JOURNAL ARTICLE

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

John G Hanly, Murray B Urowitz, Aidan G O'Keeffe, Caroline Gordon, Sang-Cheol Bae, Jorge Sanchez-Guerrero, Juanita Romero-Diaz, Ann E Clarke, Sasha Bernatsky, Daniel J Wallace, Ellen M Ginzler, David A Isenberg, Anisur Rahman, Joan T Merrill, Michelle Petri, Paul R Fortin, Dafna D Gladman, Barri J Fessler, Graciela S Alarcón, Ian N Bruce, Mary Anne Dooley, Kristjan Steinsson, Munther A Khamashta, Rosalind Ramsey-Goldman, Susan Manzi, Gunnar K Sturfelt, Ola Nived, Asad A Zoma, Ronald F van Vollenhoven, Manuel Ramos-Casals, Cynthia Aranow, Meggan Mackay, Guillermo Ruiz-Irastorza, Kenneth C Kalunian, S Sam Lim, Murat Inanc, Diane L Kamen, Christine A Peschken, Soren Jacobsen, Chris Theriault, Kara Thompson, Vernon Farewell
Arthritis and Rheumatism 2013, 65 (11): 2887-97
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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.

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