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

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.