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Individual symptoms
Our meta-analysis will summarize the findings regarding eight types of individualsymptom: Backache, headache, eyestrain, sleep disturbance, dizziness, fatigue,appetite, and gastrointestinal problems. We chose these symptoms because theyhave been found to be associated with stress and because for each one there was asufficient number of cross-sectional studies available for a meta-analysis to beconducted (k>5).
Backache. Musculoskeletal pains that originate in the upper back, lower back,shoulders, and neck generally fall into the overarching category of backache. It has been shown that tenderness in muscles and soft tissues such as tendons and ligaments are markedly influenced by the impact of daily stressors (Manne & Zautra, 1989; Zautra et al., 1998). A longitudinal study in individuals with the chronic musculoskeletal pain diseases, specifically Fibromyalgia and arthritis, found that exposure to stressors and negative mood over one week was related to increased reports of pain intensity over the ensuing weeks (Davis, Zautra, & Reich, 2001; Zautra, Johnson, & Davis, 2005). This relationship between stressors and musculoskeletal pain is believed to arise from the low cortisol and elevated prolactin levels present during times of stress, which may increase overall pain sensitivity by downregulation of the immune system and increased inflammation (Huyser & Parker, 1999; McLean et al., 2005; McLean et al., 2006).
Headache. Headache is pain experienced in the upper half and back of the head, arising from a variety of mechanisms. Tension-type headaches in particular are associated with exposure to stressors. The mechanism underlying such a headache is likely multifactorial and mostly neurological in nature (Spierings, Ranke, & Honkoop, 2001). It is widely believed that pain-signalling pathways in the brain can become overly sensitive to painful stimuli when stress is experienced (Bendtsen, 2003). Once the brain is overly sensitive to pain, even the slightest twinge may increase nerve excitability and be translated into pain signals, leading to the increased experience of headaches. This heightened nerve sensitivity leads to increased muscle ctivity, which facilitates muscular tension, thus leading to the co-occurrence of stress-induced back and body aches with headaches.

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