Dear Doctor,

For two weeks now, I have had a headache in the left side of my head. It has become so bad that even my ear hurts sometimes. I have taken medication, painkillers of every nature but this headache won’t go away. I visited a doctor about two days ago who examined me and said I had an ear, nose and throat infection and proceeded to give me antibiotics which don’t seem to be helping. Do I need a scan or something? I’m seriously worried because the pain won’t go away.

Julia, Kacyiru

Dear Julia

The pain in the head along with ear infection could be due to acute otitis; that is acute inflammation of the middle ear. The ear, nose and throat are anatomically connected to one another. Hence microbes and subsequent infection and inflammation can easily pass on from one part to another.

Ears get infected readily by insertion of foreign objects like needles, pins, etc. which people use for scratching or cleaning. Water getting in the ears perhaps when swimming also becomes a source of infection. Recurrent cold due to allergy, viral infections of the upper respiratory tract, exposure to draughts of cold air can also cause congestion and inflammation of the middle ear.

Microbes commonly implicated in causing ear infections are Streptococcus pneumoniae, haemophilus influenzae, and Moraxella catarrhalis which commonly cause throat infections as well. Middle ear infections are very common in small children as they have a small Eustachian tube (tube connecting the middle ear to the throat. But they occur frequently in adults as well. Immune depressed people like those with diabetes/HIV infection, among others, are more prone to such infections.

Diagnosis of these infections is easily done by clinical features and a complete total and differential blood count. Treatment is by suitable antibiotic. Precise causative organism and specific antibiotic can be determined by the culture of a specimen from the site. It is a curable condition. But two days with an antibiotic is too early to judge a response. As one takes antibiotics at the scheduled time intervals, gradually, a certain level of the antibiotic builds up in the blood which stops growth of microbes or kills it.

Therefore antibiotics are prescribed for a week, 10 days or longer. In your case along with the antibiotic, it would be good to take some anti-inflammatory drug like ibuprofen or diclofenac for a short duration, say two to three days. As the ongoing inflammation gets suppressed, the pain will also reduce.

Any infection or inflammation of the teeth, eyes or any facial structure can also result in headache as all these parts share a network of nerves. But in these cases, along with headache, there would be localised pain, swelling and redness, over the affected part.

A severe one sided headache can be due to infections of the brain substance or its coverings.

Here, along with severe pain, there can be high fever, neck stiffness, altered consciousness and other neurological signs. Middle ear infections, if persistent or untreated, can spread to the brain. A stroke (where blood supply to the brain is suddenly cut off) can also cause severe headache but there would be overwhelming neurological symptoms. A CT scan of the brain can confirm these conditions.

Some types of severe headaches like migraines, cluster headaches, and others, occur due to stress and tend to occur on one side. They are relieved by relaxation and some specific drugs.

Dr. Rachna is a specialist in internal medicine at Ruhengeri Hospital.