Primary Headache in SLE Linked to Depression and Raynaud Phenomenon

Primary headaches among patients with systemic lupus erythematosus (SLE) are not more common than among the general population, but the prevalence is higher than that found in other rheumatic diseases, according to study results published in Seminars in Arthritis & Rheumatism.

Researchers conducted a systematic review and meta-analysis to summarize studies published since 2004 on primary headaches among patients with SLE. Eligible studies were those with a primary or secondary outcome of neuropsychiatric lupus or “lupus headaches” published until April 2022.

The researchers aimed to explore the following outcomes:

• The prevalence of primary headaches among patients with SLE compared with the general population;
• The prevalence of migraines;
• Risk factors associated with primary headaches in SLE;
• The association between primary headaches and structural brain changes; and
• Current knowledge on “lupus headaches”.

The systematic review included 11 studies. The pooled prevalence of primary headaches in SLE was 26.8% (95% CI, 25.1-28.6), based on data from 9 studies (3 cohort and 6 case-control studies).

Comparisons with healthy controls showed no significant difference in headache prevalence based on data from 4 studies (odds ratio [OR], 2.14; 95% CI, 0.97-4.76; P =.06), though publication bias was noted. However, patients with SLE had a significantly higher prevalence of primary headaches than those with other rheumatic diseases, specifically rheumatoid arthritis (RA) and primary Sjogren syndrome (pSS) (OR, 2.50; 95% CI, 1.56-4.00; P <.0001).

Results from 1 longitudinal cohort study (n=1732) reported that 17.8% of patients had primary headaches at enrollment — the most common being migraines (60.7%) — with percentages increasing to 58% after 10 years.

When combining all study comparisons, the pooled migraine prevalence in SLE was 17.7% (95% CI, 16.2-19.4). No significant differences were found when comparing patients with lupus vs healthy controls (P =.17) or those with RA/pSS (P =.09).

Potential risk factors for headaches included Raynaud phenomenon, psychological stress, depression, and central nervous system involvement, with conflicting findings regarding antiphospholipid syndrome and lupus disease activity. Treatment with hydroxychloroquine was associated with reduced headache risk (P =.05). Structural abnormalities indicated that larger gray matter volumes decreased headache risk (OR, 0.98; P =.048), while larger white matter volumes increased migraine risk (OR, 1.04; P =.007).

The prevalence of “lupus headache” — defined as a severe headache unresponsive to narcotics — was only addressed in a single study and was reported among just 1.5% of patients from that cohort. Its rarity contrasts with the broader prevalence of primary headaches in SLE.

Study limitations include potential publication bias.

The study authors concluded, “’Lupus headache’ is a rare entity in SLE and should be suspected after excluding other possible explanations for headaches, especially when there is no known prior history of primary headaches.”

Multiple study authors reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Rheumatology Advisor