Headache in systemic lupus erythematosus: results from a prospective, international inception cohort study

Arthritis Rheum. 2013 Nov;65(11):2887-97. doi: 10.1002/art.38106.

Abstract

Objective: To examine the frequency and characteristics of headaches and their association with global disease activity and health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE).

Methods: A disease inception cohort was assessed annually for headache (5 types) and 18 other neuropsychiatric (NP) events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 (SF-36) mental and physical component summary scores were collected. Time to first headache and associations with SF-36 scores were analyzed using Cox proportional hazards and linear regression models with generalized estimating equations.

Results: Among the 1,732 SLE patients enrolled, 89.3% were female and 48.3% were white. The mean ± SD age was 34.6 ± 13.4 years, duration of disease was 5.6 ± 5.2 months, and length of followup was 3.8 ± 3.1 years. At enrollment, 17.8% of patients had headache (migraine [60.7%], tension [38.6%], intractable nonspecific [7.1%], cluster [2.6%], and intracranial hypertension [1.0%]). The prevalence of headache increased to 58% after 10 years. Only 1.5% of patients had lupus headache, as identified in the SLEDAI-2K. In addition, headache was associated with other NP events attributed to either SLE or non-SLE causes. There was no association of headache with SLEDAI-2K scores (without the lupus headache variable), SDI scores, use of corticosteroids, use of antimalarials, use of immunosuppressive medications, or specific autoantibodies. SF-36 mental component scores were lower in patients with headache compared with those without headache (mean ± SD 42.5 ± 12.2 versus 47.8 ± 11.3; P < 0.001), and similar differences in physical component scores were seen (38.0 ± 11.0 in those with headache versus 42.6 ± 11.4 in those without headache; P < 0.001). In 56.1% of patients, the headaches resolved over followup.

Conclusion: Headache is frequent in SLE, but overall, it is not associated with global disease activity or specific autoantibodies. Although headaches are associated with a lower HRQOL, the majority of headaches resolve over time, independent of lupus-specific therapies.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Autoantibodies / blood*
  • Cluster Headache / epidemiology
  • Cluster Headache / immunology
  • Female
  • Follow-Up Studies
  • Headache / epidemiology*
  • Headache / immunology*
  • Humans
  • Internationality
  • Intracranial Hypertension / epidemiology
  • Intracranial Hypertension / immunology
  • Kaplan-Meier Estimate
  • Lupus Erythematosus, Systemic / epidemiology*
  • Lupus Erythematosus, Systemic / immunology*
  • Male
  • Middle Aged
  • Migraine Disorders / epidemiology
  • Migraine Disorders / immunology
  • Proportional Hazards Models
  • Prospective Studies
  • Quality of Life
  • Tension-Type Headache / epidemiology
  • Tension-Type Headache / immunology
  • Young Adult

Substances

  • Autoantibodies