Background According to different authors central nervous system involvement in SLE called neuropsychiatric SLE (NPSLE) varies widely. One of the manifestations of NPSLE is the headache. Although the latter is not included into the diagnostic criteria, its presence is a sign of disease activity. Lupus headache could presents as: migraine, tension, headache of intracranial hypertension, atypical and relapsing pattern.
Objectives The objective of our study is to identify and characterize the lupus headache in SLE patients with different clinical characteristics.
Methods 225 SLE patients were included in the study. They were divided in three groups: group I - 62,28% of the patients, with clinically manifested of neuropsychiatric symptoms, group II – 37,72%, with no clinical manifestations of NPSLE and group III – 25,78%, with incomplete SLE. The presence of lupus headache was diagnosed based on the 1999 ACR classification criteria and other possible causes for it have been excluded (untreated hypertension, infections, treatment regimen, etc.).
Results Lupus headache was present in 52 (23,11%) of the studied patients. It was more common in the patients with clinically active NPSLE (group I) – in 41 (39,42%) of them. In 24 (58,54%) of them the headache had a tension characteristic and a duration from 10 minutes to 4 days. In 10 (24,39%) of them it had a characteristic of migraine. In the rest of the patients with lupus headache – 7 (17,07%), is was the only symptom in the absence of neurologic abnormalities, and in 2 of them (4,88%) retinal vasculitis has been diagnosed by direct ophthalmoscopy. The use of corticosteroids had good therapeutic effect in 87,80% of cases of lupus headache. In group II there were not patients with lupus headache. Lupus headache was demonstrated in 11 patients (18,97%) patients in group III. Lupus headache was more common in the patients with longer disease duration (p=0,047) or higher levels of matrix metalloproteinase 9 in the serum (p<0,001).
Conclusions In the majority of the SLE patients the lupus headache has a tension characteristic. The use of corticosteroids has good effect in controlling this disease manifestation.
Disclosure of Interest None declared