lupus headache

Lupus headache is an important item in the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), a scoring system often used in lupus research.{{cite journal |vauthors=Brunner HI, Jones OY, Lovell DJ, Johnson AM, Alexander P, Klein-Gitelman MS |title=Lupus headaches in childhood-onset systemic lupus erythematosus: relationship to disease activity as measured by the systemic lupus erythematosus disease activity index (SLEDAI) and disease damage |journal=Lupus |volume=12 |issue=8 |pages=600–6 |year=2003 |pmid=12945718 |doi=10.1191/0961203303lu430oa |s2cid=32927986 |url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0961-2033&volume=12&issue=8&spage=600&aulast=Brunner |archive-date=2019-12-09 |access-date=2009-02-02 |archive-url=https://web.archive.org/web/20191209210711/http://openurl.ingenta.com/content/nlm?genre=article&issn=0961-2033&volume=12&issue=8&spage=600&aulast=Brunner |url-status=dead }} The SLEDAI describes lupus headache as a "severe, persistent headache; may be migrainous, but must be nonresponsive to narcotic analgesia". A score of 8 is given to this item (items are given a relative weight of 1, 2, 4 or 8).{{citation needed|date=August 2021}}

The 1999 American College of Rheumatology case definitions of neuropsychiatric syndromes in SLE do not define lupus headache, but rather propose several headache disorders loosely based on the International Headache Society (IHS) classification.{{citation needed|date=August 2021}}

In the IHS scheme, headache due to lupus would be classified as "Headache attributed to other non-infectious inflammatory disease" (7.3.3). This label requires evidence of a disease flare accompanying the headache, and resolution of the headache with immunosuppressant treatment. However, a meta-analysis found no correlation between headaches and disease activity.{{cite journal |vauthors=Mitsikostas DD, Sfikakis PP, Goadsby PJ |title=A meta-analysis for headache in systemic lupus erythematosus: the evidence and the myth |journal=Brain |volume=127 |issue=Pt 5 |pages=1200–9 |date=May 2004 |pmid=15047589 |doi=10.1093/brain/awh146 |doi-access=free }}

Critics of this concept argue that there are no quality studies showing that headaches in patients with SLE differ from those in the general population. A detailed definition of the term lupus headache is lacking, since the terms "severe" and "persistent" are not quantified. Narcotic analgesics are not recommended for migraines or other common headache types. Other definitions from the IHS do not include responsiveness to treatments as a diagnostic criterion. Migraine patients are typically adult women around age 40, a demographic group in which SLE is also more common.{{cite journal |author=Omdal R |title=Some controversies of neuropsychiatric systemic lupus erythematosus |journal=Scand. J. Rheumatol. |volume=31 |issue=4 |pages=192–7 |year=2002 |pmid=12369649 |doi= 10.1080/030097402320318369|s2cid=1057841 }}

Some (but not all) studies have shown an association between (migraine) headaches in SLE and associated Raynaud's phenomenon and/or anti-cardiolipin antibodies.{{cite journal |vauthors=Bernatsky S, Pineau CA, Lee JL, Clarke AE |title=Headache, Raynaud's syndrome and serotonin receptor agonists in systemic lupus erythematosus |journal=Lupus |volume=15 |issue=10 |pages=671–4 |year=2006 |pmid=17120594 |doi= 10.1177/0961203306069997|s2cid=44643859 |url=http://lup.sagepub.com/cgi/pmidlookup?view=long&pmid=17120594}}{{cite journal |vauthors=Bettero RG, Rahal MY, Barboza JS, Skare TL |title=Headache and systemic lupus erythematosus: prevalence and associated conditions |language=pt |journal=Arq Neuropsiquiatr |volume=65 |issue=4B |pages=1196–9 |date=December 2007 |pmid=18345429 |doi= 10.1590/S0004-282X2007000700020|doi-access=free }}{{cite journal |vauthors=Annese V, Tomietto P, Venturini P, D'Agostini S, Ferraccioli G |title=[Migraine in SLE: role of antiphospholipid antibodies and Raynaud's phenomenon] |language=it |journal=Reumatismo |volume=58 |issue=1 |pages=50–8 |year=2006 |pmid=16639488 |doi=10.4081/reumatismo.2006.50 |doi-access=free }}{{cite journal |vauthors=Lessa B, Santana A, Lima I, Almeida JM, Santiago M |title=Prevalence and classification of headache in patients with systemic lupus erythematosus |journal=Clin. Rheumatol. |volume=25 |issue=6 |pages=850–3 |date=November 2006 |pmid=16437362 |doi=10.1007/s10067-005-0186-x |s2cid=28044605 }}{{cite journal |vauthors=Weder-Cisneros ND, Téllez-Zenteno JF, Cardiel MH, etal |title=Prevalence and factors associated with headache in patients with systemic lupus erythematosus |journal=Cephalalgia |volume=24 |issue=12 |pages=1031–44 |date=December 2004 |pmid=15566417 |doi=10.1111/j.1468-2982.2004.00822.x |s2cid=1845267 }}{{cite journal |vauthors=Appenzeller S, Costallat LT |title=Clinical implications of migraine in systemic lupus erythematosus: relation to cumulative organ damage |journal=Cephalalgia |volume=24 |issue=12 |pages=1024–30 |date=December 2004 |pmid=15566416 |doi=10.1111/j.1468-2982.2004.00785.x |s2cid=23055360 }}{{cite journal |vauthors=Whitelaw DA, Hugo F, Spangenberg JJ, Rickman R |title=Headaches in patients with systemic lupus erythematosus: a comparative study |journal=Lupus |volume=13 |issue=7 |pages=501–5 |year=2004 |pmid=15352420 |doi=10.1191/0961203304lu1050oa |s2cid=44450325 |url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0961-2033&volume=13&issue=7&spage=501&aulast=Whitelaw |archive-date=2019-12-09 |access-date=2009-02-02 |archive-url=https://web.archive.org/web/20191209210726/http://openurl.ingenta.com/content/nlm?genre=article&issn=0961-2033&volume=13&issue=7&spage=501&aulast=Whitelaw |url-status=dead }}{{cite journal |vauthors=Sfikakis PP, Mitsikostas DD, Manoussakis MN, Foukaneli D, Moutsopoulos HM |title=Headache in systemic lupus erythematosus: a controlled study |journal=Br. J. Rheumatol. |volume=37 |issue=3 |pages=300–3 |date=March 1998 |pmid=9566671 |doi= 10.1093/rheumatology/37.3.300|doi-access=free }}{{citation overkill|date=August 2021}}

Further studies are needed however to prove the underlying assumption that cerebral vasospasm causes migraines in lupus patients.

Although specific complications of SLE may cause headache (such as cerebral venous sinus thrombosis or posterior reversible encephalopathy syndrome), it remains unclear whether specific investigations (such as lumbar puncture or magnetic resonance imaging, MRI) are needed in lupus patients presenting with headache. Although studies using MRI or single-photon emission computed tomography (SPECT) often find abnormalities,{{cite journal |vauthors=Nobili F, Mignone A, Rossi E, etal |title=Migraine during systemic lupus erythematosus: findings from brain single photon emission computed tomography |journal=J. Rheumatol. |volume=33 |issue=11 |pages=2184–91 |date=November 2006 |pmid=17086605 |url=http://www.jrheum.com/subscribers/06/11/2184.html |access-date=2009-02-02 |archive-url=https://web.archive.org/web/20110713124733/http://www.jrheum.com/subscribers/06/11/2184.html |archive-date=2011-07-13 |url-status=dead }}{{cite journal |vauthors=Colamussi P, Giganti M, Cittanti C, etal |title=Brain single-photon emission tomography with 99mTc-HMPAO in neuropsychiatric systemic lupus erythematosus: relations with EEG and MRI findings and clinical manifestations |journal=Eur J Nucl Med |volume=22 |issue=1 |pages=17–24 |date=January 1995 |pmid=7698150 |doi= 10.1007/BF00997243|s2cid=19194183 }} the value of these findings remains unclear, and they have not been able to distinguish a special "lupus headache" from other headache types in people with lupus.{{cite journal |vauthors=Castellino G, Padovan M, Bortoluzzi A, etal |title=Single photon emission computed tomography and magnetic resonance imaging evaluation in SLE patients with and without neuropsychiatric involvement |journal=Rheumatology (Oxford) |volume=47 |issue=3 |pages=319–23 |date=March 2008 |pmid=18218648 |doi=10.1093/rheumatology/kem354 |doi-access=free }}{{cite journal |vauthors=Kovacs JA, Urowitz MB, Gladman DD, Zeman R |title=The use of single photon emission computerized tomography in neuropsychiatric SLE: a pilot study |journal=J. Rheumatol. |volume=22 |issue=7 |pages=1247–53 |date=July 1995 |pmid=7562753 }}

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Category:Rheumatology

Category:Headaches