[Headaches in autoimmune diseases]

Area of Science:

• Neurology
• Rheumatology
• Immunology

Background:

• Headaches are a significant symptom in autoimmune diseases, often indicating underlying vasculitis.
• Central nervous system (CNS) vasculitis can manifest with headaches, necessitating careful differential diagnosis.
• Understanding headache patterns in various vasculitides is crucial for accurate diagnosis and management.

Purpose of the Study:

• To review the incidence and characteristics of headaches in primary and secondary CNS vasculitides.
• To delineate headache presentation across different types of vasculitis, including large, medium, and small vessel involvement.
• To differentiate vasculitic headaches from other conditions that mimic CNS vasculitis.

Main Methods:

• Literature review of primary and secondary vasculitides associated with autoimmune diseases.
• Characterization of headache symptoms in various vasculitic entities.
• Comparison of vasculitic headaches with non-vasculitic mimics.

Main Results:

• Headache is a prominent symptom in primary CNS vasculitis.
• Headache occurs across large-vessel (e.g., Takayasu arteritis, giant cell arteritis), medium-vessel (e.g., polyarteritis nodosa), and small-vessel vasculitides (e.g., granulomatosis with polyangiitis).
• Conditions like Behcet's disease, Cogan's syndrome, and systemic autoimmune diseases (SLE, APS, RA, Sjogren's, sarcoidosis) can also present with headaches due to vasculitis.

Conclusions:

• Headache is a key indicator of CNS vasculitis in autoimmune disease patients.
• Distinguishing vasculitic headaches from mimics like reversible cerebral vasoconstriction syndrome or CADASIL is vital.
• Comprehensive evaluation of headache in the context of autoimmune conditions is essential for timely diagnosis of vasculitis.