Health Do you have a problem youd like answered? If so, write to us at: Inspire magazine, 1 Cambridge Technopark, Newmarket Road, Cambridge CB5 8PB or email inspire@arthritiscare.org.uk Ask the doctor Whether its a health niggle or emotional problem, Inspires dr sarah Jarvis gets straight to the point Q i have had osteoarthritis of the lower spine and knees, and cervical spondylosis for many years. three months ago, i had a sudden headache, which did not respond to painkillers. within a week, i experienced buzzing in my head, fullness in my ears and dizziness. every time i move my neck, my jaw muscles start throbbing, i get pins and needles around my jaw, and a zapping sound in my head. a ct scan of my head was normal and i am having physiotherapy to reduce pressure on my neck. so far theres been no improvement, though if iwear a soft neck collar i can manage light jobs, such as making a cup of tea. i cant sit, i cant sleep and ifeel stressed. what should i do? name and address withheld Q could you shed some light on why my wife brenda, who was diagnosed with severe ra in 2008, can get total relief if she avoids certain trigger foods that we identified through analysis? she had distorted joints in her hands and feet, severe pain in her joints and an inability to walk without help. this continued for two and a half years while taking a range of ever-more powerful drugs. in frustration, we analysed her food and drink intake, and her activity levels, each day, with a separate column for wellbeing. within a week, some patterns emerged as to ingredients, which were logged in greater detail. it took around an hour a week to do. she can now be symptom-free if she avoids her trigger substances. consuming any of these ingredients results in a return to hot and painfully inflamed joints. name and address withheld dr sarah Jarvis answers: The fact that you have had cervical spondylosis for years makes it more likely that the symptoms you are suffering are cervicogenic in other words, they come from your cervical spine. Its what is known as a secondary headache the pain is from another cause. In this case, the pain from your neck is being referred to your head. One theory is that referred pain happens because two parts of the body share some part of their nerve pathway sending messages to the brain. Other examples include feeling pain in your shoulder blade when something irritates your diaphragm; or pain from a heart attack, which is sometimes felt in the jaw orshoulder tip. Cervicogenic dizziness can be difficult to diagnose, because theres no single test that proves or disproves that the neck is the cause. The clues are really in thesymptoms. You tend to get dizziness, which can be worse if you move your head or if you keep your neck in one position for a long time. This is different from vertigo, where you get a sensation of the room spinning around you, usually only when you move your head. However, they can be hard to distinguish. Symptoms are often accompanied by a headache and tend to last from minutes to several hours. The zapping sounds inside your head could be tinnitus a sound that comes from inside your ears, and that tends to be more marked when youre somewhere quiet. People describe it as ringing, buzzing, roaring, whistling or humming. If it happens on one side, it can be due to a tumour on the hearing nerve but not in your case because youve had a normal CT scan. Its possible that theres more than one cause of your headache, but theres a high chance your neck problems are at least partly to blame. If physio doesnt help, you may be referred to a pain clinic. Medication such as gabapentin and pregablin to damp down messages from the nerves in your neck may relieve your symptoms. Otherwise, injections of local anaesthetic and steroid may help, if physio doesnt. dr sarah Jarvis answers: There has been interest for many years in foods as triggers for a huge range of medical problems, from irritable bowel syndrome to overactive bladder. Rheumatoid arthritis (RA) is no exception. It is an autoimmune disease your bodys immune system, which usually helps you fight off infections, turns on itself and attacks parts of your body. We also know that some people have life-threatening allergies to food, and that many more have food intolerances, which dont cause serious illness, but can be highly distressing. Its thought that certain foods can trigger inflammation, and research suggests several common culprits. Sugar, for instance, can cause the release of inflammatory chemicals called cytokines, while saturated and trans-fats can cause inflammation of fat stores in the body, which can worsen arthritis. Omega-3 oils are, on the whole, healthy fats, but too much omega-6 can unlock inflammatory messengers. Monosodium glutamate (MSG, a flavour enhancer commonly used in oriental cooking) plays a part in two pathways of inflammation in the body, and glutencan promote inflammation in some people, even if they dont have coeliac disease. One of the problems with studying foods as triggers of symptoms of RA is that people react differently to different foods. Keeping a detailed food diary can help. However, if youre going to eliminate significant sources of food from your diet, you can lay yourself open to the risk of deficiencies in vitamins and minerals. Before making major restrictive changes to your diet, its always worth speaking to your specialist team about a referral to a dietician. Our helpline is free, confidential and open to anyone with arthritis and their families. Call 0808 800 4050 the line is open Monday to Friday, 10am to 4pm. For a copy of our booklet, Healthy Eating and Arthritis, call the helpline, write to Publications Orders, Arthritis Care, Floor 4 Linen Court, 10 East Road, London, N1 6AD or click here to email.