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Primary headache in SLE -systematic review and meta-analysis.

Joy Feld¹, Oshrat E Tayer-Shifman², Jiandong Su³

¹Rheumatology unit, Carmel and Zvulun medical centers, Haifa, Israel; Department of Rheumatology, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.

Seminars in Arthritis and Rheumatism

|October 30, 2024

Summary

Patients with lupus experience primary headaches at a similar rate to healthy individuals. These headaches are linked to depression and Raynaud phenomenon, not lupus activity, with "lupus headaches" being a rare condition.

Keywords:

Keyword lupus primary headaches

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Area of Science:

Neurology
Rheumatology
Systematic Review

Background:

Systematic review of primary headaches in patients with systemic lupus erythematosus (SLE).
Focus on prevalence, risk factors, structural brain changes, and "lupus headaches" since 2004.
Examines literature published from 2004 to April 2022.

Approach:

Utilized PRISMA guidelines for systematic review.
Conducted comprehensive literature searches across four major databases (Medline, Embase, PsycINFO, Cochrane).
Included 11 studies after critical appraisal of 189 selected papers from 5096 initial references.

Key Points:

Pooled prevalence of primary headaches in lupus patients is 26.8%, similar to healthy controls but higher than in rheumatoid arthritis or primary Sjogren's syndrome.
Primary headaches in lupus are associated with depression and impaired quality of life, not disease activity.
Migraines show no difference in prevalence compared to controls or other autoimmune conditions.
Raynaud phenomenon is linked to migraines; limited data exists on structural brain changes and treatment effects.
"Lupus headaches" are rare, occurring in 1.5% of SLE patients, and should be considered after excluding other causes.

Conclusions:

Primary headaches and migraines are prevalent in lupus patients at rates comparable to healthy individuals.
Headache association with depression and Raynaud phenomenon, independent of lupus disease activity.
Limited evidence on structural brain changes; "lupus headaches" are a rare, distinct manifestation requiring further investigation.