Every few weeks it’s the same. The headache, the aching body, the tiredness sleep doesn’t touch, the heat in your body. You buy malaria drugs at the chemist, finish them, feel a bit better, and then it comes back. One colleague says do a full body check. Another says it’s stress.
No. Stress can’t cause malaria. Malaria is an infection with a parasite, passed to people through the bites of infected mosquitoes, and the only way to know if you have it is a test. What stress can do is cause headaches, body aches, tiredness and poor sleep that feel a lot like malaria, which is why so many Nigerians end up treating stress as malaria, sometimes for months. Our guide to stress in Nigeria explains stress itself. This piece is about telling the two apart.
See a doctor first
Malaria kills. In 2024 Nigeria accounted for 31.9% of malaria deaths in the World Health Organization’s African Region, which has about 95% of the world’s malaria. So never assume a fever is stress.
Get tested the same day if you have a fever, chills or shivering, sweats, a headache, muscle pains, unusual tiredness, vomiting, diarrhoea or no appetite. These are malaria’s common early signs. The WHO notes they can be mild, especially in adults who’ve had malaria before, so mild doesn’t mean it isn’t malaria.
Call 112 now, or 767 in Lagos, or get to the nearest hospital if someone has:
- extreme tiredness or weakness
- confusion, drowsiness or trouble staying awake
- fits (convulsions)
- difficulty breathing
- dark or bloody urine
- yellow eyes or skin, which can be harder to see on dark skin
- unusual bleeding
The WHO says untreated malaria from the parasite most common in Africa can become severe and kill within 24 hours. Babies, children under five, pregnant women and people with HIV are at higher risk of severe malaria, so don’t wait with them.
What malaria is, and why stress can’t cause it
Malaria is caused by Plasmodium parasites. You get it through the bite of an infected female Anopheles mosquito, and more rarely through a blood transfusion or a contaminated needle. It doesn’t pass from person to person like a cold. Symptoms usually start 10 to 15 days after the bite.
Stress changes your hormones, your sleep, your muscles and your mood. It can’t put a parasite in your blood.
A large 2004 review of more than 300 studies found that long-running stress was linked with weaker results on immune tests, but we couldn’t find good evidence in people that stress makes malaria more likely or more severe. It still takes a bite from an infected mosquito, and the protection is what the WHO recommends: sleeping under a mosquito net, repellent, coils, covering up in the evening and screens on the windows.
Why stress feels like malaria
The two overlap in the vague symptoms, the ones that make you feel unwell without telling you why. Fever is the clearest difference.
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| Symptom | Malaria (WHO, NHS) | Stress or depression (NHS) |
|---|---|---|
| Headache | One of the commonest early signs | A classic stress symptom |
| Body aches | Muscle pains | Muscle tension or pain; unexplained aches in depression |
| Tiredness | Feeling very tired; extreme tiredness in severe malaria | Lack of energy in depression; tiredness from stress and poor sleep |
| Stomach | Feeling or being sick, tummy pain, diarrhoea, no appetite | Stomach problems; eating much more or less than usual |
| Fever and chills | The key signs | Not on the NHS lists for stress or depression |
Many Nigerians describe stress and anxiety as heat in the body, and our guide to heat in the body explains that idiom, but feeling hot isn’t the same as a fever on a thermometer. If you have a thermometer, use it. A real fever means a malaria test, whatever else is going on in your life.
Test before you treat
The WHO recommends that every suspected case of malaria be confirmed with a parasite test before treatment: a rapid diagnostic test, or microscopy, where a lab looks at your blood under a microscope. Ask for a test at a clinic, hospital or lab before you buy treatment.
Treating every tiredness as malaria has costs.
- The real cause goes untreated. It might be another infection. A 2026 review of fever studies across 20 African countries found that, among fevers where no cause was obvious, viruses were the culprits reported most often. It might be anaemia, diabetes or a thyroid problem. Or it might be stress or depression.
- You pay for medicine you didn’t need, and take on its side effects for nothing.
- You learn to skip the test. You feel a little better after a rest and a course of tablets, so next time you skip it again.
Health workers do it too. A 2016 review of 14 studies in sub-Saharan Africa found that health workers went by a negative malaria test about 78% of the time. Roughly one person in five who tested negative was still given malaria treatment. If your test is negative, ask what else it could be. If you still have a fever after a negative test, or you’re getting worse, go back the same day.
After the negative tests: is it stress or depression?
If you’ve tested negative more than once and the tiredness, headaches and aches keep coming back, it’s time to look wider.
The NHS lists the common reasons for tiredness that won’t go away: not enough sleep, insomnia, an unhealthy routine, stress, depression, and life’s hard stretches, such as bereavement or a new baby. It also lists medical causes a doctor can test for, including iron deficiency anaemia, diabetes, an overactive thyroid and sleep apnoea. See a doctor who can check for those, and take an honest look at your life, before you reach for another round of malaria drugs.
Signs that point towards stress or burnout:
- the symptoms track your workload, worse in the month of targets, exams or family wahala and better on leave
- headaches, tight shoulders, a churning stomach and broken sleep arrive together
- you’ve become snappy, you’re eating or sleeping much more or less than usual, avoiding people, or drinking or smoking more
- you no longer feel rested after a weekend off
If it’s work that’s grinding you down, it may be burnout, which is more than ordinary tiredness. For the wider picture of what stress does to the body, read our guide to stress in Nigeria.
Signs that point towards depression:
- low mood, hopelessness or loss of interest most days, for weeks
- lack of energy, unexplained aches and pains, and disturbed sleep, which are among the NHS’s physical signs of depression
- changes in appetite or weight, or moving and speaking more slowly than usual
- it’s getting in the way of work, family or friends
Our guide to depression in Nigeria covers it in full. At work, “I have malaria” is easier to say than “I’m not coping”, so ask yourself which one is true.
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What to do
- Get tested. Every fever, every time.
- If the tests are negative, see a doctor about the tiredness instead of repeating treatment. Ask whether you need blood tests for anaemia, diabetes or your thyroid.
- Look honestly at the stress. Sleep, workload, money, family, grief. Write down what’s pressing on you and what you can change this month.
- Talk to someone if it’s stress or low mood. The NHS lists talking therapies such as cognitive behavioural therapy (CBT) among the treatments for tiredness, depending on its cause.
When a therapist helps
A therapist can’t diagnose malaria or stand in for a test. Once malaria has been ruled out, a therapist can help with the stress, burnout or low mood behind symptoms that keep coming back. Therapists who work with stress and burnout are on Mytherapist.ng, by video, voice or chat, and they work alongside your doctor, never instead of one.
If stress or low mood has brought thoughts of harming yourself or ending your life, call 112 now, or 767 in Lagos, or Safe Place Nigeria on 0800 800 2000, free and answered 24 hours a day. The full list is on our helplines page.
Frequently asked questions
Can stress cause malaria?
No. Malaria is caused by a parasite passed on by infected mosquitoes. Stress can cause headaches, body aches and tiredness that feel similar, but only a malaria test can tell you whether you have it.
Can stress cause malaria symptoms?
Some of them. Stress can cause headaches, muscle aches, stomach problems, poor sleep and tiredness. Fever and chills aren’t on the NHS lists of stress symptoms, so if you have them, get tested.
Why do I feel like I have malaria but my test is negative?
Possible reasons include another infection, poor sleep, anaemia, diabetes, a thyroid problem, stress and depression. See a doctor rather than treating yourself again, and go back the same day if you have a fever or are getting worse.
Can stress weaken your immune system?
Long-running stress has been linked with weaker results on immune tests in a large review of more than 300 studies. That hasn’t been shown to make people more likely to get malaria, which still needs a bite from an infected mosquito.
Should I take malaria drugs without a test?
The WHO recommends that every suspected case be confirmed with a rapid test or microscopy before treatment. A test tells you whether it’s malaria, and a negative result points you towards the real cause.
This article is awaiting clinical review. It’s based on published research and health guidelines, and we’ll update it once a clinician has reviewed it.
