Migraine Comorbidities: Raynaud’s Phenomenon/Syndrome

Migraine patients with Raynaud’s phenomenon/syndrome are usually aware they have the problem because the symptoms are startling and quite difficult to ignore. Raynaud’s is a frequent comorbid condition with Migraine however, and because it can occur with Migraine with great frequency and is also considered a complicating factor when trying to treat Migraine, it is important to be aware of the condition and the problems it can cause for patients with the diagnosis.

Symptoms

Raynaud’s is also sometimes spelled Reynaud’s and is pronounced RA-NODZ’ or RA-NADZ’.

Raynaud’s can be primary (a disorder unto itself) or secondary (caused by another condition). When Raynaud’s is primary, the term Raynaud’s disease or Raynaud’s phenomenon is used. If it is secondary, Raynaud’s syndrome is the appropriate term.

The patients who suffer Raynaud’s are often known as *frosties* both because their extremities are often icy cold to the touch, and because their bodies hyper-react to nearly everything cool.

The primary symptoms of Raynaud’s are cold and brightly discolored fingers, hands, toes, feet and other extremities. Raynaud’s can also affect the face (nose, ears, lips) and breasts. Three colors are typical and include white, blue or purple, and red.

When the patient is exposed to a trigger such as something cold, vibration, stress, or something that constricts blood vessels, the sympathetic nervous system highly over-reacts by going into fight or flight mode, shunting necessary blood to organs and brain and away from extremities by creating vasospasms that constrict blood vessels, emptying them. Digits and body parts turn white or blue due to lack of blood and oxygenation called ischemia.

Tingling and numbness during ischemia followed by pain as circulation returns, are also hallmarks of the disorder, especially when cyanosis has been present for long periods of time. In severe instances, blood supply to digits and appendages may be cut off so long that tissues begin to die. When this happens ulcerations may form which are often difficult to heal as a result of poor circulation to the area. In the worst circumstances, the hypo-perfusion (lack of blood supply) results in tissue death that is so extensive that gangrene occurs and the affected body part is removed to save the patient.

Sometimes even mild Raynaud’s which has gone on for years will eventually affect tissues permanently, resulting in changes to skin and nails. Especially noticeable are ridges that run lengthwise along brittle nails. Ridges typically start out very mild, but eventually may progress until the situation is problematic, even interfering with the patient’s ability to function.

Testing

Testing for Raynaud’s is fairly easy and usually only necessary if the condition is interfering with other treatments etc. as symptoms are usually evident when a good history is taken.

A Doppler test is an accurate way to gauge the severity of Raynaud’s. This test measures blood flow to the extremities and gives a scaled reading to the doctor.


A capillaroscopy allows the doctor to examine the blood vessels in the skin at the base of your fingernail.

A cold stimulation test involves putting the hand in ice water and measuring the temperature of the fingers at regular intervals.

Treatments

Treating Raynaud’s is somewhat similar to Migraine, and avoiding triggers that will cause an attack is key. Patients are urged to avoid all triggers, wearing gloves and avoiding air conditioning whenever possible. If the Raynaud’s is secondary it will be important to address the primary cause of the condition and treat it. This may require additional testing.

Some medications used to treat Migraine also treat Raynaud’s. Calcium channel blockers can be very effective for both conditions and are often tried as a first line treatment for those patients with this comorbid pair of disorders.

Unfortunately, some of the best ways to treat Raynaud’s involve medicines that are contraindicated for Migraineurs because they work by dilating blood vessels which can trigger Migraine for many Migraineurs. Patients are encouraged to ask their doctors or pharmacists about all new prescriptions to be sure it won’t be problematic for them.

Sympathectomy is a surgery in which doctors cut the nerves that supply the area with Raynaud’s symptoms. While this is the most drastic move for patients, it may allow some to treat their Migraines with medicines that otherwise wouldn’t be possible without the surgery. A nerve block prior to surgery allows patient and doctor to evaluate whether the sympathectomy will be successful. This is especially important in cases of secondary Raynaud’s, as it tends to react less favorably to the surgery. Sympathectomy is not a permanent cure however, and eventually nerves often grow back necessitating repeated surgeries for ongoing relief.

Let’s Talk about Raynaud’s and Migraine

While cold extremities may be a Migraine symptom for some patients, Raynaud’s is a different condition and may be much more severe, especially if the condition is secondary. Autoimmunity is one of the most frequent types of illness associated with secondary Raynaud’s.

There are many things that make Migraine and Raynaud’s very similar. For instance:

  • Migraine and Raynaud’s have many of the same triggers. These may include cigarette smoke; certain medications or chemicals; weather; foods we eat; caffeine; hormones.
  • Both affect women much more often than men
  • Both often begin around menarche
  • Both are conditions of an overly sensitive nervous system

Some Migraine preventive medicines such as beta blockers are contraindicated in patients who have Raynaud’s. Unfortunately, most abortive are also contraindicated and should be used only when both patient and doctor understand the potential problems and agree on a rescue plan should prolonged hypo-perfusion become an emergency.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (19)
  • Sunny
    3 years ago

    This is fascinating.
    I’ve had Reynaud’s for 40 years, migraines for the past 10. Even when I am warm, sweating even, my hands and feet are icy cold.
    I’ve also noticed that when I get migraines, I get even colder than usual, shivering, chills, etc.
    I’m going to try biofeedback – see if that has any impact on either condition.
    Thanks for the info.

  • Mel
    3 years ago

    I have had Raynauds for about 12 years, and Migraine tendencies since pubity, but about 8 years ago the migraines became more frequent and dirrectly related to my Raynauds attacks. I almost always get a migraine, within a few hours of blood flow returning!
    All doctors I’ve seen aren’t even aware of this correlation, and have always doubted it or stated that it’s just a rare coincidence.
    It’s so nice to finally have my long term theory justified in this article! I will most definitely be showing it to my doctor.
    Thank you :0)

  • Lue
    4 years ago

    Wait, I’m sorry if this comes out sounding dumb after that whole article, but having cold fingers and toes for awhile after being cold isn’t normal? My fingers and toes always get cold while I’m cold but isn’t that a normal thing? And then they kind of sting if you come inside and it’s really warm?

    I didn’t realize this was unusual and maybe what I have isn’t, I guess I’d just like to know either way if I should be worried about this or not.

  • Mel
    3 years ago

    It is definitely quite normal to get cold in the cold, along with tingling and even mild stinging when re-warming.
    Raynauds is different as the blood flow kind off miss-fires! Instead of the normal reaction of increasing blood to the cold area, a Raynauds reaction actually cuts it off, leaving the cold area a ghostly dead colour! The reaction is quite visibly striking. Trust me, you would know it when you see it. :0)

  • brianne
    4 years ago

    I experience this in my toes, fingers/hands and nose. It comes and goes but it’s worse in the winter and during colder weather. I find that the best “treatment” (if you can call it that) is putting my feet in luke warm water in the tub and then I gradually add hot water as my circulation comes back. This takes about 5 to 10 minutes and then my toes and feet are toasty warm for about an hour or two.

    For the hands/fingers, just running warm water on them for a minute or two helps. It’s important to start with luke warm water. You don’t want the water too hot because it’ll cause that burning/tingling/blood rushing back and hurty feeling. It’s better if it’s gradual.

  • Gerah Dutkiewicz
    5 years ago

    This is very interesting to me. My raynauds and migraines both come and go… Lately I’ve been suffering from both. Never knew they were related.

  • lara
    6 years ago

    Oh my. I’m going to have to talk to my neurologist. I had no idea this might be what was going on. I find myself wearing sweaters and sweatshirts when it is close to 80 degrees. In the winter, my feet and hands are almost painfully cold and when it snows, the “tingling” in my feet can be painful. I always associated this with Topamax but as a child and teen, I always, ALWAYS had ice cold hands and feet. So even before medication, there was a problem.

  • Ellen Schnakenberg author
    6 years ago

    It’s a good idea to talk to your doctor about anything like this that doesn’t seem to be “normal” for most people. There is cold, and then there is a reason for being cold all the time. Brrrrr!

    ~Ellen

  • BB
    6 years ago

    So does the Reynaud’s cause the migraines? I have had it for like 20 yrs but never correlated it with my headaches. Doctors never discussed it with me. Is this a new finding?

  • mo
    5 years ago

    I’ve had the cold, discolored feet and fingers ever since I can remember. I was raised in San Diego, California, so there wasn’t much cold weather! I’ve had a few doctors over the years make casual comments about my having Raynaud’s, but no one ever explained it to me (of course I looked it up), or said anything about treating it. My migraines didn’t start until my early thirties (22 years ago). I’ve recently found a headache specialist in our area and had an initial meeting with him. I will certainly be bringing this up with him at our next appointment! Thank you for continuing to report such important information!

  • Ellen Schnakenberg author
    6 years ago

    Raynaud’s – unlike Migraine – can be secondary or primary. This means Raynaud’s can be *caused* by something else. That said, Migraine is most frequently a trigger for Raynaud’s that is already present. Raynaud’s doesn’t like stress at all, of any kind. And as you know, a good Migraine attack can be extremely stressful.

  • Nancy Harris Bonk moderator
    6 years ago

    Hi BB.

    It’s not that one “causes” the other, rather they can occur at the same time. Does that help?

  • thomas51
    6 years ago

    A relative of mine has found that beetroot helps. Probably whey protine powder as well it has L-Arginine but neither are good for migraine.

  • Dr. Alex Mauskop
    6 years ago

    As you mentioned, many migraine sufferers have cold hands and feet, which is often due to magnesium deficiency. Since magnesium opens up the blood vessels it may also help Raynaud’s syndrome, which I have seen in several of my patients. Oral magnesium (I recommend starting with 400 mg of magnesium oxide daily) is usually sufficient, but some people who do not tolerate or do not absorb magnesium orally can benefit from a monthly infusion of magnesium.

  • Ellen Schnakenberg author
    6 years ago

    Dr. Alex Mauskop – I am curious if you would mind sharing your personal views on testing ionized magnesium levels before beginning supplementation? Do you feel this has any worth in the case of a Migraineur with Raynaud’s? Although I realize many patients test deficient, I have been told contradicting information as to the relative usefulness of testing blood levels since it is tissue levels that make the difference.

    I am personally getting ready to begin weekly, then monthly Mag infusions in hopes that it might be of some benefit, despite my *normal* range ionized mag levels. I found minimal effect from oral (dissolveable) mag citrate. I am cautiously optimistic as this seems to be one of the only options I haven’t yet utilized and my Raynaud’s has caused enough damage that we are mildly concerned.

  • 6 years ago

    I didn’t realize how serious Raynaud’s could be. I guess mine must be pretty mild. I only seem to get triggered if I’m outside too long on a cold, windy day, and my fingers, toes or nose get chilled. Fortunately I’ve not had symptoms more than once or twice a year.

    Thanks for all the info Ellen.

  • Ellen Schnakenberg author
    6 years ago

    I’m really glad yours hasn’t been a problem so far. Let’s hope it stays that way! 🙂

  • Ricki
    6 years ago

    I believe that triptans are not only a trigger for Reynaud’s, but that prolonged use of triptans may also cause Reynauds’s. That’s just my opinion, I’ve never read a study about that but it seems logical.

  • Ellen Schnakenberg author
    6 years ago

    Ricki – There are other drugs that can cause secondary Reynaud’s as well as trigger attacks, so it makes sense that triptans may potentially cause this to happen. However, like you I have seen no research that talks about this specifically. As a Raynaud’s patient from decades before the invention of triptans, I can’t even comment on it from personal experience. Mine is the result of my autoimmune disease. Migraines definitely exacerbate the condition, and having the condition really limits the medication related treatments I can utilize.

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