Rheumatoid arthritis and headaches

Contents

When Rheumatoid Arthritis Gives You a Headache

If you have rheumatoid arthritis (RA) and experience frequent headaches, you’re not alone. According to one report, about 61 percent of people with severe headaches or migraines also have chronic pain conditions, including RA.

Rheumatologist Eric Ruderman, MD, a professor of medicine at the Feinberg School of Medicine at Northwestern University in Chicago notes, “We don’t really think about a headache link,” with RA. He does acknowledge, though, that people with RA who have involvement of the cervical spine — the neck region — may have headaches related to RA.

Perhaps the more pressing problem faced by people with rheumatoid arthritis is how to manage headache pain, should it occur. Depending on your RA treatment plan, you could already be taking what seems like a small pharmacy of medications. It is important to make sure that you avoid interactions between the medications you take for RA and anything you want to take for a headache.

“If you start popping aspirin, ibuprofen, or naproxen on top of a prescription non-steroidal anti-inflammatory drug, you are overdoing it,” warns Dr. Ruderman. These medications can interact with each other and cause side effects that harm the kidneys and gastrointestinal tract. He advises sticking with acetaminophen for your average headache.

Managing Headaches and RA

Here are some other tips for responding to a headache:

  • Question your RA treatment. If you’ve taken Tylenol several days in a row and your headache is sticking around, you might want to talk to your rheumatologist to make sure that it’s not a side effect of your treatment or a new symptom (especially if you suspect that your shoulders or neck might be affected by rheumatoid arthritis).
  • Consider your stress level. One possible reason that people with complicated health problems like RA also have headaches is stress. Stress management techniques, including appropriate exercise, deep breathing, or meditation, can help cut back on headaches as well.
  • Stay hydrated. Independent of RA, you can get headaches if you don’t drink enough fluids during the day. You probably know how important it is to care for yourself, but even the most dedicated patient can forget to drink water when life gets busy.
  • Get enough sleep. People who don’t get high-quality sleep may also experience more headaches. Because RA pain can interfere with sleep, it may also contribute to headache pain. If you are having a hard time sleeping, let your doctor know. Likewise, any caffeine you may be relying on to get over fatigue can also contribute to headaches.
  • Avoid cigarette smoke. For some people, smoking and being around secondhand smoke can trigger headaches — yet one more reason to avoid cigarettes and secondhand smoke exposure!

Rheumatoid arthritis can be tough enough at times — you certainly do not need headache pain on top of everything else you are managing. If your headaches interfere with your quality of life and are not responding to acetaminophen, it’s time to talk to your doctor.

25 Oct Arthritis

Posted at 18:25h in Headache Fact Sheets by headache

Headaches and arthritis are common problems and, therefore, create considerable interest in the possible role of arthritis in causing headaches. Several major forms of arthritis exist. Two of the most common types are rheumatoid arthritis and osteoarthritis.

Rheumatoid arthritis may begin at any age. It is a condition in which the body misconstrues its own tissues as being foreign and attacks them, leading to destruction of the bony areas around the joints. This condition may afflict any of body’s joints and usually produces a deformity of the joint. The hands and fingers no longer appear straight but often appear angled towards one side. In some cases the spine may be involved, frequently the cervical spine (the vertebrae of the neck). The areas of the neck most commonly afflicted by rheumatoid arthritis are the first and second cervical vertebra.

The more common form of arthritis is osteoarthritis. It is a wear-and-tear form of arthritis and usually does not produce deformity of the joints or destruction of the bony tissues. Rather the ligaments weaken and may be calcified due to the body’s attempt to heal the damage. The larger joints of the body and those joints that take the most stress and strain are the most often afflicted. In the neck region osteoarthritis usually involves the fifth, sixth and seventh vertebrae, as the effects of posture produce the most fatigue on them.

During the workup for arthritis, a test evaluating inflammation and the sedimentation rate will be performed. In rheumatoid arthritis, this test will usually be elevated. Other tests for inflammation may also be elevated. In patients with osteoarthritis, x-rays of the neck or jaw joints will show changes from “lipping” of the vertebrae (caused by calcium deposits in the ligaments), narrowing of the space between the vertebrae, or spur formation (from calcium deposits). If severe, it may cause obstruction of the holes where the nerves pass from the spine to the body. In rheumatoid arthritis, dislocation of vertebrae may occur in the upper neck. CT scan and MRI in patients with osteoarthritis may show bulging of the discs that cushion the vertebrae. In the most severe cases, herniation of the discs may occur.

Headaches, felt as a pain in the neck, may be caused by arthritis if the first, second or third vertebrae are involved. This condition is due to the nerves that supply the scalp only originating from this area of the spine. Neck pain itself, whether alone or coupled with headaches, can involve any portion of the neck. If the jaw is involved, the symptoms are similar to those of Temporomandibular Joint Syndrome (TMJ).

The progressive severity of rheumatoid arthritis may be slowed by a variety of very potent prescription medications. In osteoarthritis, its progression is not usually hindered by medication. Life-style adjustment, exercise, rest and weight loss may be helpful in slowing the advancement of the disorder. Medications, such as the nonsteroidal anti-inflammatory agents (NSAIDs), are useful in reducing the pain and improving the reduction of motion that occurs in joints afflicted by arthritis. From some studies, the use of acetaminophen appears to be as effective in controlling the pain of arthritis as the NSAIDs. Physical modalities including heat, massage and exercise may also be useful for arthritis. However, physical therapy must be prescribed by a physician, just as most medications for arthritis.

Neuropsychiatric manifestations are quite common in rheumatoid arthritis (RA), according to a comprehensive review published in Autoimmunity Reviews.1 Though most commonly known for its destructive effects on joints, RA can also affect the central nervous system (CNS), spine, and brain.

“Neuropsychiatric manifestations — especially mood disorders and headache — are frequently observed in RA,” lead author Andrei Joaquim, MD, from the Department of Neurology at State University of Campinas (UNICAMP) in São Paolo, Brazil, told Clinical Pain Advisor.

“It is of paramount importance for neurologist and rheumatologist to understand the nuances of neurological symptoms in RA patients for a proper diagnosis and an adequate treatment,” write Dr Joaquim and colleague Simone Appenzeller, MD.

Accordingly, Drs Joaquim and Appenzeller searched the medical literature for studies on neuropsychiatric manifestations of RA, categorizing them according to central or peripheral nervous system involvement (Table).1 The most common symptoms and their probable etiology were included in the review.

Mood Disorders and Cognitive Impairment

The most common symptom observed in RA patients was headache, potentially resulting from the disease process, treatment, or comorbid conditions unrelated to RA.

Depression and anxiety were likewise common, affecting up to 40% of patients. The prevalence of depression was higher than that of the general population (risk ratio = 2.06; 95% confidence interval , 1.73-2.44, P < 0.001), but comparable to that observed in other chronic or disabling diseases.

RELATED: Migraine and Headache Treatments

Anxiety was reported in 21% to 70% of RA patients, often occurring in conjunction with depression. Depression was linked to a higher risk for suicide and mortality, while anxiety was associated with increased sensitivity to pain and suffering.

Patients with RA also appeared to have higher rates of cognitive dysfunction than the general population, particularly in areas of visual-spatial perception and planning. Cognitive dysfunction was associated with impaired functional ability, reduced quality of life, and poor medication adherence.

This article originally appeared on Clinical Pain Advisor

What’s the link between brain fog and rheumatoid arthritis?

Share on PinterestPoor memory and trouble concentrating are characteristics of brain fog.

People mostly associate RA with swollen and painful joints. However, for many people with RA that is only one of the symptoms they face.

RA is a chronic condition that causes inflammation throughout the body. This inflammation can lead to joint pain and stiffness, swelling, and decreased joint mobility. RA can also affect the eyes, skin, lungs, and brain.

Many people with RA and other chronic inflammatory conditions also complain of feeling mentally foggy and having difficulty thinking.

Scientists believe there may be a link between chronic inflammation and the cognitive impairment that people refer to as brain fog.

A 2018 study published in Nature Communications looked at how chronic inflammation might affect the brain. They used MRI scanners to take images of the brains of 54 people with RA.

The results showed a link between RA inflammation and changes in the patterns of brain connections. It also showed a lower volume of gray matter in an area of the brain known as the inferior parietal lobe.

The study suggests that fatigue, pain, and an impaired ability to think are associated with these brain changes.

Researchers believe these alterations to brain tissues may have a role in converting inflammation signals to the rest of the central nervous system.

A larger study from 2013 looked at 115 people with RA. This research also found that RA is related to an impaired ability to think.

The results suggest that the risk is higher in people who use corticosteroids as an RA treatment and who have risk factors for heart disease, which may include high blood pressure or high cholesterol.

Lastly, people living with chronic pain may find themselves distracted by the pain, and the fatigue the pain causes. Not only does pain pull a person’s focus away from mental tasks, but it may disrupt the amount or quality of sleep they get, leading to tiredness.

People who sleep poorly often report feelings of being not as alert or feeling foggy.

Rheumatoid Arthritis and Headaches—Is There a Connection?

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Chronic pain is a hallmark symptom of rheumatoid arthritis (RA). For many people with arthritis, pain comes in the form of headaches and migraines.

In RA, your immune system attacks your body’s tissue and joints. In some cases, your immune system attacks the vertebrae in your neck. This is known as your cervical spine. There isn’t a great deal of research exploring the connection between RA and headaches. However, experts believe that inflammation in your cervical spine can generate pain signals in the nerves of your neck and affect your brain’s blood supply. This can trigger head pain or headaches.

There are steps you can take to better manage RA and headache or migraine pain. Managing stress, getting more exercise, and examining your medication use may ultimately add up to less pain.

Check Your Meds

Are you heading to the medicine cabinet for ibuprofen (Advil) or acetaminophen (Tylenol) a little too often? Leaning on over-the-counter analgesics—everyday pain relievers that help with everything from minor aches and pains to migraines—can actually set off “rebound” headaches. If you’re taking over-the-counter medications daily and not experiencing relief, cutting back and finding a new approach may help.

More Exercise, Less Stress

Stress is a known trigger for migraines and headaches. Living with RA can cause stress, anxiety, and depression. Exercise is a known stress reliever. Exercises that can help alleviate stress include walking, bicycling, and tai chi. Exercise may also ease any muscle tension around your cervical spine and neck. This could help reduce your chances of getting a headache. Need another reason to get moving? Inactivity actually can make RA symptoms worse.

Focus on Omega-3s

Fish oil has been touted for multiple health benefits, though in most cases the scientific evidence is modest. One recent study showed that people with early-stage RA who took daily fish oil capsules for one year, in addition to getting standard treatments, experienced a greater reduction in their symptoms. And most were able to quit using NSAIDs for pain relief. Herring, mackerel, salmon, and tuna are high in omega-3 fatty acids. These are also critical for brain health and blood flow. The health benefits of eating fatty fish are supported by more evidence than are the benefits of taking fish oil supplements.

Get Your Z’s

The joint pain and stiffness that people with RA experience can also interrupt sleep. Unfortunately, a lack of sleep increases your risk for headaches and migraines. This creates an unpleasant cycle. Cutting out possible headache triggers, such as caffeine found in coffee, tea and chocolate, as well as getting regular exercise, can help you enjoy deep, quality sleep and wake up feeling rested.

Key Takeaways

  • For many people with rheumatoid arthritis, inflammation in the cervical spine may lead to headaches and migraine.

  • Managing stress, getting more exercise, and examining your use of medications and supplements may lead to fewer headaches and migraines.

  • Joint pain can interrupt sleep, which increases your risk for headaches and migraines. Cut out possible headache triggers and get regular exercise to enjoy deep, quality sleep.

Symptoms & Conditions

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WHAT IS RHEUMATOID ARTHRITIS?

Rheumatoid arthritis is a disease that affects all of the synovial joints in the body. A synovial joint,the most common and most movable joint in humans, has a capsule that surrounding the surfaces of the joint and contains a lubricating synovial fluid within the capsules.

There are synovial joints in the spine, thus people with rheumatoid arthritis can have spinal involvement. The destruction caused by the disease process affects different regions of the spine.

Based on the severity of destruction symptoms can range from minimal to serious life-threatening pressure on the spinal cord.

If you think you are suffering from rheumatoid arthritis affecting your spine, give us a call at 703-709-1114 to schedule a consultation, or register online.

  • Joint Destruction
  • Causes
  • Symptoms
  • Diagnosis
  • Treatment
JOINT DESTRUCTION OF THE SPINE

A joint is a connection between two bones. Our spine is made up of multiple joints at each level and many of these joints in the spine are synovial joints.

One is a pivot joint found at the very top of the spine, called the atlanto-axial joint. This joint is between the very first (C1) and second (C2) cervical vertebrae which are very specialized to the spine to allow for rotational movement.

The first cervical vertebra (C1) is called the atlas and is aptly named after the Greek god Altas, who carried the world on his shoulders. This bone is formed like a ring that sits upon the second cervical vertebra (C2).

C2 is called the axis as it is the line upon which the head and C1 rotate upon. The C2 vertebra has a bony knob called the odontoid process that fits in the front part of the C1 ring.

A special ligament holds the odontoid process tightly to the ring of C1. This is the atlanto-axial joint.

In addition to this specialized joint, the skull (occipital) is connected to the cervical spine at C1. Between these bones on each side of the spine are synovial joints called the occipital-cervical joint.

Each spinal motion segment of the spine also has a pair of facet joints that provide the posterior support for the spine. Facet joints are synovial joints. Thus, rheumatoid arthritis may affect the atlanto-axial joint, the occipital-cervical joint, and the facet joints along the spine.

CAUSES OF RHEUMATOID ARTHRITIS

Rheumatoid arthritis is a disease that causes destruction of synovial joints. As the joints are destroyed, the connection between each vertebra becomes unstable.

Serious problems can result when the synovial joints, in particular the atlanto-axial joint, in the neck are destroyed. If stable joints are destroyed, vertebra become unstable and are able to slide forward (listhesis) on top of the adjacent vertebra.

This slippage in the neck is called anterior listhesis and can lead to pressure on the nerve roots and the spinal cord in the neck. This is most dramatic at the atlanto-axial joint (between C1 and C2). If you remember from above, this joint is unique in that it has a knobby odontoid process. There is a risk at this level that instability causes the odontoid to push into the spinal cord which can result in serious problems.

The connection between the skull and the C1 vertebra (occipital-cervical joint) may become unstable allowing the skull to settle down. This can also cause pressure on the spinal cord if the odontoid moves up into the skull through an opening called the foramen magnum. The blood supply to the brain is from two vertebral arteries that also enter the skull through this opening and may be compressed by the odontoid.

RHEUMATOID ARTHRITIS SYMPTOMS

The symptoms of rheumatoid arthritis in the cervical spine are extremely varied. The arthritic changes can cause pain from overall joint inflammation in the synovial joints. This can be felt as dull pain in the back of the neck or at the base of the skull. More concerning rheumatoid arthritis symptoms are noticed if the disease progresses to increase pressure on the spinal cord.

Because the blood supply to the neck can also be affected, any pressure on the vertebral arteries can cause black-outs or dizzy spells if the brain does not get enough oxygen. Increased pressure on the spinal cord may cause many symptoms.

Cord compression may change in the ability to walk. You may notice changes in your gait, or walking style, or have problems with balance. Because the nerves exit our brain and run down, a high cord compression can cause symptoms into the arms or legs such as tingling, weakness, or loss of fine motor skills or coordination. Changes in bowel or bladder control such as incontinence or inability to urinate can also occur.

Back to the Top

Can arthritis of the spine trigger a migraine?

Gilaxia/iStockphoto

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.

By Jorie –

The clock reads 3 am. I turn over in my nest of bed covers, pain radiating through my side in my hip. I can’t find a position that isn’t painful. I rest there, joints stiff as a board, begging for sleep. I look at the clock again: 4:15 am.

And then, in further despair, I realize the migraine is coming on too. “Painsomnia,” a term we spoonies use for lack of sleep as a result of pain, has officially hit. Sleep isn’t going to come tonight, and I’m going to have an achy day ahead of me. At least I may have caught this migraine early—a bright light in the midst of the hurt.

The sun rises and peeks through my window as my day finally begins. My hands shake as I take my morning medications, struggling to hold the full glass of water. Yes, the glass of water is too heavy for my weak hand in the morning, joints tender, stiff, and sore.

I slip on my copper support gloves and move to the bathroom to brush my teeth—an effort.

I paint on my makeup—another strain. And so on…

“I can’t get frustrated today. I must be patient with my body,” I tell myself every morning.

This is just a glimpse into a typical morning with a rheumatoid arthritis flare. Needless to say, mornings aren’t my friend, nor anyone’s who lives with RA.

This is a fairly common, yet silent, scenario for me living a life of chronic pain. I’ve found many ways to cope, learning the ropes of reducing pain to the best of my ability and managing mentally as well. It’s physical as much as it is mental.

I don’t murmur a word to many people as I go about my day—who wants to hear from a 24 year old that her joints hurt? Not many. Who cares, really? There isn’t much sympathy for me—ageism and ableism are alive and well in our society. That being said, I’ve become pretty good at the pain poker face.

The Chronicles of Comorbidity

Living with migraine typically isn’t a solo journey. Most of us have a diagnosis of other health conditions that happen in synchronization with migraine, which are called comorbid conditions. We are predisposed to these conditions, one way or another, whether because we have been diagnosed with migraine disease, or because we were diagnosed with another illness that has left us with a higher risk of developing migraine. It’s a gamble.

It is estimated that about 61% of migraine and headache sufferers have additionally been diagnosed with a chronic pain condition or other chronic illness. Migraine just loves company.

Rheumatoid arthritis is one of those conditions, and is one that began for me around the age of 20. What I thought was a simple muscle cramp in my hand one day turned into weeks, months, and now a few years of what my doctor finally determined to be RA.

What is Rheumatoid Arthritis?

(Above: Diagram showing the comparison between normal, healthy joints and the effects of rheumatic joints. Via National Institute of Arthritis and Musculoskeletal and Skin Diseases)

As an autoimmune disorder, rheumatoid arthritis refers to a sub-type of arthritis in which the immune system attacks the joints, synovium (connective joint tissue), and other soft tissues of the body. Yes, my body actually attacks itself.

Let’s discuss autoimmune dysfunction to get a better understanding of what that really is, because I’ve found that there is often some confusion about it. Basically, having an autoimmune disorder means that the immune system is not functioning as it should—it mistakenly perceives healthy cells in the body as intruders (bacteria, viruses, etc.) and attacks them by creating inflammation in those areas to try to flush them out.

In RA, the body attacks the synovium, joints, and tissues and over time the impairment creates an abundance of pain, soreness, swelling, and even disfigurement. Unfortunately, the damage done cannot be reversed and there is no cure for RA, just treatments that help ease symptoms.

Symptoms of RA vary and can be individual to the patient, but most commonly include localized pain, redness, soreness, and swelling of the affected joints, stiffness that is most pronounced in the morning, nodules and disfigurement of joints most often in the fingers, fatigue and loss of energy, and occasional low-grade fevers. RA can affect any joint in the body, from head to toe.

Scientists estimate that about 2.1 million people, or between 0.5% and 1% of the U.S. adult population, have rheumatoid arthritis. It is present in all races and age groups, and occurs most frequently in women—75% to be exact.

The condition ranges in severity and pain level, too. Some patients are extremely high functioning and others are confined to disability. I am fortunate enough to live a relatively normal life, however there are days that my flares are excruciating and practicing daily, seemingly mundane tasks become mammoth in comparison to a “good” day.

Contrary to popular belief, RA can even begin in childhood (usually referred to as JRA, or Juvenile Rheumatoid Arthritis). Many people gawk in disbelief when I tell them I have rheumatoid arthritis, because as far as public knowledge is concerned, it’s an illness reserved for the older crowd. I couldn’t tell you how many times I’ve heard the phrase “you’re way too young to have that!”

However, because RA is an autoimmune disorder, the type of arthritis it exhibits is not reliant on wear and tear with age or activity such as with osteoarthritis. RA is the most common form of arthritis in younger people such as myself, however osteoarthritis is the most common form among all age groups, especially in the elderly.

RA is also believed to be mainly genetic, which makes sense in my case—my mother and many of my mother’s relatives have rheumatoid arthritis and other autoimmune disorders. Scientists have concluded that autoimmune dysfunction in general tends to run in families and can be handed down genetically.

However, genetic research is progressing more each day. We now know much more about the genes that contribute to RA and other forms of autoimmune dysfunction. According to the Arthritis Foundation:

“Researchers have shown that people with a specific genetic marker called the HLA shared epitope have a fivefold greater chance of developing rheumatoid arthritis than do people without the marker. The HLA genetic site controls immune responses. Other genes connected to RA include: STAT4, a gene that plays important roles in the regulation and activation of the immune system; TRAF1 and C5, two genes relevant to chronic inflammation; and PTPN22, a gene associated with both the development and progression of rheumatoid arthritis. Yet not all people with these genes develop RA and not all people with the condition have these genes.”

(Above: An example of my left hand, which affects me the worst, on two different days. The left photo shows my joints inflamed on a “flare” day, and the right photo is a “good” day. In both photos, however, you can still see that my finger joints are beginning to twist and turn — this is a characteristic that my mom also has).

How RA and Migraines work together

It is theorized that RA can affect headaches because of the inflammation it causes in the joints. Apart from migraines, many RA patients also battle chronic daily headaches as a result of the swelling in their cervical vertebrae and facial joints, such as in the jaw, which often presents as TMJD (temporomandibular jaw disorder). I personally have struggled with daily headaches as well as TMJD symptoms, likely a combination result of RA and chronic migraine.

Just as I do with migraines, I also have specific RA triggers that exacerbate my flares. Most notably, these include weather and barometric pressure changes, over-exertion or heavy exercise, and even stress. When I have migraines I’ll frequently have an RA flare as well to go with it, leaving me to believe that just getting a migraine itself is a trigger for an RA flare. Of course.

Treating RA and migraines together can be a difficult balance—I have to be wary of rebound headaches and migraines when managing RA pain. I am generally very conservative with my pain medication as a result of this and tend to only medicate when there is a dire need. Opioids are a no-go for RA (just as they often are with migraines) because opioids don’t properly target the pain. Anti-inflammatory medications, or NSAIDs, are usually the best course of action if taking medication, which is what I stick to as well.

Living with RA and chronic migraine creates a mental health obstacle too. I’ve already touched on the fact that I live with bipolar disorder and anxiety/panic disorder in previous posts; having RA leaves no exception there. The anxiety of the next flare is always impending, just as the anxiety of my next migraine attack looms over me. My mood tends to swing while managing the two. I experience a lot of irritability on top of the anxiety, as well as depression. That’s all pretty inevitable with chronic pain, but I try to keep an upbeat, positive attitude.

Taking care of mental health while living with chronic pain disorders is extremely important. It’s easy to fall into that pit of despair and panic—will my hands ever work properly? Will my strength ever return? Will I ever get a good night’s rest? Will the pain ever just go away?

These are puzzles I may never solve because the thing is, there is no cure for RA just as there is no cure for chronic migraine. Autoimmune disorders are there for life—doctors only know how to manage them and sometimes send them into remission. So, for now, I am thankful that I can keep my pain relatively in check most days, and on the particularly agonizing days, I just keep my eye on the light at the end of the tunnel.

Mindfulness practices are essential to my well being and every day I try to make sure I do some activity to help calm my nerves, show myself some compassion, and just breathe. It’s just a bad day, a bad flare… not a bad life.

Living with and treating my pain

As I mentioned earlier, my treatment regimen for RA and migraines is almost one and the same. I have not started a prescription medication for RA yet—I’ve chosen to try to target my symptoms and treat my pain individually before going on a biologic, immunosuppressant drug, or other powerful daily NSAID medication. The most powerful medications I take right now for RA management are prescription Indomethacin and Voltaren Gel, as needed.

That might not last, though. In order to keep RA from progressing into major joint deterioration, requiring joint replacement surgeries and other extreme measures, early prevention is key. Soon I may have to bite the bullet. But today isn’t that day.

(Above: Wearing my trusty copper support glove on the left, and on the right I’m wearing my hand brace and holding CBD oil for joints from Blue Ridge Hemp Co.)

Right now, my RA is mostly focused in the joints of my fingers, hands, and wrists so my main course of action in treating that is using my hand braces and copper gloves from Dr. Arthritis, which help support those joints and reduce swelling. Since my RA isn’t exceedingly progressed, I don’t have it in all of my joints. Other than my hands, my next most affected areas are my hips, shoulders, and knees.

I also use many different topical creams and gels to manage the condition in the rest of my body. CBD oil joint salve from Blue Ridge Hemp Co. is one of my favorites, as well as Tiger Balm, and a custom epsom salt bath blend from my massage therapist—all of which I also use for migraine relief. Plus, heat and cooling therapy are staples in my routine.

Other holistic treatments help, too. As I’ve touched on in previous blog posts, I use acupuncture, physical therapy, and medical massage to manage migraine symptoms. I also use these to manage RA. It’s a good way to kill two birds with one stone, so to speak.

Looking to the future…

I don’t know exactly what my future holds living with RA and chronic migraine, but I do know that I’ll have both for the rest of my life.

Sometimes I look to my mother, who also has had RA since my age and from whom I inherited the disease. Like me, she is another one of those individuals who puts on the poker face even though she has extremely painful days. Why do we who live with chronic pain feel we have to do that? Is it for the comfort of others? Is it because we try to deny our pain to ourselves?

I’ve watched Mom as she has struggled to pick up a pen and sign her name on paper, to carry a mug of coffee, or open a jar of jam. I’ve heard her in the middle of the night getting up and down, unable to sleep from the pain. I may even have shared tears with her. I may even have experienced those exact things. My Momma and I have a special bond in pain that I share with no one else, because she is no stranger to migraines either.

So, in reality, I know that’s what I have to look forward to. But there’s something else my Momma passed down to me, and that’s unrelenting strength and willpower. She gets through her pain everyday with more grace than I could ever imagine. So that’s my goal: make my pain as graceful as possible, and transform the pain into something valuable.

(Above: Me with my Momma, who is one of my biggest heroes, cheerleaders, and inspirations in living a life of pain.)
Sources:

Migraine Disease Patient Guidelines

Welcome to the First Global Healthy Living Foundation Guide to Managing Migraine Disease

Possibly the only thing worse than living with chronic pain from migraine or arthritis is living with both conditions at the same time. But for a number of people, this is a daily reality. While we need more research to better understand how arthritis and migraine and other headache conditions affect each other, we do know that having arthritis in your neck or jaw can affect migraine and headache pain. Some research even suggests that people with migraine may be at an increased risk of developing rheumatoid arthritis than people without migraine.

Like arthritis, migraine disease is complicated. It’s not “just a bad headache.” If you live with recurrent or frequent migraine attacks, you already know that there are many possible treatment options: over-the-counter medications, prescription drugs, herbal remedies, behavioral changes, and mind-body therapies, not to mention products like cooling masks or mobile phone apps to dim your screen during a migraine attack.

The trial-and-error process to find something that works — and keeps working over time — can be long and frustrating.

How do you make sense of all of these possible treatment choices for migraine disease? The most important tool is clear, simple information from a trusted, independent source. That is why this guide — vetted by both medical experts and people living with migraine disease — was created.

In these migraine patient guidelines, you’ll learn about the latest treatment options for migraine, get support for coping with migraine stigma at work and in your personal relationships, and learn more about how to be a migraine patient advocate.

Download Your Free Copy

Please fill out the form below to download the inaugural MD patient guidelines for free.

Special thanks to the National Headache Foundation, Jaime Sanders aka The Migraine Diva, and Dr. William B. Young for reviewing the first edition of our Migraine Patient Guidelines.

The migraine treatment and prevention information you’ll find in this easy-to-understand booklet is based on current recommendations from leading physician associations, including the American Headache Society and the American Academy of Neurology. We review how each type of treatment works to ease your migraine symptoms or help prevent migraine attacks, and let you know any important side effects so you can make more informed choices about your treatment.

This first edition of our migraine patient guidelines has been edited by leading doctors and health care experts. It will be updated and improved regularly as new research and updates on migraine prevention and management become available. It’s also been reviewed by patients with migraine disease to make sure the advice is helpful and relatable.

About the Patient Guidelines

If you haven’t had a chance to see our Patient Charter, please take a look. It spells out really clearly, we think, what it means to us to be patient-focused, and it gets at the core of our mission.

There are, of course, many sets of recommendations designed to help medical professionals deliver the best care possible — including from the American Academy of Neurology and the American Headache Society. These are an invaluable tool for doctors to use when they weigh different treatment options, but those guidelines are written for professional, rather than lay readers. For patients who haven’t graduated medical school, the language can be a challenge, to say the least.

Migraine is a complicated disease with many co-occurring (or comorbid) diseases that can affect which treatment options are right for you. Many common migraine drugs are prescribed off-label, which means they were technically FDA-approved for another disease but may be useful in treating aspects of migraine as well. Newer treatment options, including Botox, surgical procedures, and a new class of drugs to prevent migraine attacks, have come onto the scene in recent months and years. It’s important that people living with migraine know about all of their options in order to have informed and proactive conversation with their health care providers.

Remember that every person’s health, concerns, and insurance coverage are unique. While this guide will give you a general overview of migraine treatment options, talk with your health care professionals including your nurses, physician assistants, doctors, health insurance company, medical benefits person at your work, and pharmacists to get all your questions answered.

A special thank you Amgen Inc. for their sponsorship of this important patient resource.

The contents of this website are for informational purposes only and do not constitute medical advice. CreakyJoints.org is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition.

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