Lupus Headaches in 55 Childhood-Onset SLE

Objective: Although headache is a common complaint among patients with lupus, no universallyaccepted explanation was available until the International Headaches Society adopted Lupusheadache as a Nomenclature in its classification recently. Few studies indicate that lupus patientswith positive anti-nuclear antibody (ANA) and positive antiphospholipid antibodies (aPL)experience more frequent headaches. The aim of this study was to determine the correlationbetween headache frequencies and ANA, anti-double strand DNA (anti-ds-DNA) and aPLpositivity.Material Methods: In this prospective multicenter study were enrolled 55 children, 45 girlsand 10 boys (F/M ratio:4.5), aged 3-16 years (mean 11.5 years), with neuropsychiatric lupuscomplaining of headache, that where followed-up for 5 years.. Whether lupus headache is a signof progressive nature of the disease and how it should be treated is not clear yet. Those withactive disease, hypertension, or tension headache were not included in this study.Findings: We studied 55 children with definite lupus. Twenty three (43%) of our patientsdeveloped new or significantly worse, persistent headaches that sometimes were similar tomigraine in the early course of their disease. However their headaches were not accompaniedwith disease flare up and the headaches were not found to be related to hypertension or use ofother medications either. Accordingly, we came to a diagnosis of lupus headache for thesepatients. Among them 19/55 cases (35%) had a positive aPL and 53/55 cases (96%) had apositive ANA.Conclusion: Lupus headaches are most likely multifactorial, and probably only a smallproportion of them truly represent active lupus. The above data highlights probable correlationbetween aPL, ANA, an anti-ds-DNA and lupus headache. However, more research is required tofind better treatments and to establish a definitive correlation among them.