FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

SOLVING THE CASE OF "HEADACHE AND HOT EARS" MAY NOT BE EASY

Question: For the past year I have been having days with symptoms that keep me from feeling well. My aches migrate from joint to joint -- one time it will be my thighbones, and the next week it may be my elbow. I feel tired even when I've slept well. I also have my ears get hot for no apparent reason, and when this happens I frequently get a headache. What could be causing these problems?

Answer: The symptoms you describe can be caused by a number of illnesses. Consequently, I can't tell you specifically what is causing you to feel this way. What I can do, however, is explain the approach your doctor will take to help you find out the nature of your malady. 

The first step we physicians take in determining the nature of any illness is to listen to the patient. I know -- some of us are better at this than others. As part of that listening process, we must ask a host of "doctor-type" questions to find out about your medical history. These might include the way your symptoms began, how they are now, what you do to feel better, what you do that makes you feel worse, and questions about medical problems you've had in the past. With this information your doctor is ready to do a physical examination. After combining information from your history and your physical examination, your doctor will compile a short list of ailments that could possibly produce your combination of normal and abnormal findings. 

Tests are ordered to determine which of the ailments on the short list of possibilities is the actual cause of your symptoms. Many people don't understand that this is often a lengthy process requiring repeated trips to the lab, X-ray or hospital for additional studies. After a correct diagnosis has been established, the proper treatment can be started. I know that this entire process sounds complicated, and it is. 

Now to address your symptoms: The fatigue you report can be produced from almost any ailment from allergies to cancer -- with non-life threatening illnesses being far-and-away the most common. The "on again-off again" aching in your bones and joints is a less common complaint. There are several types of arthritis that can do this, but so can simple conditions such as fatigue, muscle overuse and depression. 

Elephants have large ears to help cool their bodies. African elephants have larger ones that Indian elephants because of the hotter African climate. We humans have a rich blood supply to our ears, too, although it is insufficient to contribute substantially to body temperature regulation. Despite this, when we get hot (or when we blush) there is increased blood flow through our ears. Yours apparently "get hot" at times other than these. Drugs can cause this. Non-prescription drugs like niacin, aspirin and ibuprofen can cause flushing as can a wide range of prescription medicines. 

The headache you experience at the same time you have hot ears makes me suspicious that the blood vessels supplying your brain are also having some change from the normal pattern of blood flow. Both symptoms may actually be a form of migraine headache. An alternative explanation is that they both result from some more generalized circulatory condition that also has increased blood pressure. They could even be the consequence of eating MSG. 

It is possible that you have more than one condition producing your combination of symptoms, although since they all started together it is logical to think that there is a single common cause. I think you are beginning to see why I said that this process of figuring out the cause of a group of symptoms is complicated. In fact, I think it is sufficiently complicated that you should make another appointment to see your doctor.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.