title: Headache in systemic lupus erythematosus: results from a prospective, international inception cohort study.
abstract: OBJECTIVE
  To examine the frequency and characteristics of headaches and their association with global disease activity and health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE).
  
  
  METHODS
  A disease inception cohort was assessed annually for headache (5 types) and 18 other neuropsychiatric (NP) events. Global disease activity scores (SLE Disease Activity Index 2000 [SLEDAI-2K]), damage scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and Short Form 36 (SF-36) mental and physical component summary scores were collected. Time to first headache and associations with SF-36 scores were analyzed using Cox proportional hazards and linear regression models with generalized estimating equations.
  
  
  RESULTS
  Among the 1,732 SLE patients enrolled, 89.3% were female and 48.3% were white. The mean ± SD age was 34.6 ± 13.4 years, duration of disease was 5.6 ± 5.2 months, and length of followup was 3.8 ± 3.1 years. At enrollment, 17.8% of patients had headache (migraine [60.7%], tension [38.6%], intractable nonspecific [7.1%], cluster [2.6%], and intracranial hypertension [1.0%]). The prevalence of headache increased to 58% after 10 years. Only 1.5% of patients had lupus headache, as identified in the SLEDAI-2K. In addition, headache was associated with other NP events attributed to either SLE or non-SLE causes. There was no association of headache with SLEDAI-2K scores (without the lupus headache variable), SDI scores, use of corticosteroids, use of antimalarials, use of immunosuppressive medications, or specific autoantibodies. SF-36 mental component scores were lower in patients with headache compared with those without headache (mean ± SD 42.5 ± 12.2 versus 47.8 ± 11.3; P < 0.001), and similar differences in physical component scores were seen (38.0 ± 11.0 in those with headache versus 42.6 ± 11.4 in those without headache; P < 0.001). In 56.1% of patients, the headaches resolved over followup.
  
  
  CONCLUSIONS
  Headache is frequent in SLE, but overall, it is not associated with global disease activity or specific autoantibodies. Although headaches are associated with a lower HRQOL, the majority of headaches resolve over time, independent of lupus-specific therapies.
authors.affiliation: Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Hanly
authors.forename: Murray B
authors.initials: MB
authors.lastname: Urowitz
authors.forename: Aidan G
authors.initials: AG
authors.lastname: O'Keeffe
authors.forename: Caroline
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authors.lastname: Gordon
authors.forename: Sang-Cheol
authors.initials: SC
authors.lastname: Bae
authors.forename: Jorge
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authors.lastname: Sanchez-Guerrero
authors.forename: Juanita
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authors.lastname: Romero-Diaz
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authors.forename: Sasha
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authors.lastname: Bernatsky
authors.forename: Daniel J
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authors.lastname: Wallace
authors.forename: Ellen M
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authors.forename: Dafna D
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authors.forename: Graciela S
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authors.lastname: Alarcón
authors.forename: Ian N
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authors.lastname: Bruce
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Dooley
authors.forename: Kristjan
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authors.lastname: Steinsson
authors.forename: Munther A
authors.initials: MA
authors.lastname: Khamashta
authors.forename: Rosalind
authors.initials: R
authors.lastname: Ramsey-Goldman
authors.forename: Susan
authors.initials: S
authors.lastname: Manzi
authors.forename: Gunnar K
authors.initials: GK
authors.lastname: Sturfelt
authors.forename: Ola
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authors.lastname: Nived
authors.forename: Asad A
authors.initials: AA
authors.lastname: Zoma
authors.forename: Ronald F
authors.initials: RF
authors.lastname: van Vollenhoven
authors.forename: Manuel
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authors.lastname: Ramos-Casals
authors.forename: Cynthia
authors.initials: C
authors.lastname: Aranow
authors.forename: Meggan
authors.initials: M
authors.lastname: Mackay
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Irastorza
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Kalunian
authors.forename: S Sam
authors.initials: SS
authors.lastname: Lim
authors.forename: Murat
authors.initials: M
authors.lastname: Inanc
authors.forename: Diane L
authors.initials: DL
authors.lastname: Kamen
authors.forename: Christine A
authors.initials: CA
authors.lastname: Peschken
authors.forename: Soren
authors.initials: S
authors.lastname: Jacobsen
authors.forename: Chris
authors.initials: C
authors.lastname: Theriault
authors.forename: Kara
authors.initials: K
authors.lastname: Thompson
authors.forename: Vernon
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mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D003027:Cluster Headache / Q000453:epidemiology / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D038622:Internationality; D019586:Intracranial Hypertension / Q000453:epidemiology / Q000276:immunology; D053208:Kaplan-Meier Estimate; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology / Q000276:immunology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D018781:Tension-Type Headache / Q000453:epidemiology / Q000276:immunology; D055815:Young Adult
chemical_list: D001323:Autoantibodies