Q. I am getting severe headache on taking Arava for inflammatory arthritis. Why?

Answered by
Dr. Catherine Bevington
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 24, 2019 and last reviewed on: Dec 26, 2019

Hello doctor,

I have a low-grade inflammatory arthritis. I have awful joint pain but minimal swelling and occasional slight inflammation in blood tests. The RA test is negative. Systemic steroid injection gives massive improvement. My consultant started me on Arava recently. At the same time, I have been weaning myself off Tramadol after being put on this irresponsibly by a pain consultant. Within a couple of days of starting Arava, a background headache began and a few days ago this reached an agonizing peak. The only thing that helped was Aspirin. My BP was raised and my Lisinopril has now been doubled. I stopped the Arava. My current medications are Lisinopril, Simvastatin, Omeprazole, Duloxetine. The headache is better but still in the background. So, I have the double issue of this and stopping Tramadol.

My question is - Is the headache caused mostly by the Arava? And how long should I wait before seeing GP again? My BP is much better. I stress I am prone to migraines in any case.



Welcome to

The headache is likely to have been caused by a combination of the Arava (Leflunomide) and your raised blood pressure. Although we cannot know how much each of these contributed? Anyway, if your blood pressure rose a lot on Arava it is probably best not to have this again. Perhaps Methotrexate would be better for you. Has this drug been mentioned to you? Alternatives would be Hydroxychloroquine or Sulphasalazine. I suggest trying to see your consultant or specialist nurses again to discuss these drugs. It might be possible to reduce your Lisinopril back to normal dose soon, your GP can help with this, perhaps in a month.

I hope this helps.

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