Brain Pain Ain't from Lupus

Systemic lupus erythematosus does not cause migraines or other headaches

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) People with lupus have to deal with enough pain without worrying about headaches. Even though lupus patients were once told their headaches were caused by their disease, it now seems like they should be treated as a separate problem.

Migraines and other types of headaches are not related to the disease activity of lupus - an autoimmune disease that usually causes joint pain and swelling. Instead, lupus patients may have slightly more headaches because of the stress of having their disease.

"Headaches are not a symptom of lupus."

For years, many researchers have come to the same conclusion: migraines are more common in lupus patients than others. However, Dimos D. Mitsikostas, M.D., Ph.D., from Athens Naval Hospital in Greece, and colleagues write that these conclusions could be due to to weaknesses in setup of past studies.

In their own study, Dr. Mitsikostas and his fellow Greek researchers found that migraines are no more common among lupus patients than they are among multiple sclerosis (MS) patients or otherwise healthy people.

Even though the researchers found that chronic tension headaches (the most common type of headache) were more common among lupus patients, these headaches had nothing to do with the symptoms or disease activity of lupus. In fact, no type of headache was associated with lupus.

"Yes, it is important to treat headaches in lupus patients, as it is important for every-one," says Dr. Mitsikostas. "But there is no need to treat them as a SLE feature by administered steroids or other disease modifying agents. Migraines in SLE patients should be treated like migraines in every-one, like a primary disorder therefore, not a secondary to SLE. This is our major point."

The researchers arrived at these results by comparing 72 patients with systemic lupus erythematosus, or SLE (the clinical name for lupus) to 72 healthy individuals. Forty-eight MS patients were also included in the study. All of the study's participants were examined for the presence of headaches in the previous year as well as for anxiety, depression, and quality of life. Throughout the next year, all of the participants kept headache diaries. Every three months they were examined for headaches.

According to Dr. Mitsikostas, "Previous studies did not follow similar methodology. We used not only healthy controls, but also patients suffering from multiple sclerosis, another autoimmune disease that targets specifically the CNS, and we compared both retrospective and one year prospective data, based on carefully designed headache diaries, to confirm the headache diagnosis according to the current International Headache Society diagnostic criteria."

Dr. Mitsikostas goes on to explain that headache specialists, rheumatologists, and neurologists were also involved in the study. These specialists assessed participants for headaches, anxiety, and depression.

"There is no other study with these methodological characteristics," says Dr. Mitsikostas. "Our aim was to provide a final answer to previous contradictory results, by using the most strict and precise methodology."

The prevalence of migraines was pretty much the same among all groups in the study. Migraines affected 21 percent of lupus patients, 23 percent of MS patients, and 22 percent of the healthy individuals. Chronic tension headaches were more common in lupus patients compared to MS patients and healthy individuals. However, MS patients also had an increased frequency of chronic tension headaches compared to healthy individuals.

The study's authors conclude that migraines should not be treated as a result of lupus.

The study is published in the journal Headache.

Reviewed by: 
Review Date: 
August 30, 2011
Last Updated:
September 6, 2011