EDS is a complex group of inherited disorders that affect and weaken connective tissues such as tendons and ligaments (1). Primary sites of involvement include skin, joint and blood vessels(2). Joints are typically hypermobile with excessive joint range of motion.
Pain can arise from tissue trauma to the tendons, ligaments, and muscles but also arise from injury of an affected joint and cartilage. In a previous blog, I discussed EDS low back pain.
Can EDS cause migraines?
Yes!. Due to an inherent disorder in the brain blood flow patients with EDS are prone to migraines.(3). Ehler-Danlos syndromes are classified into thirteen subtypes. (4). Migraines with or without aura are the most common form of headaches in The EDS, hypermobility type (EDS-HT) (5). A recent study demonstrated that in the EDS-HT group, migraines had an earlier onset and a higher number of episodes per month when compared to non-EDS patients.(5).
Can EDS cause other types of headaches?
EDS patients commonly suffer a variety of headache types which include:
- Tension headache (6)
- Occipital neuralgia due to pressure and irritation of the lesser and greater occipital nerves. (7)
- Facet headache pain due to the instability of the facet capsule and ligaments ligament (7). The facet joint is a posterior joint in the cervical, thoracic and lumbar spine that limits the movement and protects the spine from excessive rotation and flexion. Each cervical facet has a specific referral pattern illustrated below. For example, injury to the C2/3 facet can result in pain radiating from the neck into the head and frontal area.
C1/2 Joint Pain
The C1 vertebra is the most superior vertebra in the neck and is called the atlas whereas the C2 vertebrae is called the axis. The C1 and C2 vertebrae stack upon one another and create a joint which is termed the AA (Atlantoaxial) joint. Patients with EDS have ligament instability which makes them prone to AA joint injury and dysfunction(8), AA joint pain is typically referred to the base of the skull. At the Centeno-Schultz Clinic we have extensive experience with C1/2 joint injections for patients with neck and headache pain. Patients with ligament injury or hypermobility are oftentimes plagued with headaches arising from this joint. x-ray guided injections of PRP or stem cells can provide significant benefit and stability of supporting ligaments.
The neck is connected to the head by several critical ligaments which include the Alar, Transverse and Accessory Ligaments. Trauma, strain or degeneration of these critical ligaments can result in instability and agroup of neurological and pain symptoms including neck pain, headache and brain fog. The accurate medical term to describe this condition is Craniocervical junction (CCJ) Instability. It is a life-changing condition as many providers do not understand it and fail to diagnose it. EDS patients are particularly susceptible to CCJ instability given the defect in collagen formation and loose ligaments. At the Centeno-Schultz Clinic we are the only clinic in the world to offer a stem cell injection to treat CCJ instability. To review CCJ instability and the injection watch video.
Patients with EDS have significant pain including headaches which can be tension, occipital neuralgia, facets or arising from injury to C1/2 joint or alar and transverse ligaments. The Centeno-Schultz Clinic has extensive experience in the management and treatment of EDS type headaches utilizing both PRP and stem cells. Schedule an appointment and learn how PRP and stem cells can address your debilitating headaches.
1.. Zhou Z, Rewari A, Shanthanna H. Management of chronic pain in Ehlers-Danlos syndrome: Two case reports and a review of literature. Medicine (Baltimore). 2018;97(45):e13115. doi:10.1097/MD.0000000000013115
2. Hakim AJ, Sahota A. Joint hypermobility and skin elasticity: the hereditary disorders of connective tissue. Clin Dermatol. 2006;24(6):521-33.DOI: 10.1016/j.clindermatol.2006.07.013
3. Jacome DE. Headache in Ehlers-Danlos syndrome. Cephalalgia. 1999;19(9):791-6.DOI: 10.1046/j.1468-2982.1999.1909791.x
4. Malfait F, Francomano C, Byers P, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8-26.DOI: 10.1002/ajmg.c.31552
5. Puledda F, Viganò A, Celletti C, et al. A study of migraine characteristics in joint hypermobility syndrome a.k.a. Ehlers-Danlos syndrome, hypermobility type. Neurol Sci. 2015;36(8):1417-24.DOI: 10.1007/s10072-015-2173-6
6. Jacome DE. Headache in Ehlers-Danlos syndrome. Cephalalgia. 1999;19(9):791-6.DOI: 10.1046/j.1468-2982.1999.1909791.x
7. Castori M, Morlino S, Ghibellini G, Celletti C, Camerota F, Grammatico P. Connective tissue, Ehlers-Danlos syndrome(s), and head and cervical pain. Am J Med Genet C Semin Med Genet. 2015;169C(1):84-96.DOI: 10.1002/ajmg.c.31426
8. Mathers KS, Schneider M, Timko M. Occult hypermobility of the craniocervical junction: a case report and review. J Orthop Sports Phys Ther. 2011;41(6):444-57.DOI: 10.2519/jospt.2011.3305