Abstract
BackgroundThe prevalence of primary headache in patients with systemic lupus erythematosus (SLE) varies widely and whether it should be attributed to neurological involvement is controversial. We aimed to investigate the prevalence and characteristics of headache in SLE patients, describe its association with disease-related variables and brain imaging, and explore its impact on life.ResultsThe overall prevalence of headache was 54.4%, and migraine was the most common type among headache sufferers (48.4%). Headache severity (VAS) and impact (HIT-6) correlated with SLEDAI-2K (P = 0.019 and P < 0.001, respectively) as well as with each other (P = 0.006). Brain imaging abnormalities were found in 25.8%, with white-matter hyperintensities (WMH) being the most frequent pathology. Musculoskeletal manifestations, positive anti-phospholipid (aPL) antibodies, and SLEDAI score ≥ 13.5 were identified as predictors of headache.ConclusionPrimary headache, especially migraine, is a common feature of patients with SLE, and its presence is associated with negative impact on quality of life. Musculoskeletal features, aPL positivity, and overall disease activity appear to predict primary headache in SLE.
Highlights
The prevalence of primary headache in patients with systemic lupus erythematosus (SLE) varies widely and whether it should be attributed to neurological involvement is controversial
None of the patients met the SLEDAI2K criteria for lupus headache and none had more than one type of headache at the same time either
Headache characteristics and impact are described in table 1
Summary
The prevalence of primary headache in patients with systemic lupus erythematosus (SLE) varies widely and whether it should be attributed to neurological involvement is controversial. Lupus headache has a strong weight in the SLE disease activity index (SLEDAI-2K) suggesting the presence of an Elolemy et al Egyptian Rheumatology and Rehabilitation (2021) 48:31 underlying significant pathology, its clinical significance remains unclear. This issue raises the inquiry; is it a symptom of morbidity related to acute pain but has no other significance or is it a sign of significant underlying pathology [12]?
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