Contrary to what many physicians who treat lupus patients believe, headaches—and especially migraines—are not a manifestation of the disease and should be treated as a separate issue, according to a study published in the journal Headache.
Previous findings that migraine is more prevalent in patients with systemic lupus erythematosus (SLE) may have stemmed from methodological errors, according to senior author Dimos Mitsikostas, MD, PhD, of Athens Naval Hospital in Greece. This research led physicians to dismiss headaches as a neurological symptom of lupus. Instead of being part of the disease, however, headaches may result from the stress of having the disease.
“In SLE, headaches may be associated with poor quality of life and bad mood. If an SLE patient reports headaches, please see if he or she is happy and if there is any other reason to cause secondary headaches and treat them not as an SLE feature, but like a separate disorder,” Mitsikostas told Reuters Health.
Although various headache studies have produced conflicting results, the American College of Rheumatology includes headaches and migraine as part of the spectrum of lupus symptoms.
In a previous analysis, Mitsikostas and colleagues found no significant association between migraines and lupus. To determine whether an association existed, they assessed a group of participants—which included 48 patients with multiple sclerosis (MS) and 72 pairs of patients with lupus and healthy controls—every 3 months using headache diaries.
All participants had similar headache frequencies in the year before the study period, with the exception of the lupus patients, who had a significantly higher number of tension-type headaches.
According to the report, results were similar during the year that headache diaries were kept: the 3 groups suffered comparable numbers of headaches, but chronic tension-type headache continued to occur more often in the lupus patients. Migraine attacks were less severe and tended to be of shorter duration in lupus patients, whereas the severity of the chronic tension-type headaches was milder among lupus patients than among controls.
Among both lupus and MS patients, the presence and type of headache could not be related to any other detectable manifestation of the disease, flare-up, or cumulative damage, according to researchers. Lupus patients had higher levels of anxiety and lower quality of life compared to controls and MS patients, and depression status was worse in lupus and MS patients than in controls. None of these features, however, coincided with the presence of headache.
"Although there are always missed points and issues for further evaluation, we feel that this study may be the last one in a long clinical research (path), starting 15 years ago," Mitsikostas told Reuters Health. "Yet, no pathophysiological links between SLE and migraine" could be found along the way, he wrote.