Migraine Comorbidities: Lupus
Lupus, also known as Systemic Lupus Erythematosis (SLE) is a primary autoimmune disease. Lupus can sometimes be secondary (resulting from something else- usually another autoimmune disease).
Autoimmunity occurs when the body’s immune system (like an army) which was designed to keep the patient healthy, begins to attack its own tissues (friendly fire). Antibodies usually designed to destroy viruses, bacteria and other foreign invaders are created against self (the person’s own body) and an attack is waged against organs and cells within the body instead of foreign invaders. Inflammation is created and cells and organs are damaged or destroyed during periods of increased disease activity called flares.
Flares are triggered primarily by physiologic stressors including disease or illness, infection, emotional stress, pain and injury. Anything that can cause inflammation in the body can trigger a Lupus flare. This includes diet, travel, UV exposure (sunlight, fluorescent lighting), vaccination and some medications.
Lupus is known as a connective tissue disease because it primarily affects this type of tissue throughout the body. Connective tissue is the “glue” that holds our organs and our body together and is found in every system and part of the body, including the central nervous system and brain. Neurologic symptoms of Lupus are not as common as symptoms in other body systems, but when they occur can be devastating to the patient.
While Lupus can be genetic and great leaps have occurred in our knowledge of Lupus related genes and antibodies in the recent past, some patients are sero-negative (antibodies are not found in blood work). It is unknown why some patients exhibit the disease. It is thought to be initially triggered by such things as viral infection and environmental or other toxins.
While the current theory is that an overactive immune system is at the root of the disease, scientists are beginning to discover that — at least in some patients — underactivity in parts of the immune system leads to immune confusion and resulting disease.
Symptoms of Lupus include but are not limited to:
- Butterfly rash
- Chest pain
- Cognitive problems
- Decreased blood complement levels
- Hair loss
- Joint pain
- Kidney problems
- Low platelets and white cells
- Memory loss
- Muscle aches
- Nervous system symptoms/headache/Migraine
- Psychiatric symptoms
- Raynaud’s phenomenon (circulation disorder)
- Shortness of breath
- Swollen glands
- Ulcerations in mouth and nose
- UV sensitivity
- Weight changes
Because Lupus affects all systems, any part of the body can show Lupus symptoms.
Treatment for Lupus includes the use of anti-inflammatory medicines like NSAIDs and steroids, antimalarials like Plaquenil, Biologic medications (genetically engineered compounds designed to interfere with cell action) and Disease-Modifying Anti-Rheumatic Drugs (DMARDs). These DMARDs include potent chemotherapy medications used in cancer patients, and anti-rejection drugs designed to lower the body’s errant immune response. Unlike cancer patients who may someday eliminate their disease, most Lupus patients must remain on DMARDs and other drugs for the duration of their lives. Remission is possible but uncommon.
Side effects of these treatments can range from mild to life-threatening. Several common Lupus medications are known to act as Migraine triggers for those patients who suffer Migraine attacks. A list of some of these interactions may be found here: Medication Triggers in Autoimmune Migraineurs
Lupus is a difficult disease to live with — no two days are the same and hospitalizations are a frequent part of life for many patients. Lupus can be fatal, although fortunately, most patients live normal life spans with the disease and a good, proactive health care team. Sometimes the treatments are as bad as or worse than the disease itself, however. A large percentage of fatalities are the result of compromised immune systems. The DMARDs did their job, but an opportune infection such as pneumonia, or cancer — unchecked by a depleted immune system - killed the patient.
Migraine and headache are currently listed as a “symptom” of Lupus outside the spectrum of medication triggers/interactions. Rheumatologists use these criteria to diagnose and treat their patients, so they are important.
According to the International Headache Society (IHS) diagnostic criteria ICHD II, Migraine is a primary (not caused by something else) headache disorder. This discrepancy has led to some controversy within the medical community. Because of the results of a handful of studies compared to IHS diagnostic criteria for Migraine, researchers asked themselves, “Were previous studies done appropriately?” The answer was, “Maybe not.” So researchers tried again with some interesting results.
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