Headache in patients with systemic lupus erythematosus: A matched case-control study.

Objectives: To compare the prevalence and characteristics of headaches between patients with systemic lupus erythematosus (SLE) and people without the disease and to assess whether there was a relationship between headaches and disease activity.

Background: Headache is a common symptom in patients with SLE; however, the effect of SLE on headaches is not fully known.

Methods: This was a case-control study. Individuals with and without SLE matched by age and sex were compared. All participants were assessed by a neurologist. A semi-structured questionnaire, the six-item Headache Impact Test (HIT-6) and the Hospital Anxiety and Depression Scale were used. Disease activity was measured by a rheumatologist using the Physician Global Assessment (PGA) and quantified using the modified Systemic Lupus Erythematosus Disease Activity Index 2000 scale (modified SLEDAI-2K). Data were collected between November 2021 and January 2023.

Results: A total of 228 individuals were included, 114 in each group. The SLE group presented with more moderate/severe headache attacks than the controls (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.21-4.95; p = 0.013). When comparing patients with active SLE and those without disease activity, there was no difference in the prevalence (OR 1.48, 95% CI 0.38-5.74), type (migraine: OR 1.69, 95% CI 0.71-3.99; tension-type headache: OR 0.64, 95% CI 0.25-1.68), frequency (4; 2-15 vs. 3; 1-12 days/month; p = 0.250), intensity (moderate/severe intensity: OR 0.59, 95% CI 0.19-1.82), or impact of headache (HIT-6: 61; 50-65 vs. 56; 45-63; p = 0.278). The magnitude of SLE activity (modified SLEDAI-2K) demonstrated no statistically significant association with the impact (standardized beta coefficient: 0.02, 95% CI -0.05 to 0.09; p = 0.792) or monthly frequency of headache (standardized beta coefficient: 0.09, 95% CI -0.08 to 0.26; p = 0.275).

Conclusions: Headache is a common symptom in SLE, although the prevalence was similar to that of the controls without the disease. While patients with SLE had more intense headache attacks than the controls without SLE, there was no association between headache and SLE activity.