Patients often present with painful legs and these are almost never due to varicose veins or underlying venous problems. Although pain is a very subjective sensation and what is painful for one person may be an ache for someone else, patients almost never have pain as the presenting problem. This is because the discomfort due to vein problems is at worst a score of 3 and more likely to have a score of 1 or 2. (On a pain scale of 0 to 10 where 0 = no pain, 10 = unbearable pain.) The sensation in the overwhelming majority of patients is that of a mild ache.
There is often no discomfort even for very large varicose veins. The pattern of any discomfort is very characteristic if it due to veins. It is invariably absent upon awakening and gets worse as the day goes on. It gets better with elevation of the leg. It does not wake people at night. It is not present during exercise but may be most noticeable after exercise. It gets worse with time. It is worse in warmer weather (and periods) and after standing for long periods of time. It is improved by the wearing of compression stockings.
Ache in the legs that does not have these characteristics is very unlikely to be due to vein problems. Conversely an ache in the legs that does have this pattern is not always due to vein problems. A higher pain score of 5+ is never due to vein problems unless there is an associated ulcer (infected). Interestingly, leg pain or ache is not a good indicator of the severity of the underlying problem. Many very large varicose veins do not ache at all and in some patients even spider veins give some aching.