, a board-certified dermatologist, dermatologic surgeon at Memorial Sloan Kettering Cancer Center, and fellow of the American Academy of Dermatology.

However, when shingles symptoms don’t present in the usual way or the infection is relatively new, as Gill’s was when she first sought care, it’s possible to be misdiagnosed. That’s especially true if the patient is young and otherwise healthy. If you notice these five early signs of shingles, seek medical care immediately. Getting prompt treatment can ease your recovery and help prevent complications.

Tingling, numbness, and buzzing

While severe pain and burning are typical symptoms, tingling and buzzing sensations, along with numbness, can also be early signs of shingles. “[These symptoms] can be mistaken for irritation, a minor injury, or even a pulled muscle,” Dr. Markus says.

“Similarly, some people feel skin sensitivity or pain in just one area of the body, often on their torso, face, or back. It might feel like sunburn or nerve pain without any visible rash,” says Amanda Levine, MD, a board-certified dermatologist at NYU Langone Health. For instance, she adds, before a shingles rash manifests on a patient’s chest, some people think they’re having a heart attack because of the pain they feel in the area.

Headache, light sensitivity, and vision changes

Head pain or migraines can signal many different viral ailments, including shingles. “Sometimes shingles presents as a really terrible headache, and that’s actually what brings patients into the hospital,” Dr. Levine says. “Then, usually a day or so later, the rash appears near the face or the eyes.”

Others with shingles experience photophobia, or light sensitivity, when the infection affects the area around the eyes. At times patients will mistake this for a migraine or eye strain, Dr. Markus says.

Developing shingles near the eyes can also impact your vision or cause discomfort in the ocular area. “Patients can have eye symptoms, and that can be eye pain, blurred vision, redness of the eye, and swelling of the lid,” Dr. Levine says. “This is important to identify correctly because it can actually be an emergency, and the patient should be evaluated by an ophthalmologist immediately.”

Gill’s biggest concern about her shingles diagnosis was her eye health. “The thing I was most worried about was that [my doctor said if the rash] gets too close to your eye, you could go blind,” she says.

Mouth sores and toothaches

While she was sick, Gill developed painful sores on her tongue and lips called oral shingles, which she says made it hard to eat and talk for about a week. “I had to do all of my chewing on my left side because everything was on the right side,” she says.

She describes these lesions as similar to really bad cold sores. Before the lesions form, it’s possible to mistake the pain for a toothache and experience pain, burning, or tingling inside the mouth.

Fatigue

Unfortunately, not only can shingles leave you drained, but feeling fatigued and stressed can also make you more susceptible to illnesses and infections, including—you guessed it—shingles.

“If you’re feeling fatigued and stressed, your immune system might be dipping down,” Dr. Rossi says. Since shingles is always dormant in your body, it can reactivate when your immune system is compromised, whether from stress or another illness, Dr. Rossi says. “A lot of times when I’ve diagnosed shingles in people, they will say, ‘Oh, I feel really stressed,’ or, ‘I feel fatigued,’” he says. This was precisely the case for Gill: “I got shingles around the first Trump inauguration,” she says. “I literally was in bed from the stress of the new administration.”

Flulike symptoms

Dr. Markus says early shingles symptoms can sometimes mimic signs of the flu or common cold. “Fever, chills, fatigue, and body aches can develop in the early stages of shingles,” she says. As a result, many people may not even consider that they have shingles, given that these symptoms pop up regularly for other more common illnesses. Gill recalls having a moderate fever when she was sick, even though that’s not a typical symptom.

In some cases shingles may even prompt gastrointestinal symptoms. “Shingles can sometimes cause nausea or stomach pain, leading people to believe they have food poisoning or a stomach virus rather than a viral skin condition,” Dr. Markus says.

Preventing shingles

The best way to avoid shingles is to get the Shingrix vaccine. “Shingles is preventable,” Dr. Markus says. Currently, the U.S. Centers for Disease Control and Prevention (CDC) recommends the shot for those 5src and older, as well as for individuals with weakened immune systems. “The vaccine is quite effective at preventing shingles and its complications,” says Dr. Markus.

One of the long-term risks of shingles is postherpetic neuralgia (PHN), which causes chronic burning and stabbing pain. According to the CDC, PHN can last for months or years after a shingles rash disappears, and the pain can be debilitating. Gill says nearly 1src years after she got shingles, that spot where her rash first developed—the area where she thought she was getting a zit—will vibrate when she’s about to get sick. “It will sort of buzz a little bit,” she says. “It’s giving me a little warning, like, ‘Oh, you’re about to get a cold.’” Luckily, the vaccine is designed to protect against PNH, so don’t opt out just because you made it through shingles unscathed. “You can still get vaccinated to prevent future outbreaks, even if you’ve previously had shingles,” Dr. Markus adds.

Diagnosing and treating shingles

If you think you have shingles, getting a diagnosis as soon as possible will help you ensure a successful recovery—and avoid serious health complications. Since Gill’s shingles case was originally misdiagnosed, she missed her window to get antiviral medication, which could have sped up her recovery and offered more protection against long-term side effects. “The medication works best when taken within 72 hours of the appearance of the rash, so catching it before it gets to this particular phase is ideal,” Dr. Levine says.

Shingles can happen to anyone, which is why early detection and treatment are so important. Gill says she has quite a lot of colleagues in academia who were diagnosed with shingles before the age of 4src, just like her. “It’s actually remarkably common among my friends and colleagues because we work in a high-stress environment,” she says.

Don’t let that scare you, though. Shingles can be sneaky, but if you pay attention to what your body’s telling you—and advocate for yourself at the doctor’s office— it’s possible to secure the correct diagnosis early on and get yourself on the fastest (and smoothest) track to feeling better.

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