Ankylosing Spondylitis and Headaches

Could your headaches be related to your Ankylosing Spondylitis?  It is possible.   

 

Dr. Brad Klein,  Medical Director of the Abington Headache Center in Abington, PA and Clinical Associate Professor of Neurology at Thomas Jefferson University in Philadelphia mentioned in Brain and Life Magazine (April/May 2019 issue) that arthritis of the spine (spondyloarthropathies) can trigger headaches for some, especially if the arthritis causes pain in, or damage to, the neck. 

There are 2 types of headaches in general:  Primary headaches, which are the result of some type of abnormality in the brain or head.  Tension headaches, cluster headaches and migraine headaches can fall into this category.   

 

The second type of headache is called a Secondary headache.  This is the type of headache that may be related to your Ankylosing Spondylitis.  In these types of headaches, they are caused by an underlying disease or medical condition, especially inflammatory disorders that affect the neck.  In this category are what we call "cervicogenic headaches."  

Classifying the type of headache that you have is very important, as it will ensure you receive appropriate treatment, and even more importantly, are not prescribed a course of treatment with unnecessary risks and side effects that have absolutely no benefit to your particular type of headache and may even make the situation worse.  For example, you could begin to experience medication-induced headaches, which are caused by taking either painkillers or migraine medication (such as Triptans) too regularly.

What are cervicogenic headaches?  Basically, these are headaches caused by damage and inflammation in the neck, or cervical area, yet the pain is perceived to be in the head.  Often times the pain radiates to the eye (orbital) area and/or the front of the head.  About 1%-2% of people in the general population suffer from these types of headaches, and women seem to be more affected than men.  In fact, women are reported to be 4 times more likely to have cervicogenic headaches.   Interestingly, women also are more likely to experience neck pain due to their Ankylosing Spondylitis than men are.

Clinical studies have shown that pain from the upper joints in the cervical region, as well as muscles and connective tissue, can often refer pain into the head. In fact, the pain is often felt more prominently in the head than it is in the neck, although it is originating from the neck.  

How can you tell the difference from a migraine headache and a cervicogenic headache, since migraines also can sometimes include neck pain?  Both types of headaches can result in nausea and throwing up, sensitivity to lights and sounds, and sometimes blurry vision.  Both types of headaches can last for days.

 

With cervicogenic headaches, the pain often starts in the neck FIRST and then migrates to the head, whereas with migraines, the pain usually starts in the head first, and may migrate into the neck.  Also, with cervicogenic headaches, there must be some sort of physical or structural damage to the neck region, or an underlying disease process that can cause inflammation to the neck.  Frequently there is reduced range of motion in the cervical spine and the presence of painful joint dysfunction in the neck.  However, with migraines there does not have to be any particular physical problem with the neck.  Cervicogenic pain is usually a steady pain (rather than a throbbing pain), and is also often accompanied by a stiff neck.  The pain associated with a cervicogenic headache is typically restricted to the areas of the neck (the occipital region), and the frontal, temporal and eye (orbital) regions of the head.  The pain is often (but not always) unilateral, meaning on one side of the neck and head and frequently patients with this type of headache have altered neck posture.

How to Treat These Types of Headaches

 

Pharmaceutical medications often prove to be of little help in treating Cervicogenic headaches.  Injections of botulinum toxin type A (botox) have recently been employed as a means for deadening the area where the nerves in the neck are affected.  These injections work only temporarily and have various outcomes of success for individuals. 

Nerve blocks have also been used both for diagnostic and treatment purposes.  If numbing the cervical structures stops the headache, then that can confirm the diagnosis of a cervicogenic headache,  and it also can provide relief from the pain.  One of the biggest benefits from the nerve blocks is that by alleviating the pain, an exercise regimen then becomes possible, which can maintain and possibly even restore flexibility, as well as strengthen the muscles that stabilize the cervical region.  Physical therapists are sometimes employed for assistance in finding the most appropriate and safe exercises for the neck.

Cervical blocks, however, are not without their risks, and if they work, their effects do wear off.  A cervical block involves receiving an injection of a numbing chemical into particular nerves.  Sometimes it is a challenge to know exactly which nerve or nerves are involved in your particular pain, and therefore, the procedure may not work or may only work with minimal effectiveness.  Also, side effects, including death in rare cases, have resulted from nerve blocks.

Many patients with Ankylosing Spondylitis who suffer from headaches that originate from the cervical region prefer instead to block their pain with patented therapeutic magnets, such as Quadrabloc,  since they have no known side effects (even after decades of use), and can work indefinitely (as long as you leave the magnet on) and can be moved around as needed.  When placed correctly, by blocking the pain signals in the neck region, you can prevent the headaches that originate from this area.  By reducing or eliminating the pain, you can benefit from physical therapy and exercises to strengthen the area, whereas the previous pain may have made this prohibitory.

To learn more about how these magnets work and how you can obtain them,  CLICK HERE!

Other ways to prevent and manage cervicogenic headaches:

1.  Pay attention to your posture 

2.  Avoid prolonged periods in any particular position, such as sitting for too long

3.  Use a desk that can easily adjust to raise or lower to a standing or sitting position

4.  Drink plenty of water

5.  Exercise regularly to encourage good blood supply to the neck area and to maintain flexibility

6.  Sleep in a position that supports your neck in the proper position.  A small neck roll placed under the curve of your neck, without pushing your head forward, works well (a rolled up towel works well, or an appropriate cervical pillow).  Some patients use a soft cervical collar during sleep to prevent injuring the area at night time.

7.  Many patients find relief with massage therapy, acupuncture, deep breathing and relaxation practices

8.  Soaking in hot baths with epsom salt can help to relax the muscles that can become very tense and tight in the neck region as a result of pain.  Likewise, neck wraps that can be microwaved and then placed around the neck often help to relax the muscles.

9.  Topical rubs that reduce inflammation and pain, such as magnesium lotion, Arnica lotion, or products with menthol, can provide temporary relief.

10.  Some patients have found benefit from prescribed lidocaine patches that they can place on their neck.

REFERENCES:

Book "Wolff's Headache and Other Head Pain- Seventh Edition", Chapter 19 "Disorders of the Neck: Cervicogenic Headache". John G. Edmeads

 

David Biondi. Cervicogenic Headache:  A Review of Diagnostic and Treatment Strategies. The Journal of the American Osteopathic Association, April 2005, Vol. 105, 16S-22S.

Blau JN, MacGregor EA. Migraine and the neck. Headache. 1994;34:88-90.

Sjaastad 0, Saunte C, Hovdahl H, Breivik H, Gronback E. “Cervicogenic” headache. A hypothesis. Cephalalgia. 1983;3:249-256.

Edmeads J. The cervical spine and headache. Neurology. 1988;38:1874-1878.

Pollmann W, Keidel M, Pfaffenrath V. Headache and the cervical spine: a critical review. Cephalalgia. 1997;17:501-516.

Marcus D, Scharff L, Mercer MA, Turk DC. Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups. Headache. 1999;39:21-27.

 

Martelletti, P. & van Suijlekom, H. CNS Drugs (2004) 18: 793. https://doi.org/10.2165/00023210-200418120-00004