The British Journal of Rheumatology, Vol 37, 300-303, Copyright © 1998 by British Society for Rheumatology
PP Sfikakis, DD Mitsikostas, MN Manoussakis, D Foukaneli and HM Moutsopoulos
Intractable headaches, the so-called 'lupus headaches', have been long
thought of as a common and characteristic manifestation of systemic lupus
erythematosus (SLE). Seventy-eight patients with SLE, including 10 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 characteristics and type of
headache. Clinical features of SLE, neurological manifestations and
treatment, disease severity and autoantibody profiles were correlated to
the presence of headache. One year prevalence of headache was similar
between patients (32%) and otherwise healthy individuals (30%). No
significant differences regarding frequency, family history of headache and
need for analgesic medication were observed. Headache refractory to
analgesic treatment, but responsive to corticosteroid regimen, was recorded
in only one patient. Clinical and serological features of SLE, including
Raynaud's phenomenon and the presence of anticardiolipin antibodies, were
not significantly different between headache sufferers and non-sufferers.
In the majority of patients reporting headache, anxiety and/or depression
co-existed. Episodic tension headache was the most frequent type, while
migraine was traced in a quarter of headache sufferers. Neither the
presence nor the clinical type of headache was related to, or predictive
of, the development of seizures or psychosis. These results indicate that
headache is not specifically 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 overestimation of the disease status.
ORIGINAL PAPERS
Headache in systemic lupus erythematosus: a controlled study
Department of Propedeutic Medicine, Laikon Hospital, Athens University Medical School, Greece.
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