Headache and systemic lupus erythematosus: A narrative review

Abstract

Objective To review the epidemiology, the differential diagnosis, and the clinical and laboratory factors associated with the care management of headaches in patients with systemic lupus erythematosus (SLE). Background SLE is a chronic autoimmune disease and in 12%–95% of patients, the nervous system is involved. Headache is a frequently reported, although nonspecific, symptom that may potentially represent serious underlying diagnoses. Primary headaches may also occur in these patients, thereby causing a negative and significant impact on their quality of life. Methods This is a narrative review. A literature review was conducted on the PubMed platform using the following terms: (1) headache and (2) lupus. All articles considered relevant were included. No limitations were imposed for the publication date. Results Headache is a frequent symptom in patients with SLE. Although its prevalence is similar to the general population, headaches nonetheless tend to have a greater negative impact on these patients. Patients with SLE are more likely to experience headache due to vascular diseases such as cerebral venous sinus thrombosis, stroke, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, and vasculitis. Aseptic meningitis, neuroinfections, intracranial neoplasms, and intracranial hypertension or hypotension may also be a cause of headache in these patients. Although used in disease activity scores, the concept of lupus headache is controversial. Conclusions Headache is a frequent symptom in patients with SLE. An appropriate approach enables the potentially serious conditions, which are the causes of secondary headaches, to be recognized and treated, together with an appropriate diagnosis and treatment of primary headaches.

Causal association between systemic lupus erythematosus and the risk of migraine: A Mendelian randomization study

“…These findings support the necessity of routine evaluation and early recognition of migraine in patients with SLE in clinical practice. This may help to avoid unnecessary invasive examinations and aggressive treatment and allow for appropriate therapies, ultimately improving patients’ quality of life (Igor de Oliveira & Augusto, 2023 ). However, due to the lack of support from clinical and basic research, these findings should be interpreted with caution.…”

“…Headache in SLE patients ranges from severe secondary headache (such as CNS infection, aseptic meningitis, and cerebral venous sinus thrombosis) to primary headache (such as migraine). Although not fatal, primary headache has a significant influence on individuals’ lives (Igor de Oliveira & Augusto, 2023 ).…”

The Association of Hypertension With Posterior Reversible Encephalopathy Syndrome in Systemic Lupus Erythematosus Patients: A Systematic Review

“…The neurological system is affected by SLE in 12% to 95% of patients [ 15 ]. SLE-PRES patients frequently experience a significant rise in blood pressure, renal failure, and humoral retention, particularly when high doses of methylprednisolone or immunosuppressants are used to treat it.…”

Reversible Cerebral Vasoconstriction Syndrome and Raynaud’s Phenomenon: Is There a Link between the Pathogeneses of Their Underlying Complex Etiology? A Case Report and Literature Review

“…Both disorders exhibit similar abnormalities in vascular reactivity, endothelial dysfunction, and sympathetic nervous system activity, which are characterized by both vasoconstriction and poor vasodilation. Endothelial dysfunction contributes to the development of both diseases [ 3 , 4 , 5 , 12 , 13 ]. Additionally, abnormalities in the release of vasoactive molecules such as endothelin-1, and dysregulation of sympathetic nervous system activity may also play a role in the etiology of Raynaud’s phenomenon and RCVS [ 14 , 15 ].…”

“…Additionally, abnormalities in the release of vasoactive molecules such as endothelin-1, and dysregulation of sympathetic nervous system activity may also play a role in the etiology of Raynaud’s phenomenon and RCVS [ 14 , 15 ]. The possibility of cerebral artery involvement in autoimmune rheumatic diseases is not well described because of the rarity of both disorders [ 1 , 2 , 3 , 5 , 12 , 13 , 14 , 15 , 16 , 17 ]. RCVS was originally described using the diagnostic criteria of Calabrese et al in 2007 [ 2 ].…”