Headache in systemic lupus erythematosus: a controlled study

Abstract

Intractable headaches, the so-called 'lupus headaches', have been long thought of as a common and characteristic manifestation of systemic lupus erythematosus (SLE). Seventy-eight patients with SLE, including 10 patients with definite central nervous system (CNS) involvement, and 89 healthy individuals matched for age, sex and socioeconomic status, were studied by a specific questionnaire addressing the characteristics and type of headache. Clinical features of SLE, neurological manifestations and treatment, disease severity and autoantibody profiles were correlated to the presence of headache. One year prevalence of headache was similar between patients (32%) and otherwise healthy individuals (30%). No significant differences regarding frequency, family history of headache and need for analgesic medication were observed. Headache refractory to analgesic treatment, but responsive to corticosteroid regimen, was recorded in only one patient. Clinical and serological features of SLE, including Raynaud's phenomenon and the presence of anticardiolipin antibodies, were not significantly different between headache sufferers and non-sufferers. In the majority of patients reporting headache, anxiety and/or depression co-existed. Episodic tension headache was the most frequent type, while migraine was traced in a quarter of headache sufferers. Neither the presence nor the clinical type of headache was related to, or predictive of, the development of seizures or psychosis. These results indicate that headache is not specifically related to SLE expression or severity, and suggest that accepting the presence even of a severe headache as a neurological manifestation of SLE in the absence of seizures or overt psychosis may result in overestimation of the disease status.

Dysimmune disorders and migraine: is there a possible common denominator?

“…Montalban et al [7] diagnosed migraine in 31% of 103 patients, tension-type headache in 20%, and cluster headache in less than 1% of the patients. A lower proportion of patients (8%) suffered from migraine in a study carried out by Sfikakis et al [8], but in this study a diagnosis of migraine required at least one episode every 2 weeks, whereas the 1988 IHS classification [9] requires five separate lifetime attacks and two lifetime attacks, respectively, for migraine without and with aura. In a more recent study carried out by Glanz et al [10], 186 SLE patients completed the San Diego Migraine Questionnaire based on IHS criteria for migraine, which has been shown to accurately distinguish between migraine and nonmigraine headache syndromes.…”

Pain in systemic connective tissue diseases

“…Although its relationship with SLE is not clear, headache and migraine are reported by 32e66% of SLE patients and may have various causes, including neuropsychiatric SLE (NPSLE) [24]. A recent study of 40 SLE patients found that 70% experienced headache (tension type headache in 37.5%, migraine in 30%, cluster headaches in 2.5%, and intracranial hypertension in 5%) but there was no association with disease activity [25,26].…”

Headache, Seizures, Cognitive Disorders, and Cerebrovascular Diseases as the Most Common Neuropsychic Syndromes in Systemic Lupus Erythematosus

“…Эти данные противоречивы, и описано как наличие данного факта, так и его отсутствие [25][26][27]. Головная боль при СКВ развивается как в активной фазе заболевания [28], так и вне обострения [25,27].…”

“…Вторичная головная боль у пациентов с СКВ может развиваться на фоне патологии почек [29], инфекции [30], церебрального венозного тромбоза [31,32], внутримозго-вых или субарахноидальных кровоизлияний [33,34] Возникновение головной боли при СКВ может быть связано с тревожно-депрессивными расстройствами [26,27]. У 59% пациентов она сопровождалась наличием двух и более стрессовых симптомов [26].…”

“…У 59% пациентов она сопровождалась наличием двух и более стрессовых симптомов [26]. С помощью шкалы Га-мильтона существенные проявления тревоги обнаружены у 73%, депрессии -у 60% пациентов с СКВ [27]. Схожие результаты описаны в других работах, показавших, что па-циенты с СКВ очень часто страдают от перепадов настрое-ния и тревожных расстройств [8,9].…”