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).

What is autoimmunity?

Autoimmunity occurs when the body’s immune system (like an army), 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). 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.

What triggers a flare?

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, including diet, travel, UV exposure (sunlight, fluorescent lighting), vaccination, and some medications.

Why is lupus a connective tissue disease?

Lupus is 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 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 they can be devastating to the patient when they occur.

What causes it?

While lupus can be genetic, great leaps have occurred in our knowledge of lupus-related genes and antibodies in the recent past. Some patients are seronegative (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 the resulting disease.

What are the symptoms?

Symptoms of lupus include but are not limited to:

  • Anemia
  • Butterfly rash
  • Chest pain
  • Cognitive problems
  • Decreased blood complement levels
  • Fatigue
  • Fever
  • GERD
  • 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
  • Vasculitis
  • Weight changes

Because lupus affects all systems, any part of the body can show lupus symptoms.

How is it treated?

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.

What are the side effects?

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

What does life with lupus look like?

Lupus is a difficult disease to live with — no two days are the same, and hospitalizations are a regular part of life for many patients. Lupus can be fatal, although fortunately, most patients live normal lives 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.

How is migraine related?

Migraine and headache are currently listed as “symptoms” 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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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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