Rheumatoid arthritis can trigger serious neck strain and disabling headaches. Learn how to break the cycle.
Maybe you get frequent headaches or even migraine attacks. Maybe your neck throbs, too, and you’re not sure why. Maybe—just maybe—you’re blaming your head and neck pain on how you’re sitting at your desk, clocking in too much screen time, or eating the wrong foods. However, you might be pointing at all the wrong suspects as you try to get to the root of the problem—especially if you’ve already been diagnosed with rheumatoid arthritis (RA).
RA is an autoimmune disorder, which occurs in some people when their immune system goes rogue and mistakenly attacks healthy tissue in the body, causing damaging inflammation. Classic symptoms of RA, including joint pain, swelling, and tenderness, can present throughout the body.
One area RA really likes to target? You guessed right: the neck.
In fact, research shows us that neck pain from RA is found in about half of all people with this condition. Specifically, it drives inflammation in the upper cervical spine, the space known as C1-2. This can trigger what’s called cervicogenic headaches, defined as pain in the neck up to the head through the muscles of the upper neck and also the back of the head, per the National Headache Foundation.
What’s Happening in Your Head, and Why?
But migraine pain is a specific type of headache pain. How can one be triggered by RA? The short answer? Multiple ways.
The first thing to know is that migraine attacks are pretty common in people with this condition—some research shows that people who get them are more likely to have RA. This type of headache, marked by crushing head pain that can be accompanied by light sensitivity, nausea, and even vision problems (called aura), per the Mayo Clinic, can be driven by the systemic inflammation that’s caused by RA. Meaning, the same inflammation that attacks your joints also can cause neurogenic inflammation in the head and neck that triggers migraine.
It’s important to understand that if you do have both RA and migraine, your headaches can be potentially a serious and even life-threatening problem if neck pain is caused by issues with your cervical spine, according to the Arthritis Foundation (AF). Moreover, people with RA have an increased risk of stroke due to narrowed or blocked arteries in the brain caused by RA inflammation.
It’s also important to note that people with RA may have migraine or tension headaches that may not be related to inflammation. One major trigger for people with RA is stress. Stress related to RA can also contribute to increased muscle tension in the neck, which in turn causes headaches. And folks with RA may also deal with TMJ (temporomandibular) joint involvement, which can also trigger jaw pain, neck pain, and headaches.
In addition, some medications used to treat RA, including methotrexate and biologic drugs (which we’ll discuss in just a moment), may occasionally cause headaches, according to the Arthritis Foundation.
Diagnosing and Treating RA Neck and Head Pain
Generally, people with RA and neck pain will have other specific indicators of active joint inflammation associated with RA, including joint swelling, morning stiffness, and fatigue, per the Arthritis Foundation. In other words: Your neck pain is likely related to systemic inflammation that’s happening in your body.
To diagnose you, your rheumatologist will do a neurologic evaluation, which may include testing muscle strength in your arms and legs, and review your balance, gait (walking) and sensation (the ability to feel). Your doctor may also ask you to touch your chin to your chest or tip your head back to determine how much your RA has affected your neck.
After this, if RA is still considered a possible cause of the problem, your doctor will likely have you follow up with imaging tests of your neck, including X-rays and possibly an MRI.
Medications for RA Head Pain
the good news People with RA who are dealing with neck pain, headaches, and migraine have many effective treatment options. What’s right for you and your specific symptoms will be determined after your doctor has examined you and the imagining you’ve had done.
According to John Davis III, MD, a rheumatologist at the Mayo Clinic in Rochester, MN, if you receive an RA diagnosis, you may be treated with disease-modifying antirheumatic drugs (DMARDs). These medications, including Arava (leflunomide), Azulfidine (sulfasalazine), Plaquenil (hydroxychloroquine), and Trexall (methotrexate), are used to slow down the progression of RA inflammation.
Additionally, your doctor may suggest you take over-the-counter (OTC) meds like acetaminophen or ibuprofen (that’s Tylenol or Advil/Motrin to you and me). If headaches or migraine attacks are severe, your doctor may also prescribe stronger medication, like triptans or ergot alkaloids, according to the American Migraine Foundation.
And if your head pain is being triggered by an RA flare, other medications may be prescribed, too. “If there is a flare of RA, prednisone [a powerful steroid that curbs inflammation in the body] might be necessary, temporarily,” explains Dr. Davis. Muscle relaxers may also help alleviate pain, he adds.
At-Home Remedies for RA Neck and Head Pain
There are many safe at-home treatments people with RA can try, says Howard Feinberg, DO, a rheumatologist and professor emeritus at Touro University in Vallejo, CA. These include using moist heat or a cold compress on your neck; sports creams meant for sore muscles can also be used on your shoulders and neck to decrease inflammation.
“Neck pain in RA is very common. It can be a simple cause with simple treatments,” says Dr. Feinberg.
While migraine can be more physically debilitating than regular headaches, some at-home treatments also include using a cool cloth or ice pack on your forehead, closing/resting your eyes in a dark, quiet room, and making sure you are adequately hydrating.
Surgery for RA Neck and Head Pain
In severe cases of neck pain, some people with RA may require surgery, according to Dr. Feinberg. This surgery is a fusion of the first and second neck bones.
“What treatment is required will vary greatly based on the neurologic examination and X-rays,” Dr. Feinberg adds.
The Bottom Line
If your headaches or neck pain are progressively worsening and disproportionate to the degree of other joint pain, you should seek further medical evaluation, advises Dr. Davis. Any persistent neck pain, or new numbness, tingling, and/or weakness should be brought to the attention of a doctor as soon as possible, Dr. Feinberg adds.