Brad Klein, MD, FAAN, Responds

The answer is yes. Certain types of arthritis, including arthritis of the spine, can trigger a migraine for some people. Arthritis causes inflammation of the joints, which can lead to pain and joint disease. Other symptoms include swelling, stiffness, and decreased range of motion. The types of arthritis that mainly affect the back are known collectively as spondyloarthropathies. Osteoarthritis and rheumatoid arthritis are two of the most common.

Osteoarthritis

Sometimes called degenerative joint disease or degenerative arthritis, osteoarthritis (OA) breaks down the cartilage that cushions the ends of the bones where they meet to form joints. In the spine, the cartilage breaks down in the facet joints where the vertebrae join. Symptoms are pain, swelling, and problems moving the joint. Over time, the bones may break down and develop growths called bone spurs. For some people, bone spurs cause no problems. In others, they cause pain in the neck that radiates to the head, triggering a migraine.

In late stages of OA, the cartilage wears away completely. With no cushioning, bones rub against each other, leading to joint damage and pain that can radiate to the head.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease in which the body's immune system mistakenly attacks the joints, producing inflammation. That inflammation causes the tissue that lines the inside of joints—the synovium—to thicken, resulting in swelling and pain in and around the joints.

Continuing inflammation can damage cartilage and bones. Loss of cartilage narrows the space between bones, which can cause pain. Like OA, rheumatoid arthritis may cause pain in the spine, which may trigger a migraine.

Cervicogenic Headaches

Conditions other than arthritis of the spine can cause a cervicogenic headache, which refers to pain perceived in the head from a source in the neck. This type of headache is secondary to a separate illness or physical problem such as a herniated disk, pinched nerve, tumor, fracture, or RA. It can cause decreased range of motion in the neck or worsening of pain with certain movements or with pressure on the neck. The headache is usually resolved by blocking a cervical structure or its nerve supply.

Some cervical abnormalities can trigger migraine by activating what's called the spinal trigeminal nucleus. Cervical nerves communicate with the trigeminal nerves leading to trigeminocervical complex, which may result in arthritic pain at the front of the head. Not all patients with abnormal cervical spine imaging have migraine triggered by arthritis. Neck pain is the leading symptom of migraine with or without arthritis.

Options for Treatment

Your doctor will determine the cause of your migraine to develop the best treatment plan. That may involve taking X-rays or computerized tomography (CT) or MRI scans. An MRI is used to pinpoint the source of pain as well as evaluate the bones, disks, and soft tissue.

Before taking any medication for pain relief, even over-the-counter pills, speak to your doctor about all the options. Your doctor will likely start with a nonsteroidal anti-inflammatory drug such as naproxen, ibuprofen, or aspirin as it can ease inflammation and pain. Additional options may include nerve blocks for temporary pain relief or steroid injections to treat pain and reduce inflammation.

Neck pain may also be relieved by exercise and physical therapy. Your doctor may take some images beforehand to determine which exercises or physical therapy would help, but not cause pain or injury.

Reducing Stress

Arthritis pain could cause stress, which may worsen the pain. Deep breathing, meditation, and yoga, if advised by your doctor, can help relieve stress.

Missing out on sleep may also trigger headaches. If your arthritis is particularly bad at night and interferes with sleeping, talk to your doctor about ways to improve your sleep. The use of a soft cervical collar at night to stabilize the neck and avoid rotation—which can cause nerve compression—may help.

The timing and doses of your current medication, in addition to when you have caffeine, could also have an impact on your sleep.