ARE THERE ANY FACTORS ASSOCIATED WITH HEADACHE IN PATIENTS WITH SLE?

Background: Prevalence of headache in systemic lupus erythematosus (SLE) is reported as high as 70%. There are many controversies in the occurrence of headache in SLE patients and it is still debated whether it is a separate entity. Objectives: To compare clinical, serological and instrumental features of a group of SLE patients with headache appearing at onset or after the onset of the disease with those of a group of SLE patients without headache. Methods: We prospectively performed a questionnaire (following IHS 2004 and ACR 1999 case definitions) and neurological examination on 108 SLE patients referring more than 5 episodes of headache/year on 247 SLE patients tested. Among them 28 patients (27 women and 1 men, median age 48.5) referred onset of headache concomitant or subsequent to SLE diagnosis. We compared their characteristics with those of 50 consecutive SLE patients (49 women, 1 men, median age 46 years) without headache. Results: We didn't found any clinical, serological and instrumental finding typical of the SLE headache population. In particular, concerning clinical manifestations, there were no differences in prevalence of Raynaud's phenomenon (14% vs 9%) and concomitant neuropsychiatric involvement (64% vs 50%). Concerning laboratory data SLE headache population had a 32% anti-DNA positivity vs 50% of the control population; among ENA antibodies, SSA alone or associated with SSB was the most frequent (43% vs 34%) followed by ENA-RNP (3% vs 4%) but equally distributed. Antiphospholipid antibodies (IgG, IgM) and/or Lupus anticoagulant were in 39% of SLE headache population and in 44% of the control population. Concerning instrumental abnormalities, 19 SLE patients with headache and 41 controls performed magnetic resonance imaging with pathological findings respectively in 63% (12/19) and 54% (22/41). In the same way SPECT findings showed abnormalities respectively in 71% (17/24) and in 55% (24/44). Conclusion: Although a high prevalence of various headache types has been suggested by several studies, the specific relationship of headache to SLE features still remains unclear. Data dealing with this matter are not clear since characteristics of SLE related headache are still not defined. Our study referred to a selected population of headache SLE patients (i.e. onset concomitant or consequent to SLE diagnosis) shows how there is no distinct headache syndrome or pathogenetic mechanism for headache in SLE patients. So the question is still open: is SLE really comorbid with migraine or this view is simply based on old fashioned methodologies and concepts? Further investigations with well designed controlled and prospective studies are needed. Until then, the association of migraine or headache in general with SLE is under investigation and no conclusion can be made.