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Lyme Disease

A bacterial infection spread by the bite of an infected blacklegged tick — in California, the western blacklegged tick. Caught early, it is treated with a few weeks of antibiotics and most people recover fully; untreated, it can reach the joints, heart and nerves.

Call 911 if, after a tick bite or an expanding rash, someone faints, has chest pain, or feels very weak, light-headed or short of breath. Lyme disease can infect the heart (Lyme carditis) and block its electrical signals, causing light-headedness, fainting, shortness of breath, palpitations or chest pain; severe cases need immediate hospital care (CDC). Chest pain and feeling faint can also be heart attack signs, which always mean calling 911 (CDC).

  • A drooping face can be a stroke. Lyme disease can cause facial palsy (CDC), but call 911 at once if the face droops suddenly along with arm or leg weakness or numbness, confusion, trouble speaking or seeing, loss of balance or a sudden severe headache — and don’t drive yourself (CDC).
  • A severe headache with a stiff neck can be meningitis, including Lyme meningitis (CDC). The NHS advises emergency care for a very painful headache, or a stiff neck with trouble looking at bright lights (NHS); in the U.S., call 911 or go to the ER.

See a provider the same day if, days to months after a tick bite or time where ticks live, you notice:

No herb, supplement, adjustment or needle treatment can treat Lyme disease. Antibiotics are the only known effective treatment (NCCIH).

What is Lyme disease?

Lyme disease is a bacterial infection spread by the bite of an infected blacklegged tick. In the U.S. it is caused by Borrelia burgdorferi and, rarely, Borrelia mayonii. Early symptoms are fever, headache, tiredness and a rash called erythema migrans; untreated, the infection can spread to the joints, heart and nervous system (CDC). Prompt antibiotic treatment can cure it and prevent the complications of late Lyme disease (CDPH).

How ticks spread it

  • The blacklegged or “deer” tick spreads Lyme disease in the East and Midwest; the western blacklegged tick (Ixodes pacificus) spreads it along the Pacific Coast (CDC), including California (CDPH).
  • In most cases a tick must be attached for more than 24 hours to pass on the bacteria, so prompt removal greatly lowers the risk. Young ticks (nymphs) are the size of a poppy seed, and many people with Lyme disease never knew they were bitten (CDC).
  • There is no credible evidence that it spreads by touching, kissing or sex, or from pets directly — though pets can carry ticks indoors (CDC).

For avoiding and removing ticks, see our Insect Bites & Stings guide.

How common is it?

More than 80,000 cases are reported to CDC each year (CDC) — 89,468 in 2023, the latest year in CDC’s tables (CDC). Reports miss many cases: an estimate from insurance claims suggests about 476,000 people may be diagnosed and treated each year, possibly an overestimate because billing codes don’t always reflect a confirmed diagnosis. Surveillance also misclassifies some cases, counts people where they live rather than where they were infected, and has changed its case definition several times, most recently in 2022 (CDC). Most cases occur in the Northeast, mid-Atlantic and upper Midwest (CDC).

The stages of Lyme disease

Early localized: the rash (3 to 30 days after a bite)

The erythema migrans (EM) rash appears in about 70% to 80% of infected people, on average about 7 days after the bite. It expands over several days to as much as 12 inches (30 cm) or more, may feel warm, and is rarely itchy or painful. It is not always a bull’s-eye. Fever, chills, headache, tiredness, aches and swollen lymph nodes can come with or without it. A small red bump that appears right away and fades in a day or two is not Lyme disease (CDC). On brown or black skin the rash may look more like a bruise (CDPH, NHS); CDC shows its many forms and its look-alikes (CDC).

Early disseminated: the infection spreads (days to months)

  • More EM rashes elsewhere on the body (CDC).
  • Nerve problems: facial palsy on one or both sides; shooting pain, numbness or tingling in the limbs; and Lyme meningitis, with fever, headache, stiff neck and sensitivity to light. Of every 100 cases reported to CDC, about 9 involve facial palsy and 3 meningitis or encephalitis — figures that may overstate what clinicians usually see (CDC).
  • Lyme carditis, in about 1 in 100 reported cases: “heart block” that can change quickly (CDC). See our Heart and Fainting guides.

Late: Lyme arthritis (months after a bite)

Lyme arthritis usually begins one to a few months after infection, with obvious swelling of one or a few large joints, most often the knee. Swelling can come and go or move between joints. It accounts for about 1 in 4 reported cases, and without prompt treatment it can permanently damage the joint (CDC). See our Arthritis guide. Rarely, untreated serious symptoms can be fatal (CDPH).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Antibiotics — most often doxycycline, amoxicillin or cefuroxime — for 10 days to 4 weeks depending on the stage; IV antibiotics for some heart and nervous-system cases; sometimes a single dose of doxycycline after a high-risk tick bite; and symptom care, not more antibiotics, for lingering symptoms. Cost estimate being researched. People treated early usually recover rapidly and completely. Most treated later also respond well, though some have lasting joint or nerve damage. Lyme carditis usually resolves within 1 to 6 weeks.
Chiropractic No role in treating the infection. We found no studies of chiropractic care for Lyme disease. Joint swelling, nerve pain or a drooping face after a tick bite needs a medical evaluation first. Not a treatment for Lyme disease, so no cost is listed. A chiropractor who suspects Lyme disease should refer you for testing and antibiotics.
Acupuncture No role in treating the infection. We found no clinical trials of acupuncture for Lyme disease — only a mouse study and two single-patient reports. Not a treatment for Lyme disease, so no cost is listed. At most, possible help with pain after antibiotic treatment. Never a substitute for antibiotics.
Herbal medicine No herb cures Lyme disease; antibiotics are the only known effective treatment. Herbal “Lyme protocols”, colloidal silver, bismuth injections and dozens of other marketed remedies are unproven, and some have caused serious harm. Plant-based repellents do help prevent tick bites. Not a treatment for Lyme disease, so no cost is listed. No effect on the infection. Using these products instead of antibiotics lets the infection spread to the heart, nerves and joints.
Massage therapy Comfort only. Gentle massage may ease aches and stress during recovery; it doesn’t treat the infection. Research is limited to one single-patient case study. At one national chain, about $125–$160 for a 60-minute massage without a membership, or about $70–$90 a month for a membership with one session. Possible short-term relaxation and relief. Not for a hot, swollen joint or an undiagnosed illness.
MBHA Wellness Coach Tick-bite prevention and daily tick checks, knowing the warning signs, and — for lingering symptoms — pacing, sleep habits, preparing for medical visits and steering clear of unproven treatments. Cost estimate being researched. Fewer tick bites, earlier care if symptoms appear, and steadier day-to-day recovery. Coaching supports, never replaces, medical care.

Approach 1 of 6

Conventional medicine (AMA)

People treated with appropriate antibiotics early usually recover rapidly and completely. The antibiotics most often used are doxycycline, amoxicillin and cefuroxime axetil; the choice and length depend on symptoms, age, allergies and pregnancy, and most cases are treated for 10 days to 4 weeks (CDC). CDC’s regimens are consistent with guidance from the Infectious Diseases Society of America, the American Academy of Neurology and the American College of Rheumatology (CDC). We don’t list doses.

  • EM rash: treat promptly, without waiting for a blood test, which is often negative in the first weeks. CDC lists doxycycline for 10 to 14 days, or amoxicillin or cefuroxime for 14 days; when lengths work equally well, the shorter is preferred to limit side effects such as infectious diarrhea and antibiotic resistance (CDC).
  • Facial palsy: oral doxycycline for 14 to 21 days, with eye drops or a patch if an eye won’t close. Meningitis or nerve-root pain: oral doxycycline or intravenous (IV) ceftriaxone for 14 to 21 days, depending on severity (CDC).
  • Carditis: mild cases take oral antibiotics for 14 to 21 days; severe cases need hospitalization, heart monitoring and IV ceftriaxone, and some need a temporary pacemaker. Most recover within 1 to 6 weeks (CDC).
  • Arthritis: a 4-week (28-day) oral course, with a second course — IV ceftriaxone if there was no response — when swelling persists. If swelling continues after two courses, it is thought to be immune-driven; more antibiotics haven’t been shown to help, and a rheumatologist can advise (CDC).

One dose of doxycycline after a tick bite

In certain circumstances, a single dose of doxycycline after a tick bite where Lyme disease is common may lower the risk (CDC). CDC’s flowchart for clinicians considers it when the bite happened where ticks are likely infected (or you recently traveled there); the tick was removed within 72 hours; it was engorged with blood, since a flat tick is unlikely to have spread infection; it was or may have been a blacklegged tick, or can’t be identified; and doxycycline is safe for you, considering allergy, pregnancy and breastfeeding. CDC says the single dose is safe for all ages, including young children (CDC). In the original trial of 482 people, the rash developed in 0.4% of those given doxycycline and 3.2% given placebo; nausea and vomiting were more common with the drug (Nadelman et al., 2001). It hasn’t been shown to prevent other tick-borne diseases (CDPH).

Recovery and reinfection

Most people treated in later stages also respond well, though some have lasting nerve or joint damage. Anaplasmosis, the most common co-infection, is treated by the same antibiotic (CDC). Having Lyme disease once doesn’t protect you from getting it again (CDPH).

Who to see, and what it costs

Family doctors and pediatricians usually manage Lyme disease; infectious disease specialists are often best for complicated cases (CDC). Cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating Lyme disease, a bacterial infection treated with antibiotics (NCCIH). A PubMed search we ran in October 2026 found no treatment studies — only a 2016 review explaining CDC’s blood testing to chiropractors, because people with Lyme symptoms may come to their offices (Miraglia, 2016), and a 1990 report of a tennis player treated for neck pain whose migrating joint pain later proved to be Lyme disease (Brier, 1990).

The lesson: joint swelling, nerve pain or a drooping face after time in tick country needs a medical check before hands-on care. Spinal manipulation often causes brief soreness or stiffness, and rare serious problems have been reported (NCCIH).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has no role in treating the infection, and we found little research. A PubMed search in October 2026 found no clinical trials in people — only a study of electroacupuncture in mice with Lyme arthritis (Akoolo et al., 2022) and single-patient reports, such as a boy with Lyme facial palsy who had acupuncture after 4 weeks of antibiotics (Molsberger et al., 2016). One case can’t show that a treatment works.

For lingering symptoms after treatment, CDC suggests strategies developed for ME/CFS may help (CDC), and its ME/CFS page says acupuncture by a licensed practitioner might help pain for some patients (CDC). Nonsterile needles or poor technique can cause infections and other injuries (NCCIH).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb cures Lyme disease. Antibiotics are the only known effective treatment; “natural” cures such as herbal therapy and essential oils haven’t been shown to work, and some may be harmful (NCCIH). A PubMed search we ran in October 2026 for clinical trials of herbal or plant-based treatments for Lyme disease returned no records.

Herbal “Lyme protocols” and other remedies are marketed widely. A 2015 review of websites selling non-antibiotic Lyme treatments found more than 30, from oxygen and energy therapies to nutritional and heavy-metal treatments; the medical literature didn’t support them, and many were potentially harmful (Lantos et al., 2015). Garlic supplements and colloidal silver are among the unproven treatments given for “chronic Lyme” (CDC, MMWR 2017).

  • Bismuth injections (“bismacine”). In 2006 the FDA warned against this unapproved injectable, high in the heavy metal bismuth, after one death and a hospitalization; bismuth poisoning can cause cardiovascular collapse and kidney failure (FDA, 2006).
  • Colloidal silver isn’t safe or effective for any disease, according to the FDA. It can permanently turn the skin bluish-gray and can reduce absorption of some antibiotics (NCCIH).

Where plants do help is prevention: oil of lemon eucalyptus and 2-undecanone are among the EPA-registered tick repellents CDC recommends (CDC). See our Insect Bites guide for safe use.

Approach 5 of 6

Massage therapy

Massage doesn’t treat Lyme disease, but it may bring comfort. The only study we found followed one young woman, whose pain, fatigue and concentration problems were lower during weeks with massage (Thomason and Moyer, 2012) — too little to draw conclusions. For lingering symptoms, CDC’s ME/CFS strategies include gentle massage and heat for pain, and massage and relaxation for stress (CDC).

Serious problems are rare but have been reported, some with deep tissue massage, and massage shouldn’t delay seeing a provider (NCCIH) — a hot, swollen joint or an expanding rash needs a diagnosis first. At one national chain, a 60-minute massage runs about $125–$160 without a membership, or about $70–$90 a month with one (The Pricer).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help with the everyday side of Lyme disease, alongside — never instead of — medical care.

  • Prevent bites: EPA-registered repellent, long sleeves and pants or permethrin-treated clothing, tick checks of your body, gear and pets (including after yard work), and a shower soon after coming in (CDC). A hot dryer for 10 minutes kills ticks on clothes (CDPH). Details are in our Insect Bites guide.
  • If you’re bitten: remove the tick right away (CDC), note when and where, photograph any skin change, and tell your doctor about outdoor activity and travel (CDPH).
  • Pace your recovery: CDC suggests ME/CFS strategies for lingering symptoms (CDC) — learn your limits, plan activity and rest to stay within them, keep a symptom diary, avoid “pushing” on good days, and break big tasks into small steps. Keep good sleep habits, and use calendars for memory (CDC). A doctor can support a gradual return to work or school (NHS). See also our Chronic Fatigue guide.
  • Partner with your clinician: explain how you feel, start with your most important questions, and set achievable goals together (CDC).
  • Avoid unproven offers: some websites sell tests and treatments not supported by evidence (NHS), and some labs that don’t take insurance use tests that aren’t FDA-cleared (CDC). Get a second opinion before committing to long treatment or an IV line.

Another approach

Lyme disease in California and on the Central Coast

CDPH lists the San Francisco Bay Area and Central Coast, the northern coast and the northern Sierra foothills among the places Californians are more likely to get Lyme disease; about 1 in 3 California cases are infected out of state. Unlike in the East, risk here is highest from late fall through early summer (CDPH): adult western blacklegged ticks are most active in fall and winter, nymphs in spring (CDPH). Nymphs hide in leaf litter and on logs and rocks in shady oak woodlands; adults wait on grass and shrubs along trails (CDPH).

From CDPH’s 2025 Vector-Borne Disease Section report (CDPH, 2025 annual report):

  • 114 cases were reported statewide in 2025, 84 of them confirmed.
  • From 2016 to 2025, rates were highest in north and central coastal counties. Santa Cruz County reported 85 confirmed cases — the most of any county — a rate of 3.16 per 100,000 people per year, second only to Mendocino (3.41) and far above the state’s 0.20. Monterey County reported 5 confirmed cases and San Benito 1. Cases are counted by home county, not where the bite happened.
  • In 2025, 4.6% of individually tested nymphs and 0.9% of adult western blacklegged ticks carried Lyme bacteria.

Another approach

How Lyme disease is diagnosed

A provider weighs your symptoms, likely tick exposure, other possible causes and, when needed, lab results (CDC). An EM rash is diagnosed by sight and treated without waiting for tests (CDC). Later, CDC recommends a two-step antibody test with FDA-cleared tests on one blood sample; it is positive only if both steps are (CDC). Tests are often falsely negative early but have good sensitivity after 4 to 6 weeks (CDC), so you may need a repeat test (MedlinePlus). Antibodies can stay positive for years after cure, and other conditions can cause false positives (CDC). There is no evidence that Bartonella or Mycoplasma “co-infections” are spread by ticks (CDC), and CDPH doesn’t recommend testing a removed tick to guide treatment (CDPH).

Another approach

When symptoms linger: post-treatment Lyme disease syndrome

Most people recover completely after 2 to 4 weeks of antibiotics, but some have lingering tiredness, aches or trouble thinking. Six months after treatment, these symptoms are 5% to 10% more common in people who had Lyme disease than in those who didn’t. The cause is unknown; similar symptoms follow other infections, including COVID-19. CDC calls this post-treatment Lyme disease syndrome (PTLDS) (CDC). The NHS notes such symptoms can last years and are often compared to fibromyalgia and chronic fatigue syndrome (NHS).

These symptoms are real and can cause considerable suffering. The hopeful news: people with PTLDS usually improve over time without more antibiotics, though it can take many months (CDC, MedlinePlus). Because fatigue and aches have many other causes — other infections, medicines, depression, diabetes, even cancer — work with your provider to check them all, and to treat the symptoms that affect you most (CDC). There is no proven treatment for PTLDS (MedlinePlus).

Another approach

“Chronic Lyme” and long-term antibiotics

CDC discourages the term “chronic Lyme disease” because it implies an ongoing infection when the cause of lingering symptoms isn’t known (CDC). The diagnosis has no consistent definition, is sometimes made without lab evidence or likely tick exposure, and can leave the real cause of symptoms undiagnosed (CDC, MMWR 2017).

If you’ve been told you have chronic Lyme disease, you deserve care that takes your symptoms seriously. Ask what the diagnosis is based on and what evidence supports the treatment, and consider a second opinion from an infectious disease specialist (CDC).

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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