A Prospective Study of Chronic or Recurrent Headache in Systemic Lupus Erythematosus

Abstract

This study was conducted to analyze the prevalence and features of chronic or recurrent headache in Systemic Lupus Erythematosus (SLE), and also the relationship of such headache with other manifestations of the disease. A total of 76 patients (69 women and 7 men) with a mean age of 40 years (r: 24-74 years) were included. An overall severity index for SLE was applied. Fifty-two patients (68%) presented headache, 27 (52%) being vascular and 25 (48%) muscle contraction type. Headache in general was more frequent after the onset of SLE (p less than .001). Prevalence of muscle contraction headache in particular was greater following manifestations of SLE. Family history of migraine was recorded in 54% of the patients with vascular headache. This antecedent was more common in patients in whom migraine started before the onset of SLE (p = .05). A greater number of neuropsychiatric symptoms was observed in the patients with vascular headache and family history (p less than .02). Patients with thrombocytopenia presented headache less frequently (p less than .05). Our results showed headache, of both vascular and muscle contraction types, to be frequent in SLE. We note that there is an increased frequency of muscle contraction headache after the onset of SLE, and that there is a migraine-like headache directly related to SLE. Migrainous patients with familial history have a greater probability to suffer neuropsychiatric manifestations. Finally, it is suggested that severity of SLE is not related to presence of headache.

Clinical Implications of Migraine in Systemic Lupus Erythematosus: Relation to Cumulative Organ Damage

“…Our study shows that SLE patients with past history of migraine have higher SLICC‐DI scores than patients without this manifestation. Although most previous controlled studies (1–7) did not find an association between SLE and migraine, we demonstrate that, patients with active migraine had higher disease activity scores than patients without migraine and were therefore more often treated with corticosteroids to control SLE activity than patients without migraine. Both the chronic use of corticosteroids and the presence of SLE flairs are features associated with greater organ damage in SLE patients.…”

Prevalence and Factors Associated with Headache in Patients with Systemic Lupus Erythematosus

“…This could mean that headache in SLE could have a vascular physiopathological mechanism among other different associated mechanisms. Nevertheless, other studies had not found association between headache and Raynaud's phenomenon in patients with SLE (3, 8, 21, 22). This discrepancy could be related to population or study design differences or to searching intensity considering that prevalence of Raynaud's phenomenon varies with the observer's specific questioning of the patient.…”

“…Nervous system involvement has been found ranging from 14% to 75% (1, 2). Headache, especially of migraine type, is very common in SLE with reported prevalences as high as 65–70% in some studies (3–5). The impact of migraine on daily life is enormous.…”

Is Migraine Really Comorbid with Systemic Lupus Erythematosus?

“…Interestingly, both studies used SLE as a human brain inflammatory model to explore the vascular hypothesis of migraine pathogenesis, with contradictory results. A large number of papers followed reporting high headache prevalence in SLE ranging from 30% to 65%(3–19). Furthermore, in some studies the headache occurrence has been related to SLE exacerbation (3, 9, 12), Raynaud's phenomenon (19) and anticardiolipin antibodies (19, 20), but not all investigators have agreed (12, 15, 21).…”