Headache in systemic lupus erythematosus and its relation to other disease manifestations

Objective: To investigate headache in systemic lupus erythematosus (SLE) and its relation to other disease manifestations. Methods: Clinical and laboratory variables of 148 SLE patients were prospectively recorded in a computed data base. Results: The patients were divided into two groups. Group A consisted of patients who reported moderate to severe headache on at least two consecutive encounters, and Group B consisted of the remainder of the patients, with mild or no headache. The two groups did not significantly differ in age or in sex distribution. Patients in Group A suffered from more severe joint pain and inflammation, muscle pain, photosensitivity, mouth ulcers, fever and fatigue. They also had higher disease activity scores, and a higher number showed central nervous involvement. There were no significant differences between the two groups in any of the laboratory variables examined, nor in the proportion of patients with renal involvement. The prevalence of non-thromboembolic central nervous system (CNS) manifestations was 7.2%. The sensitivity of headache for the diagnosis of non-thromboembolic CNS manifestations was 90.9%, and the specificity was 29.2%. On logistic regression analysis, the total arthritis score, muscle pain, fatigue and photosensitivity were each found to be significantly independently related to headache. Conclusions: Headache is common in SLE, and in the majority of patients is related to musculoskeletal and constitutional disease manifestations.