title: Antiphospholipid syndrome (APS) revisited: Would migraine headaches be included in future classification criteria?
abstract: Headaches have been extensively reported in Antiphospholipid syndrome (APS)/Antiphospholipid antibodies (aPL)-positive patients. The aim of this study was to highlight the prevalence of headaches among APS/aPL-positive patients and discuss its association with laboratory, clinical and imaging findings. We searched the literature through Google Scholar and PubMed for publications on the epidemiology, pathogenesis, laboratory, imaging and clinical findings, and management of headaches in APS/aPL-positive patients. The following keywords were used: Antiphospholipid, Hughes syndrome, anticardiolipin, lupus anticoagulant, anti-β2 glycoprotein I, headache, migraine, tension, and cluster. All reports published between 1969 and 2015 were included. Migraine is the most commonly reported type of headache in APS/aPL-positive patients. Thrombotic and platelet dysfunction hypotheses have been studied to uncover the pathogenic role of aPL in the development of headaches. Several studies are reporting higher levels of aPL in primary and secondary APS migraineurs, but only few reached statistical significance. Migraine patients without clinical signs/symptoms of cerebral infarction rarely show positive imaging findings. Digital subtraction angiography shows promise in demonstrating small vascular lesions otherwise not detected on computed tomography, magnetic resonance imaging, or cerebral angiograms. Although it may be solitary and harmless in many cases, the deleterious effect of migraine on the quality of life of APS patients prompts rapid diagnosis and proper management. An anticoagulation trial is advisable in APS patients with migraine as many cases of severe, refractory migraine resolved with anticoagulation therapy. The profile of migraine headaches discussed in this study permits its candidacy for inclusion in future APS classification criteria.
authors.affiliation: Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon.
authors.forename: Mohammad Hassan A
authors.initials: MHA
authors.lastname: Noureldine
authors.affiliation: Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Haydar
authors.affiliation: Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Berjawi
authors.affiliation: Department of Neurology, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.
authors.forename: Rody
authors.initials: R
authors.lastname: Elnawar
authors.affiliation: Department of Neurosurgery, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Sweid
authors.affiliation: Lupus Research Unit, The Rayne Institute, Division of Women's Health, St Thomas Hospital, London, UK.|Department of Rheumatology, Dubai Hospital, Dubai, UAE.
authors.forename: Munther A
authors.initials: MA
authors.lastname: Khamashta
authors.affiliation: Head of the London Lupus Center, London Bridge Hospital, London, UK.
authors.forename: Graham R V
authors.initials: GRV
authors.lastname: Hughes
authors.affiliation: Division of Rheumatology, Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon. iuthman@aub.edu.lb.
authors.forename: Imad
authors.initials: I
authors.lastname: Uthman
mesh_terms: D017152:Antibodies, Antiphospholipid; D016736:Antiphospholipid Syndrome / Q000145:classification* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D008881:Migraine Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology
chemical_list: D017152:Antibodies, Antiphospholipid
keywords: Antiphospholipid antibodies; Antiphospholipid syndrome; Headache; Migraine; Tension headache