Lupus headache - Revision history

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	~~'''Lupus headache''' is a proposed, specific [[headache]] disorder in patients suffering from [[systemic lupus erythematosus]] (SLE).<ref name="pmid14714915">~~{{~~cite journal~~ \|~~vauthors=Cuadrado MJ, Sanna G \|title=Headache and~~ systemic lupus erythematosus \|journal=Lupus \|volume=12 \|issue=12 \|pages=943–6 \|year=2003 \|pmid=14714915 \|doi= 10.1191/0961203303lu506oa\|url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0961-2033&volume=12&issue=12&spage=943&aulast=Cuadrado}}~~</ref><ref name="urlLupus Headache">{{cite web \|url=http://www.relieve-migraine-headache.com/lupus-headache.html \|title=Lupus Headache \|website= \|accessdate=}}</ref>~~		{{Short description\|A type of headache associated with systemic lupus erythematosus}}
	~~Research shows that headache is a symptom commonly described by SLE patients —57% in one meta-analysis, ranging in different studies from 33% to 78%;<ref name="pmid18254898">~~{{cite journal \|vauthors=Davey R, Bamford J, Emery P \|title=The ACR classification criteria for headache disorders in SLE fail to classify certain prevalent headache types \|journal=Cephalalgia \|volume=28 \|issue=3 \|pages=296–9 \|date=~~March 2008 \|pmid=18254898 \|doi=10.1111/j.1468-2982.2007.01510.x \|url=~~}}</ref> of which [[migraine]] 31.7% and [[tension-type headache]] 23.5%. The existence of a special lupus headache is contested, although few high-quality studies are available to form definitive conclusions.<ref name="pmid17665430">{{cite journal \|vauthors=Davey R, Bamford J, Emery P \|title=The validity of the inclusion of "lupus headache" in the Systemic Lupus Erythematosus Disease Activity Index \|journal=Arthritis Rheum. \|volume=56 \|issue=8 \|pages=2812–3 \|date=August 2007 \|pmid=17665430 \|doi=10.1002/art.22798}}</ref><ref name="pmid15047589"/>		{{Use dmy dates\|date=October 2023}}

	==~~Definition~~==		==Lupus Headache==
	~~Lupus~~ headache is ~~an important item~~ in ~~the~~ [[~~Systemic Lupus Erythematosus Disease Activity Index~~]] (~~SLEDAI~~), ~~a scoring~~ system ~~often used in lupus research~~.~~<ref name="pmid12945718">{{cite journal \|vauthors=Brunner HI, Jones OY, Lovell DJ, Johnson AM, Alexander P, Klein-Gitelman MS \|title=~~Lupus headaches ~~in childhood-onset systemic~~ lupus erythematosus: relationship to disease activity as measured by the systemic lupus erythematosus disease activity index (SLEDAI) and disease damage \|journal=Lupus \|volume=12 \|issue=8 \|pages=600–6 \|year=2003 \|pmid=12945718 \|doi= 10.1191/0961203303lu430oa\|url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0961-2033&volume=12&issue=8&spage=600&aulast=Brunner}}</ref> The SLEDAI describes lupus headache as a "severe, ~~persistent headache; may be migrainous, but must be nonresponsive to narcotic analgesia".<ref name="pmid17665430"/> A score of 8 is given to this item (items are given~~ a ~~relative weight~~ of ~~1, 2, 4 or 8)~~.		A '''lupus headache''' is a type of headache that occurs in individuals with [[systemic lupus erythematosus]] (SLE), an [[autoimmune disease]] characterized by the body's immune system attacking its own tissues. Lupus headaches are considered a manifestation of [[neuropsychiatric lupus]], which encompasses a range of neurological and psychiatric symptoms associated with SLE.

	~~The 1999~~ [[~~American College of Rheumatology~~]] ~~case definitions of~~ [[~~Neuropsychiatric systemic lupus erythematosus\|neuropsychiatric syndromes in SLE~~]] do not ~~define lupus headache~~, ~~but rather propose several headache disorders loosely based on the [[International Headache Society]] (IHS) classification~~.		==Characteristics==
			Lupus headaches are often described as being similar to [[migraine]] headaches, with symptoms that can include severe, throbbing pain, sensitivity to light ([[photophobia]]), and nausea. However, the exact nature and cause of lupus headaches are not fully understood, and they may vary significantly among individuals.

	In the ~~IHS scheme~~, ~~headache due to lupus would be classified~~ as ~~"Headache attributed to other non-infectious inflammatory disease" (7.3.3)~~. This ~~label requires evidence of a disease flare accompanying the headache,~~ and ~~resolution of the~~ headache ~~with immunosuppressant treatment~~. ~~However~~, ~~a meta-analysis found no correlation between headaches~~ and ~~disease activity.<ref name="pmid15047589">{{cite journal \|vauthors=Mitsikostas DD, Sfikakis PP, Goadsby PJ \|title=A meta-analysis for headache~~ in ~~systemic lupus erythematosus:~~ the ~~evidence and~~ the ~~myth \|journal=Brain \|volume=127 \|issue=Pt 5 \|pages=1200–9 \|date=May 2004 \|pmid=15047589 \|doi=10~~.~~1093/brain/awh146 \|url=}}</ref>~~		==Pathophysiology==
			The pathophysiology of lupus headaches is not well-defined, but it is believed to involve [[inflammation]] of the [[blood vessels]] in the brain, known as [[vasculitis]]. This inflammation can lead to changes in blood flow and contribute to headache symptoms. Additionally, the presence of [[autoantibodies]] and [[cytokines]] in the central nervous system may play a role in the development of these headaches.

	==~~Criticism~~==		==Diagnosis==
	~~Critics of this concept argue that there are no quality studies showing that~~ headaches ~~in patients with SLE differ~~ from ~~those in the general population. A detailed definition~~ of ~~the term lupus headache is lacking~~, ~~since the terms "severe" and "persistent" are not quantified.~~ [[~~Narcotic analgesic~~]]~~s are not recommended for~~ migraines ~~or other common headache types~~. ~~Other definitions from the IHS do not include responsiveness to treatments as a diagnostic criterion.<ref name="pmid18254898"/> Migraine patients~~ are ~~typically adult women around age 40~~, ~~a demographic group in which SLE is also more common~~.<ref name="pmid12369649">{{cite journal \|author=Omdal R \|title=Some controversies of neuropsychiatric systemic lupus erythematosus \|journal=Scand. J. Rheumatol. \|volume=31 \|issue=4 \|pages=192–7 \|year=2002 \|pmid=12369649 \|doi= 10.1080/030097402320318369\|url=}}</ref>		Diagnosing lupus headaches involves distinguishing them from other types of headaches, such as [[tension headaches]] or migraines. A thorough medical history and physical examination are essential, and additional tests may be conducted to rule out other causes. [[Magnetic resonance imaging]] (MRI) or [[computed tomography]] (CT) scans may be used to assess any structural changes in the brain.
	~~==Mechanism==~~
	~~Some (but not all) studies have shown an association between (migraine) headaches in SLE and associated~~ [[~~Raynaud's phenomenon~~]] ~~and/~~or [[~~anti-cardiolipin antibodies~~]].<ref name="pmid17120594">{{cite journal \|vauthors=Bernatsky S, Pineau CA, Lee JL, Clarke AE \|title=Headache, Raynaud's syndrome and serotonin receptor agonists in systemic lupus erythematosus \|journal=Lupus \|volume=15 \|issue=10 \|pages=671–4 \|year=2006 \|pmid=17120594 \|doi= 10.1177/0961203306069997\|url=http://lup.sagepub.com/cgi/pmidlookup?view=long&pmid=17120594}}</ref><ref name="pmid18345429">{{cite journal \|vauthors=Bettero RG, Rahal MY, Barboza JS, Skare TL \|title=Headache and systemic lupus erythematosus: prevalence and associated conditions \|language=Portuguese \|journal=Arq Neuropsiquiatr \|volume=65 \|issue=4B \|pages=1196–9 \|date=December 2007 \|pmid=18345429 \|doi= 10.1590/S0004-282X2007000700020}}</ref><ref name="pmid16639488">{{cite journal \|vauthors=Annese V, Tomietto P, Venturini P, D'Agostini S, Ferraccioli G \|title=[Migraine in SLE: role of antiphospholipid antibodies and Raynaud's phenomenon] \|language=Italian \|journal=Reumatismo \|volume=58 \|issue=1 \|pages=50–8 \|year=2006 \|pmid=16639488 \|doi= 10.4081/reumatismo.2006.50\|url=http://www.reumatismo.org/admin/filesArticoli/58-1-50.pdf}}</ref><ref name="pmid16437362">{{cite journal \|vauthors=Lessa B, Santana A, Lima I, Almeida JM, Santiago M \|title=Prevalence and classification of headache in patients with systemic lupus erythematosus \|journal=Clin. Rheumatol. \|volume=25 \|issue=6 \|pages=850–3 \|date=November 2006 \|pmid=16437362 \|doi=10.1007/s10067-005-0186-x \|url=}}</ref><ref name="pmid15566417">{{cite journal \|vauthors=Weder-Cisneros ND, Téllez-Zenteno JF, Cardiel MH, etal \|title=Prevalence and factors associated with headache in patients with systemic lupus erythematosus \|journal=Cephalalgia \|volume=24 \|issue=12 \|pages=1031–44 \|date=December 2004 \|pmid=15566417 \|doi=10.1111/j.1468-2982.2004.00822.x \|url=}}</ref><ref name="pmid15566416">{{cite journal \|vauthors=Appenzeller S, Costallat LT \|title=Clinical implications of migraine in systemic lupus erythematosus: relation to cumulative organ damage \|journal=Cephalalgia \|volume=24 \|issue=12 \|pages=1024–30 \|date=December 2004 \|pmid=15566416 \|doi=10.1111/j.1468-2982.2004.00785.x \|url=}}</ref><ref name="pmid15352420">{{cite journal \|vauthors=Whitelaw DA, Hugo F, Spangenberg JJ, Rickman R \|title=Headaches in patients with systemic lupus erythematosus: a comparative study \|journal=Lupus \|volume=13 \|issue=7 \|pages=501–5 \|year=2004 \|pmid=15352420 \|doi= 10.1191/0961203304lu1050oa\|url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0961-2033&volume=13&issue=7&spage=501&aulast=Whitelaw}}</ref><ref name="pmid9566671">{{cite journal \|vauthors=Sfikakis PP, Mitsikostas DD, Manoussakis MN, Foukaneli D, Moutsopoulos HM \|title=Headache in systemic lupus erythematosus: a controlled study \|journal=Br. J. Rheumatol. \|volume=37 \|issue=3 \|pages=300–3 \|date=March 1998 \|pmid=9566671 \|doi= 10.1093/rheumatology/37.3.300\|url=http://rheumatology.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9566671}}</ref>
	~~Further studies are needed however to prove~~ the ~~underlying assumption that cerebral [[vasospasm]] causes migraines in lupus patients~~.

	==~~Diagnosis~~==		==Treatment==
	~~Although specific complications~~ of SLE ~~may cause~~ headache ~~(such as~~ [[~~cerebral venous sinus thrombosis~~]] or [[~~posterior reversible encephalopathy syndrome~~]]), ~~it remains unclear whether specific investigations (~~such as [[~~lumbar puncture~~]] or [[~~magnetic resonance imaging~~]], ~~MRI) are needed in lupus~~ patients ~~presenting~~ with ~~headache~~. Although studies using MRI or [[single-photon emission computed tomography]] (SPECT) often find abnormalities,<ref name="pmid17086605">{{cite journal \|vauthors=Nobili F, Mignone A, Rossi E, etal \|title=~~Migraine during systemic lupus erythematosus: findings from brain single photon emission computed tomography \|journal~~=~~J. Rheumatol. \|volume~~=~~33 \|issue~~=11 \|pages=2184–91 \|date=November 2006 \|pmid=17086605 \|doi= \|url=http://www.jrheum.com/subscribers/06/11/2184.html}}</ref><ref name="pmid7698150">{{cite journal \|vauthors=Colamussi P, Giganti M, Cittanti C, etal \|title=Brain single-photon emission tomography with ~~99mTc-HMPAO in neuropsychiatric systemic~~ lupus ~~erythematosus: relations~~ with EEG and MRI findings and clinical manifestations \|journal=Eur J Nucl Med \|volume=22 \|issue=1 \|pages=17–24 \|date=January 1995 \|pmid=7698150 \|doi= 10.1007/BF00997243\|url=}}</ref> the value of these findings remains unclear, ~~and they~~ have ~~not been able to distinguish a special "lupus headache" from other headache types in people with lupus~~.~~<ref name="pmid18218648">{{cite journal \|vauthors=Castellino G, Padovan M, Bortoluzzi A, etal \|title=Single photon emission computed tomography and magnetic resonance imaging evaluation in~~ SLE ~~patients with~~ and without neuropsychiatric involvement \|journal=Rheumatology (Oxford) \|volume=47 \|issue=3 \|pages=319–23 \|date=March 2008 \|pmid=18218648 \|doi=10.1093/rheumatology/kem354 \|url=}}</ref><ref name="pmid7562753">{{cite journal \|vauthors=Kovacs JA, Urowitz MB, Gladman DD, Zeman R \|title=The use of ~~single photon emission computerized tomography in neuropsychiatric SLE: a pilot study \|journal=J. Rheumatol~~. ~~\|volume=22 \|issue=7 \|pages=1247–53 \|date=July 1995 \|pmid=7562753 \|doi= \|url=}}</ref>~~		Treatment of lupus headaches typically involves managing the underlying SLE and addressing the headache symptoms. [[Nonsteroidal anti-inflammatory drugs]] (NSAIDs) and [[corticosteroids]] may be used to reduce inflammation. In some cases, medications commonly used for migraines, such as [[triptans]] or [[beta-blockers]], may be prescribed. It is important for patients to work closely with their healthcare providers to develop an individualized treatment plan.

			==Prognosis==
			The prognosis for individuals with lupus headaches varies. While some patients may experience significant relief with appropriate treatment, others may have persistent or recurrent headaches. Managing SLE effectively can help reduce the frequency and severity of lupus headaches.

	==~~Footnotes~~==		==Related pages==
	~~{{reflist\|2}}~~		* [[Systemic lupus erythematosus]]
			* [[Migraine]]
			* [[Autoimmune disease]]
			* [[Neuropsychiatric lupus]]

	~~[[Category:Rheumatology]]~~
	[[Category:Headaches]]		[[Category:Headaches]]
	~~{{No image}}~~		[[Category:Autoimmune diseases]]
			[[Category:Neurology]]

Prab at 12:59, 18 March 2025

2025-03-18T12:59:48Z

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2025-03-17T17:51:37Z

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'''Lupus headache''' is a proposed, specific [[headache]] disorder in patients suffering from [[systemic lupus erythematosus]] (SLE).<ref name="pmid14714915">{{cite journal |vauthors=Cuadrado MJ, Sanna G |title=Headache and systemic lupus erythematosus |journal=Lupus |volume=12 |issue=12 |pages=943–6 |year=2003 |pmid=14714915 |doi= 10.1191/0961203303lu506oa|url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0961-2033&volume=12&issue=12&spage=943&aulast=Cuadrado}}</ref><ref name="urlLupus Headache">{{cite web |url=http://www.relieve-migraine-headache.com/lupus-headache.html |title=Lupus Headache |website= |accessdate=}}</ref>
Research shows that headache is a symptom commonly described by SLE patients —57% in one meta-analysis, ranging in different studies from 33% to 78%;<ref name="pmid18254898">{{cite journal |vauthors=Davey R, Bamford J, Emery P |title=The ACR classification criteria for headache disorders in SLE fail to classify certain prevalent headache types |journal=Cephalalgia |volume=28 |issue=3 |pages=296–9 |date=March 2008 |pmid=18254898 |doi=10.1111/j.1468-2982.2007.01510.x |url=}}</ref> of which [[migraine]] 31.7% and [[tension-type headache]] 23.5%. The existence of a special lupus headache is contested, although few high-quality studies are available to form definitive conclusions.<ref name="pmid17665430">{{cite journal |vauthors=Davey R, Bamford J, Emery P |title=The validity of the inclusion of "lupus headache" in the Systemic Lupus Erythematosus Disease Activity Index |journal=Arthritis Rheum. |volume=56 |issue=8 |pages=2812–3 |date=August 2007 |pmid=17665430 |doi=10.1002/art.22798}}</ref><ref name="pmid15047589"/>

==Definition==
Lupus headache is an important item in the [[Systemic Lupus Erythematosus Disease Activity Index]] (SLEDAI), a scoring system often used in lupus research.<ref name="pmid12945718">{{cite journal |vauthors=Brunner HI, Jones OY, Lovell DJ, Johnson AM, Alexander P, Klein-Gitelman MS |title=Lupus headaches in childhood-onset systemic lupus erythematosus: relationship to disease activity as measured by the systemic lupus erythematosus disease activity index (SLEDAI) and disease damage |journal=Lupus |volume=12 |issue=8 |pages=600–6 |year=2003 |pmid=12945718 |doi= 10.1191/0961203303lu430oa|url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0961-2033&volume=12&issue=8&spage=600&aulast=Brunner}}</ref> The SLEDAI describes lupus headache as a "severe, persistent headache; may be migrainous, but must be nonresponsive to narcotic analgesia".<ref name="pmid17665430"/> A score of 8 is given to this item (items are given a relative weight of 1, 2, 4 or 8).

The 1999 [[American College of Rheumatology]] case definitions of [[Neuropsychiatric systemic lupus erythematosus|neuropsychiatric syndromes in SLE]] do not define lupus headache, but rather propose several headache disorders loosely based on the [[International Headache Society]] (IHS) classification.

In the IHS scheme, headache due to lupus would be classified as "Headache attributed to other non-infectious inflammatory disease" (7.3.3). This label requires evidence of a disease flare accompanying the headache, and resolution of the headache with immunosuppressant treatment. However, a meta-analysis found no correlation between headaches and disease activity.<ref name="pmid15047589">{{cite journal |vauthors=Mitsikostas DD, Sfikakis PP, Goadsby PJ |title=A meta-analysis for headache in systemic lupus erythematosus: the evidence and the myth |journal=Brain |volume=127 |issue=Pt 5 |pages=1200–9 |date=May 2004 |pmid=15047589 |doi=10.1093/brain/awh146 |url=}}</ref>

==Criticism==
Critics of this concept argue that there are no quality studies showing that headaches in patients with SLE differ from those in the general population. A detailed definition of the term lupus headache is lacking, since the terms "severe" and "persistent" are not quantified. [[Narcotic analgesic]]s are not recommended for migraines or other common headache types. Other definitions from the IHS do not include responsiveness to treatments as a diagnostic criterion.<ref name="pmid18254898"/> Migraine patients are typically adult women around age 40, a demographic group in which SLE is also more common.<ref name="pmid12369649">{{cite journal |author=Omdal R |title=Some controversies of neuropsychiatric systemic lupus erythematosus |journal=Scand. J. Rheumatol. |volume=31 |issue=4 |pages=192–7 |year=2002 |pmid=12369649 |doi= 10.1080/030097402320318369|url=}}</ref>
==Mechanism==
Some (but not all) studies have shown an association between (migraine) headaches in SLE and associated [[Raynaud's phenomenon]] and/or [[anti-cardiolipin antibodies]].<ref name="pmid17120594">{{cite journal |vauthors=Bernatsky S, Pineau CA, Lee JL, Clarke AE |title=Headache, Raynaud's syndrome and serotonin receptor agonists in systemic lupus erythematosus |journal=Lupus |volume=15 |issue=10 |pages=671–4 |year=2006 |pmid=17120594 |doi= 10.1177/0961203306069997|url=http://lup.sagepub.com/cgi/pmidlookup?view=long&pmid=17120594}}</ref><ref name="pmid18345429">{{cite journal |vauthors=Bettero RG, Rahal MY, Barboza JS, Skare TL |title=Headache and systemic lupus erythematosus: prevalence and associated conditions |language=Portuguese |journal=Arq Neuropsiquiatr |volume=65 |issue=4B |pages=1196–9 |date=December 2007 |pmid=18345429 |doi= 10.1590/S0004-282X2007000700020}}</ref><ref name="pmid16639488">{{cite journal |vauthors=Annese V, Tomietto P, Venturini P, D'Agostini S, Ferraccioli G |title=[Migraine in SLE: role of antiphospholipid antibodies and Raynaud's phenomenon] |language=Italian |journal=Reumatismo |volume=58 |issue=1 |pages=50–8 |year=2006 |pmid=16639488 |doi= 10.4081/reumatismo.2006.50|url=http://www.reumatismo.org/admin/filesArticoli/58-1-50.pdf}}</ref><ref name="pmid16437362">{{cite journal |vauthors=Lessa B, Santana A, Lima I, Almeida JM, Santiago M |title=Prevalence and classification of headache in patients with systemic lupus erythematosus |journal=Clin. Rheumatol. |volume=25 |issue=6 |pages=850–3 |date=November 2006 |pmid=16437362 |doi=10.1007/s10067-005-0186-x |url=}}</ref><ref name="pmid15566417">{{cite journal |vauthors=Weder-Cisneros ND, Téllez-Zenteno JF, Cardiel MH, etal |title=Prevalence and factors associated with headache in patients with systemic lupus erythematosus |journal=Cephalalgia |volume=24 |issue=12 |pages=1031–44 |date=December 2004 |pmid=15566417 |doi=10.1111/j.1468-2982.2004.00822.x |url=}}</ref><ref name="pmid15566416">{{cite journal |vauthors=Appenzeller S, Costallat LT |title=Clinical implications of migraine in systemic lupus erythematosus: relation to cumulative organ damage |journal=Cephalalgia |volume=24 |issue=12 |pages=1024–30 |date=December 2004 |pmid=15566416 |doi=10.1111/j.1468-2982.2004.00785.x |url=}}</ref><ref name="pmid15352420">{{cite journal |vauthors=Whitelaw DA, Hugo F, Spangenberg JJ, Rickman R |title=Headaches in patients with systemic lupus erythematosus: a comparative study |journal=Lupus |volume=13 |issue=7 |pages=501–5 |year=2004 |pmid=15352420 |doi= 10.1191/0961203304lu1050oa|url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0961-2033&volume=13&issue=7&spage=501&aulast=Whitelaw}}</ref><ref name="pmid9566671">{{cite journal |vauthors=Sfikakis PP, Mitsikostas DD, Manoussakis MN, Foukaneli D, Moutsopoulos HM |title=Headache in systemic lupus erythematosus: a controlled study |journal=Br. J. Rheumatol. |volume=37 |issue=3 |pages=300–3 |date=March 1998 |pmid=9566671 |doi= 10.1093/rheumatology/37.3.300|url=http://rheumatology.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9566671}}</ref>
Further studies are needed however to prove the underlying assumption that cerebral [[vasospasm]] causes migraines in lupus patients.

==Diagnosis==
Although specific complications of SLE may cause headache (such as [[cerebral venous sinus thrombosis]] or [[posterior reversible encephalopathy syndrome]]), it remains unclear whether specific investigations (such as [[lumbar puncture]] or [[magnetic resonance imaging]], MRI) are needed in lupus patients presenting with headache. Although studies using MRI or [[single-photon emission computed tomography]] (SPECT) often find abnormalities,<ref name="pmid17086605">{{cite journal |vauthors=Nobili F, Mignone A, Rossi E, etal |title=Migraine during systemic lupus erythematosus: findings from brain single photon emission computed tomography |journal=J. Rheumatol. |volume=33 |issue=11 |pages=2184–91 |date=November 2006 |pmid=17086605 |doi= |url=http://www.jrheum.com/subscribers/06/11/2184.html}}</ref><ref name="pmid7698150">{{cite journal |vauthors=Colamussi P, Giganti M, Cittanti C, etal |title=Brain single-photon emission tomography with 99mTc-HMPAO in neuropsychiatric systemic lupus erythematosus: relations with EEG and MRI findings and clinical manifestations |journal=Eur J Nucl Med |volume=22 |issue=1 |pages=17–24 |date=January 1995 |pmid=7698150 |doi= 10.1007/BF00997243|url=}}</ref> the value of these findings remains unclear, and they have not been able to distinguish a special "lupus headache" from other headache types in people with lupus.<ref name="pmid18218648">{{cite journal |vauthors=Castellino G, Padovan M, Bortoluzzi A, etal |title=Single photon emission computed tomography and magnetic resonance imaging evaluation in SLE patients with and without neuropsychiatric involvement |journal=Rheumatology (Oxford) |volume=47 |issue=3 |pages=319–23 |date=March 2008 |pmid=18218648 |doi=10.1093/rheumatology/kem354 |url=}}</ref><ref name="pmid7562753">{{cite journal |vauthors=Kovacs JA, Urowitz MB, Gladman DD, Zeman R |title=The use of single photon emission computerized tomography in neuropsychiatric SLE: a pilot study |journal=J. Rheumatol. |volume=22 |issue=7 |pages=1247–53 |date=July 1995 |pmid=7562753 |doi= |url=}}</ref>

==Footnotes==
{{reflist|2}}

[[Category:Rheumatology]]
[[Category:Headaches]]