HEADACHE IN SYSTEMIC LUPUS-ERYTHEMATOSUS - A CONTROLLED-STUDY

Intractable headaches, the so-called 'lupus headaches', have been long thought of as a common and characteristic manifestation of systemic l upus erythematosus (SLE). Seventy-eight patients with SLE, including 1 0 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 characteristi cs and type of headache. Clinical features of SLE, neurological manife stations and treatment, disease severity and autoantibody profiles wer e correlated to the presence of headache. One year prevalence of heada che was similar between patients (32%) and otherwise healthy individua ls (30%). No significant differences regarding frequency, family histo ry of headache and need for analgesic medication were observed. Headac he refractory to analgesic treatment, but responsive to corticosteroid regimen, was recorded in only one patient. Clinical and serological f eatures of SLE, including Raynaud's phenomenon and the presence of and icardiolipin antibodies, were not significantly different between head ache sufferers and non-sufferers. In the majority of patients reportin g headache, anxiety and/or depression co-existed. Episodic tension hea dache was the most frequent type, while migraine was traced in a quart er of headache sufferers. Neither the presence nor the clinical type o f headache was related to, or predictive of, the development of seizur es or psychosis. These results indicate that headache is not specifica lly 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 ov erestimation of the disease status.