Can ankylosing spondylitis cause headaches?

Quick Take: Ankylosing Spondylitis and Headaches

Yes, ankylosing spondylitis (AS) can be associated with headaches. These headaches often originate from the neck and might be linked to inflammation or structural changes caused by AS. However, it’s essential to differentiate these headaches from other types and understand their underlying causes.

Delving Deeper: Understanding Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine. It can lead to some of the vertebrae in your spine fusing together, making the spine less flexible and resulting in a hunched posture in some people.

The Connection Between AS and Headaches

Headaches in patients with AS can arise from various factors:

  • Inflammation at the base of the spine or neck
  • Structural changes due to fused vertebrae
  • Muscle tension from pain or posture changes
  • Other related conditions or medications

Types of Headaches

Not all headaches are the same. With AS, the most commonly reported type is the cervicogenic headache, which originates from the cervical spine or the base of the skull. This type of headache can be due to inflammation or structural abnormalities caused by AS.

Many of my patients with AS report headaches that often stem from the neck region. It’s crucial to diagnose and address them appropriately as they can significantly impact quality of life.

Diagnosing the Cause

When an individual with AS presents with headaches, the diagnostic process usually involves:

  1. Clinical history and physical examination
  2. Radiological studies, such as X-rays or MRIs, to identify structural changes or inflammation
  3. Referral to specialists when necessary to rule out other causes

Management and Treatment

Treating headaches associated with AS requires a multi-faceted approach. It’s not just about addressing the pain but also managing the underlying causes.

Pharmacological Interventions

Non-steroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment for pain and inflammation in AS. They can also help alleviate headaches resulting from inflammation.

Other medications, such as biologics or disease-modifying antirheumatic drugs (DMARDs), can be used to manage AS itself, indirectly helping to reduce associated headaches.

Physical Therapy

Physical therapy plays a vital role in managing AS and related symptoms. For headaches, exercises that improve posture, flexibility, and strength, especially in the neck and upper back, can be beneficial.

Alternative Therapies

Many patients find relief through alternative therapies such as:

  • Acupuncture
  • Massage
  • Chiropractic adjustments

Can ankylosing spondylitis affect the head?

Yes, ankylosing spondylitis (AS) can have effects that relate to the head, though it primarily affects the spine and sacroiliac joints. Here are some ways in which the head and neck might be affected:

  1. Cervical Spine Involvement: AS can affect the cervical spine (the neck portion of the spine). Over time, inflammation of the vertebrae in the neck can lead to fusion, which can limit mobility and potentially cause pain or stiffness in the neck.
  2. Jaw Involvement (Temporomandibular Joint Disease): In some cases, AS can affect the temporomandibular joint (TMJ), which connects the jaw to the skull. This can lead to pain, stiffness, or difficulty opening and closing the mouth.
  3. Eye Involvement (Uveitis/Iritis): One of the most common extra-articular (outside of the joints) manifestations of AS is uveitis, which is inflammation of the uvea, a layer of the eye. This can lead to redness, pain, light sensitivity, and blurred vision. If not treated promptly, it can cause complications, including cataracts, glaucoma, and even vision loss.
  4. Neurological Effects: Rarely, inflammation and changes in the vertebrae can put pressure on the spinal cord or nerve roots, potentially leading to neurological symptoms. Atlantoaxial subluxation, a potentially serious condition where the first and second cervical vertebrae become misaligned, can occur in severe AS cases, posing a risk to the spinal cord.
  5. Other Systemic Effects: AS is a systemic condition, meaning it can affect various parts of the body. Fatigue, inflammation, and other systemic effects can potentially have indirect impacts on cognitive and emotional wellbeing.

Regular monitoring by a rheumatologist is essential for people with AS. If any new or unusual symptoms develop, it’s crucial to discuss them with a healthcare professional. Treatment can help manage symptoms and potentially slow the progression of the disease.


Headaches can indeed be a manifestation of ankylosing spondylitis. However, with the right diagnosis, management, and treatment, they can be effectively addressed. If you have AS and experience headaches, it’s vital to discuss them with your healthcare provider to determine the best course of action.

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