Association of Headache, Body Ache, and Fever with Common Colds

The common cold is one of the most frequently encountered disease in our medical practice. Despite the usually nonthreatening nature of this illness, it plays a vast economic burden on our country due to expenses from visits to physicians, treatments, and work absences. Common cold is defined as an acute, self-limiting viral infection of the upper respiratory tract involving the nose, sinuses, pharynx and larynx. Rhinoviruses account for 30–50% of all colds while coronaviruses are the second most common agent, accounting for 10–15% of colds. These viruses are spread through direct or indirect contact with secretions from an infected person or from aerosol.

Common colds can be mistaken for other upper respiratory tract diseases such as allergic rhinitis, sinusitis and most commonly as flu. In contrast to common colds, allergic rhinitis is often accompanied by a seasonal pattern of clear rhinorrhea along with family history of allergy and associated asthma and eczema. On the other hand, sinusitis, as opposed to common cold, occurs when the sinus lining becomes inflamed blocking the drainage of mucus produce by the sinuses. We often see patients with sinusitis complaining also of facial pain with yellow or green nasal discharge resulting from trapped mucus. Moreover, it is difficult to define common cold from flu exactly due to similarity of most symptoms. Flu which account for 5–15% of colds is caused by Influenza viruses. Both patients may present with headache, sneezing, chilliness, sore throat, nasal obstruction, cough, body aches and fever. Common cold symptoms typically peak at 1–3 days and usually last 7–10 days while Influenza is usually more severe and sudden in onset. Cough and fever are the best predictors differentiating influenza from flu-like symptoms.

Common cold diagnosis is frequently made upon consult at the clinic. The diagnosis is typically based on symptoms and physical examination only and laboratory tests are not useful.

Common colds accounts for up to 40% of work absences among the economically active population in the United States. Among the symptoms of common colds, fever, headache and body aches are one of the most bothersome. Our immune response to this viral infection is the main factor in generating these symptoms. The macrophage which is the major cell monitoring our body for the invasion of pathogens trigger an acute phase immune response. It was said that the surface of these macrophages exhibits toll-like receptors which then combine with the components of these viruses and trigger the production of cytokines. These cytokines then act to recruit other immune cells, trigger inflammation, and generate systemic symptoms which may then cause fever. Sensation of chilliness and shivering could have triggered when the cytokines cross the blood–brain barrier or interact with the vagus nerve endings to signal the temperature control center of the hypothalamus to increase thermal set point.

Headaches and muscle aches are seen in nearly 50 percent of common cold sufferers. The mechanism by which headache is caused by cytokines is unknown. But some studies showed that these cytokines present in common cold increase the levels of prostaglandin E2 in the brain and CSF causing headache. Meanwhile, patients with common colds also experience muscle aches and pains also due to the effects of these cytokines. These cytokines induce the breakdown of muscle proteins and production of prostaglandin E2 in skeletal muscle which may cause these body aches.

Antibiotics do not decrease the duration or severity of common cold but may increase adverse events. There are also no antiviral medications available for treatment but alleviating the symptoms is possible. Nonpharmacologic measures include adequate hydration, balanced diet, vitamins, herbal supplement and enough rest.

On the other hand, there are a lot of medications for pain, fever, cough and colds readily available at our local pharmacy including decongestants, antihistamines, NSAIDS, paracetamol, and cough suppressants. Nasal congestion which is caused by the dilation of large veins in the nasal epithelium as a result from inflammation is one of the most common symptoms of common cold as well. Hence decongestants like phenylephrine, which may be taken with or without antihistamines are found to be effective for short-term relief of cold symptoms. These are found to decrease nasal edema to improve air intake. NSAIDS such as ibuprofen have proven its efficacy to control pain and decrease inflammation, however its use has been limited to patients with comorbidities like kidney failure and peptic ulcer disease. Paracetamol which is also one of the most used drugs over the counter has been recommended as a first-line drug in pain management. This is partly because of its safety and tolerability especially among the elderly population in addition to its potent analgesic and antipyretic effects. Moreover, antihistamines have been helpful to relieve runny nose, sneezing and watery eyes.

Studies showed that a triple combination of analgesic, decongestant and antihistamine are found to be safe and more effective in the symptomatic treatment of the common cold. Antihistamines found in some fixed dose combination medications for common colds however may cause drowsiness, blurring of vision and dizziness. This can possibly interfere with work activities and hence can be one of the limitations on its use. Combination with analgesic and decongestant such as phenylephrine and paracetamol would therefore be advantageous in alleviating the symptoms of common colds especially when taken during working hours.