Headaches can occur occasionally as a result of osteoarthritis in the neck. Typically, these headaches go up the back of the head. The pain may be more apparent on one side than the other. The pain then radiates to the crown of the head.

Rarely, the pain will radiate to the temples.

The pain sometimes is aggravated by movement of the head or possibly if the head is held in one position for too long a period of time.

Patients will often comment that it feels like sand or crunchy when they turn their head.

Sometimes the pain will be felt in the back of the shoulder and along the inside of the shoulder blade.

The diagnosis is made through a careful history, physical examination, and imaging studies such as x-ray and magnetic resonance imaging (MRI).

Once the diagnosis is confirmed treatment with medication, physical therapy, traction, and different types of injections are often successful in relieving the pain. A soft cervical collar and neck support pillow may also be useful.

Sometimes patients who have arthritis take pain relievers. If they stop taking them they can get rebound headaches. This often prompts the patient to take more pain relievers and therefore may make the problem worse. The solution: try to avoid the cycle of medication- discontinuation of medication- rebound.

Patients with fibromyalgia, a diffuse pain syndrome, may also have severe headaches as part of their disease. A treatment plan incorporating exercise, analgesics, and antidepressant types of medicines may help.

Finally, a potentially serious type of headache can occur as a result of giant cell arteritis (GCA). This is also known as temporal arteritis. GCA is an autoimmune disease that causes inflammation of blood vessels, particularly the ones in the head. Typically a patient will have pain in the temples, tenderness of the scalp, and pain in the jaw with chewing. If not diagnosed and treated aggressively with high dose steroids, this condition can lead to blindness.

The diagnosis is suspected if the patient has an abnormally elevated erythrocyte sedimentation rate in their blood and a biopsy of the temporal artery can help confirm the diagnosis. While the biopsy may be negative even in cases where GCA is present, the presence of a positive biopsy clinches the diagnosis. Unfortunately, a negative biopsy should not dissuade one from making the diagnosis since it can be negative in a significant percentage of cases.

Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland (http://www.aocm.org). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: http://www.arthritis-treatment-and-relief.com/types-of-arthritis.html">Types of Arthritis

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