Background Headache (HA) is common to SLE and is a component of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), however, it precise characterization in both situations has been limited.
Objective 1) To evaluate headache characteristics unique to SLE and SLE disease activity.
Methods 436 SLE patients and 86 controls participating in the University of New Mexico Lupus Cohort were evaluated prospectively and cross-sectionally through physcial examination, neuropsych inventory and medical interview about headache characteristics. All subsets regression and multivariate modeling was used to analyze the HA characteristics associated with increased SLEDAI.
Results Patients with SLE had significantly more HA now (current HA), headache frequency, HA more frequent, N/V, photophobia, visual, activity, audio, decreased cognition, decreased performance, incapacitating HA, increased HA severity and muscle tenderness than controls. SLE had 20% more vascular-type headache than control (p=.002). Overall, SLE patients experienced 7.4 more days/month of headache than control (p≤.001). Females with SLE experienced 8.1 more days per month of headache (p≤.001) than control females. When comparing male vs female patients with SLE, females experienced significantly more frequent headaches than males with SLE (10.8 vs 5.4 days/month, respectively, p≤.001). Additionally, females experienced increased duration (6.1 vs 3.6 hours), severity (5.1 vs 3.5), more current HA, more constant HA, more n/v, photoph, tearing, visual activity, decreased activity, decreased cognition, decrease performance and more incapacitating HA. In the multivariate, paired analyses, HA frequency and duration most closely predicted total SLEDAI (r=.54, p≤.0001).
Conclusions HA in SLE is more frequent, more severe and more vascular than HA in controls. The characteristics most closely associated with increased disease activity are frequency and duration ≥ 8 days/month and ≥ 4 hours. HA should indeed be a component of SLEDAI, but should include frequency and duration, not the current definition of“Lupus Headache” which is probably incorrect. This suggests a need for reconceptualization of “Lupus Headache” and inclusion of headache in SLEDAI as outlined above.