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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 13-year-old girl presented to our emergency with a one week history of fever and skin rash and new onset of chorea for the last three days. There was a long standing history of right predominant headache; followed by personality change, fatigue, arthralgia and weight loss over the last few months. Previous investigations by head CT and ophthalmological examination did not explain the symptoms. Further investigations revealed peri- and pancarditis with aortic insufficiency, a renal involvement with elevated creatinin, protein- and hematuria and a hemolytic anemia. Diagnosis of lupus eythematodes was confirmed by high ANA, anti-dsDNS and Anticardiolipin antibodies. Within the first 48 hours after admission there was significant deterioration with reduced vigilance and dysarthria. MRI of the brain and dopplersonography of cerebral vessels showed a complete thrombosis of the right medial cerebral artery with a small net of collaterals, irregularities of the left cerebral artery due to vasculitis and several subacute leftsided ischemias. Immunosuppressive therapy with high-dose corticosteroids and cyclophosphamid together with antithrombotic therapy induced an improvement of neurologic, renal and cardiac function.
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PMID:[Vasculitis as a reason of chronic headache]. 1854 40

Antiphospholipid syndrome (APS) is one of the most common reasons of thromboembolic complications in the course of connective tissue diseases. There is a strong relationship between presence of antiphospholipid antibodies and the risk of thrombosis. APS related thromboembolic complications range from superficial vein thrombosis up to rapidly developing, life threatening, multi-organ embolism. We present a case of a 21-year old female who presented with myocardial infarction as the first symptom of systemic lupus erythematosus and APS. Afterwards she was consequently treated with antithrombotic and anti-aggregation agents but it did not prevent her from reoccurrence of middle retinal vein. During the 10-year follow up she presented with reoccurring neurological symptoms i.e.: headache, memory deficits, concentration loss and impairment of the cognitive functions. She was found many times to be positive for IgG and IgM anticardiolipin antibodies, anti-beta2glicoprotein-I antibodies and lupus anticoagulant.
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PMID:[Therapy resistance antiphosholipid syndrome in the course of systemic lupus erythematosus: case report]. 1877 25

The key feature of fibromyalgia is a chronic pain picture located in different structures of the musculoskeletal system, but without any evidence of disease in them. Besides pain, patients with fibromyalgia often describe tiredness, sleep disorders, headache, and emotional problems, as well as many other psychosomatic complaints. Genetic and environmental factors have been implied in the pathogenesis of fibromyalgia, its perpetuation being explained by an alteration of the nociceptive system, thus leading to a neuroendocrine syndrome of chronic stress. Although research has provided a significant amount of data, there is no definite biomarker for fibromyalgia so far. The disease can appear alone or associated, among other diseases, with rheumatoid arthritis, erythematous systemic lupus, myopathies and multiple sclerosis. Fibromyalgia generally has very important repercussions on family, social and professional life of the patient, especially considering that therapeutics (aerobic exercise, antidepressants and antiepileptic drugs) have hardly shown any effectiveness. However, achieving a precise diagnosis, being able to transmit it to patients in a realistic way, along with attaining an optimally personalized treatment, are of primary importance, among other things, in order to reduce possible iatrogenesis caused from an individual viewpoint in a problem with multiple aspects.
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PMID:[Is fibromyalgia a neurological disease?]. 1892 41

Neuropsychiatric symptoms are recognized to occur in a significant percentage of systemic lupus erythematosus patients and to be a leading cause of morbidity and mortality in lupus. The aim of the present study is to investigate neuropsychiatric symptoms in the patients with lupus nephritis without chronic renal failure. We studied 74 patients (4 male, 70 female) with SLE without chronic renal failure. Disease activity was assessed by the European Consensus Lupus activity Measurement (ECLAM). Renal biopsies disclosed type V lesions in 23 patients, type IV--in 34, type III--in 3, type II--in 11, type I--in 3 patients. Two control groups are used--with rheumatoid arthritis (96 patients) and 63 healthy subjects. The most frequent clinical manifestations are cognitive dysfunction (52.94%), headache (29.41%), psychoses (17.65%), epileptic seizures (20.59%) etc., and the most common cognitive deficit is related to impairment of the memory. The tests for cognitive disorders and nuclear magnetic resonance are the methods of investigation, by which the nervous system injuries are most early detected in the course of the disease. The presented study describes the correlations between the immunologic deviations (antiribosomal P-antibodies, aPL, aSm, aC1q), MMP-9, AT III and the NP injuries.
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PMID:Neuropsychiatric lupus in patients with lupus glomerulonephritis. 1892 62

Headache is a frequent occurrence in patients with systemic lupus erythematosus (SLE). We present two cases of young women with headache and papilledema. One patient had this as a presenting manifestation of SLE, and the other had known active SLE. The first patient had a diagnosis of cerebral venous thrombosis, and the other pseudotumor cerebri. Both of these conditions are rare but have known associations with lupus. In the lupus patient with headache, it is essential that the clinician rule out these potentially treatable conditions by carefully taking a history and performing a physical examination as well as using ancillary investigations, including lumbar puncture, computed tomograph and magnetic resonance imaging as required. These uncommon causes of headache in the lupus patient must not be missed, because there is significant potential for morbidity, such as visual loss, or even mortality.
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PMID:Two Less Common Causes of Headache in Systemic Lupus Erythematosus that May Require Specific Measures. 1907 53

The objective is to study the neuropsychiatric (NP) manifestations in pediatric onset systemic lupus erythematosus (SLE) at a tertiary care hospital of northwestern India applying American College of Rheumatology (ACR) case definitions in the context of occurrence of antiphospholipid antibodies (APLA). Data of 53 children with SLE were analyzed for NP syndromes. Tests for detection of APLA were performed as per international standards for quality control. Twenty-seven of the 53 (50.94%) children with lupus had at least one NP manifestation. The male to female ratio of our cohort of pediatric lupus was 1:2.8. However, there was significant male preponderance in patients with NPSLE as compared to patients without NPSLE (1:1.25 vs. 1:12; P < 0.0001). Majority of children with NPSLE (15/27, 55.5%) already had NP manifestations at the time of diagnosis and most of them (81.5%) had experienced more than one NP symptom. Headache was the commonest NP manifestation and was seen in 39.6% children with SLE followed by seizure disorder (35.8%) and cognitive dysfunction (16.9%). Tests for APLA were carried out in 37 of 53 (69.8%) patients with SLE and in 24 of 27 (88.8%) patients with NPSLE. While anticardiolipin antibodies were seen more frequently in children with NPSLE as compared to those without NPSLE (57.8 vs. 23%), lupus anticoagulant was more frequent in children without NPSLE (53.8 vs. 34.7%). However, these differences were statistically not significant. Eleven of the 27 children with NPSLE succumbed to their illness, primarily due to uncontrolled disease activity. Mean duration of follow-up of patients with NPSLE who are alive was 65.4 +/- 36.9 months. NP manifestations are common in pediatric onset lupus and contribute to significant morbidity. As compared to previously published literature, a significantly greater proportion of boys were affected. APLA were frequently detected in children with NPSLE. There is paucity of literature pertaining to NP manifestations of pediatric lupus in the context of APLA, especially with regard to antibodies to beta-2 glycoprotein I. To the best of our knowledge, this is the first detailed study on NP manifestations in childhood lupus from a developing country applying ACR case definitions.
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PMID:Neuropsychiatric manifestations and antiphospholipid antibodies in pediatric onset lupus: 14 years of experience from a tertiary center of North India. 1930 97

Controversy exists as to whether patients with migraine may suffer cortical damage. We investigate the possible association between impaired cognitive function and chronic headache in lupus patients. Sixty one patients with systemic lupus erythematosus but without the antiphospholipid (Hughes) syndrome were questioned about headaches and formally assessed for cognitive function. They were also subjected to magnetic resonance imaging (MRI). Twenty one patients denied any significant headaches, 19 reported migrainous headaches and 11 experienced an aura. Eleven patients experienced headaches with features of migraine but did not fulfill the criteria, and seven patients had tension headaches. All patients had stable lupus; there was no difference in the incidence of hypertension, age or previous episodes of neuropsychiatric lupus. Patients with migrainous headaches without aura had marginally shorter duration of disease. There was no difference between the groups with respect to eight different cognitive tests or the ventriculo brain index on MRI. We failed to detect cognitive impairment in lupus patients with chronic headaches including migrainous headaches.
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PMID:An investigation in the possible effect of chronic headache on neuropsychological function in aCL-negative patients with SLE. 1943 61

In 1999, the nomenclature and case definitions for neuropsychiatric lupus syndromes were published by American College of Rheumatology (ACR), and the cognition of neuropsychiatric damage of systemic lupus erythematosus (SLE) was gradually unified and standardized. Lupus headache is an intractable problem in SLE, especially in SLE patients complicated with multiple organ injury. In general, vascular headache is common in most SLE patients, and a small number of SLE patients complicated with nervous headache are found in clinic. Moreover, its pathophysiological mechanism is far from being understood. Although early diagnosis is essential for good outcomes, the diagnosis method is rather confused in the world. There still exist some limitations in the proposal of clinical classification of headache from ACR and International Headache Society (IHS), and the proposal does not mention the classification of headache related to psychiatric damage. Current therapeutic regimens are almost exclusively based on empirical evidence. Treatment approaches include symptomatic treatment, immunosuppressive, anticoagulant and anti-aggregant therapies. It provides enormous and hopeful space in research of combined therapy strategy, especially in the field of traditional Chinese medicine. The authors discussed the relationship between lupus headache and headache due to internal injury in the view of integrated traditional Chinese and Western medicine, and suggested that the treatment strategy for lupus headache should be made in argument with the headache due to internal injury. Syndrome differentiation treatment according to deficiency in the root and excess in the branch and the therapy for activating blood to dredge collaterals maybe have great advantages in treatment of the headache in SLE.
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PMID:[Relationship between lupus headache and headache due to internal injury in traditional Chinese medicine]. 1943 52

To evaluate the efficacy of hydroxychloroquine (HCQ) and quinacrine (Qn) association, at two different dosages, in treatment of lupus skin lesions not responding to HCQ alone. Thirty-four patients, affected by cutaneous and systemic lupus erythematosus, were retrospectively analysed. They were treated by HCQ (5 mg/Kg/qd) and Qn with two regimens: 100 mg/qd (29 cases) and 50 mg/qd (5 cases). Discoid lupus erythematosus (19 cases), acute malar rash (6 cases), chilblain lupus (4 cases) showed a significant improvement with combination therapy (P = 0.009, P = 0.019, and P = 0.04, respectively). Ten patients with subacute cutaneous lupus showed a partial response, whereas lupus profundus didn't improve. The same overall response rate was recorded comparing two Qn regimens, but subjects taking 100 mg/qd improved more rapidly than the others (P = 0.001). Ten patients developed side effects, mainly represented by skin yellowish discolouration. Depression and severe headache with nausea, which were globally recorded in two cases, led to drug withdrawal. One additional case of hepatitis was recorded in a patient with preexisting Hepatitis C virus (HCV) infection. Combination of HCQ and Qn is rapidly effective at 100 mg/qd and well tolerated in the treatment of lupus skin lesions unresponsive to HCQ alone.
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PMID:Treatment of lupus skin involvement with quinacrine and hydroxychloroquine. 1950 70

Current diagnostic classification criteria recommend elevated titres of anti-cardiolipin (aCL) and/or anti-beta(2)GPI antibody by ELISA IgG or IgM and/or lupus anticoagulant (LA) to confirm antiphospholipid syndrome (APS). Although IgA aPL antibodies have been shown to be pathogenic in animal models of APS, their clinical significance has remained elusive. We report four cases of exclusive IgA anti-beta(2)GPI antibody sero-positivity with concomitant clinical manifestations associated with APS. Four of the five patients were LA negative. 1) Thirty-eight-year-old African-American female with SLE presented with resolving digital ulcers. Serum IgA anti-beta(2)GPI antibody titres were 118.5 SAU (normal range: 0-20 SAU). 2) Twenty-seven-year-old African-American woman with SLE was evaluated for recent onset of severe headaches, unresponsive to analgesics and anti-migraine medications. MRI of the brain revealed hyper-intensities in the white matter in the frontal lobes. Serum IgA anti-beta(2)GPI antibody titres were 29.1 Standard A Units (SAU). 3) Thirty-two-year-old Hispanic female with history of two unexplained miscarriages and negative serologies for SLE. Serum IgA anti-beta(2)GPI antibody titres were 102.0 SAU. 4) Twenty-five-year-old white female with history of recent unexplained miscarriage in the 11th week of gestation and associated complaints of numbness and tingling in her hands. Her IgA anti-beta(2)GPI antibody titre was 62.0 SAU. 5) Twenty-five-year-old African-American woman with SLE, positive for anti-Ro antibodies with a history of ischemic fingers, a pregnancy loss and recent pregnancy complicated due to pre-eclampsia. Her LA was positive and her IgA anti-beta(2)GPI antibody titer was 186.0 SAU. This case series supports that elevated IgA anti-beta(2)GPI antibody titres may identify additional patients who have clinical features of APS but who do not meet current diagnostic criteria.
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PMID:Isolated elevation of IgA anti-beta2glycoprotein I antibodies with manifestations of antiphospholipid syndrome: a case series of five patients. 1976 4


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