High headache-related disability in patients with systemic lupus erythematosus and primary Sjögren's syndrome

Background and purpose: It is often argued that patients with systemic lupus erythematosus (SLE) have more headaches than healthy subjects, but this association remains controversial. Thus the magnitude and severity of headaches in SLE were evaluated in comparison with another autoimmune disease, namely primary Sjögren's syndrome (pSS).

Methods: Sixty-seven patients with SLE, 71 pSS patients and 108 healthy subjects were included. The International Classification of Headache Disorders, Headache Impact Test-6 (HIT-6), and the Migraine Disability Assessment (MIDAS) questionnaire were used to classify and assess headache-related disability.

Results: Primary headaches were more prevalent in SLE patients than in healthy subjects (82% vs. 69%, P = 0.01). Amongst the headache sufferers, SLE patients (N = 55) and pSS patients (N = 51) had higher HIT-6 scores (median 51, range 36-67, and median 54, range 36-72, respectively) than healthy subjects (N = 69) (median 46, range 36-72; P = 0.02 and P = 0.0009, respectively). Also, MIDAS scores were higher in SLE (median 0, range 0-110) and pSS patients (median 1, range 0-40) than in healthy subjects (median 0, range 0-10; P = 0.04 and P = 0.003, respectively).

Conclusion: Patients with SLE and pSS have a higher burden from headaches and more severe headaches than headache sufferers without these diseases. However, evidence of a specific bothersome SLE headache was not possible to identify as the headaches had the same characteristics and similar impact and severity in pSS patients. Depressive mood significantly influenced headache severity.