Based on PubMed | Are headaches a symptom of lupus, and how can I tell if they are due to lupus activity rather than a primary migraine?

Headaches can occur in lupus and may range from common tension-type or migraine headaches to, less commonly, headaches associated with active inflammation in the brain or its coverings. ^[1] Headaches in lupus are often similar to those seen in the general population, and many people with lupus experience migraines; however, most headaches are not directly caused by lupus activity. ^{[2] [3]}

How common are headaches in lupus?

• Many individuals with lupus report headaches, including migraines and tension-type headaches. ^[2]
• Headaches are listed among recognized neurologic symptoms when lupus affects the brain or central nervous system, along with dizziness, vision changes, seizures, or behavior/memory changes. ^{[3] [1]}
• Studies comparing people with lupus to those without lupus show similar rates of migraine overall; chronic tension-type headache may be somewhat more frequent in lupus. ^[4]
• In some research, migraine appears more common in lupus groups, but these migraines typically do not track with lupus disease activity or specific lupus biomarkers. ^[5]

When might a headache be related to lupus activity?

A headache may be more likely linked to lupus activity (sometimes referred to as neuropsychiatric lupus) if it occurs alongside other signs of inflammation in the nervous system or a systemic flare. ^{[3] [1]}

• Concerning features include new neurologic symptoms such as seizures, focal weakness or numbness, speech problems, behavior or personality changes, or new vision problems. ^{[3] [1]}
• Headache occurring with other lupus flare signs like fever, swollen glands, weight changes, or new inflammatory symptoms can raise suspicion of disease activity. ^[2]
• Headache that is unusually severe, persistent, or different from your typical pattern, especially with new daily onset, warrants evaluation. ^{[3] [1]}

Clues that point toward a primary migraine or tension-type headache

Most headaches in people with lupus follow patterns identical to primary headache disorders and are not driven by lupus activity. ^{[4] [5]}

• Migraines often have throbbing pain, sensitivity to light or sound, nausea, and may include visual aura; these features alone do not indicate lupus activity. ^[4]
• In controlled studies, migraine characteristics and frequency in lupus were similar to those in healthy controls and did not correlate with lupus disease activity or MRI/CSF inflammatory markers. ^{[4] [5]}
• Chronic tension-type headache (a tight, band-like pressure) may be more frequent in lupus but likewise does not reliably reflect lupus inflammation. ^[4]

Practical ways to tell the difference

While no single test distinguishes a “lupus headache” from a primary migraine, a combination of history, exam, and targeted testing helps guide the diagnosis. ^{[4] [5]}

• Track the pattern: If headaches match your usual migraine or tension-type pattern and respond to typical treatments, they are more likely primary. ^[4]
• Look for accompanying lupus flare signs: Fever, swollen glands, new rashes, joint swelling, or pronounced fatigue with neurologic changes suggest lupus activity. ^{[2] [3] [1]}
• Neurologic red flags: New seizures, focal deficits, progressive confusion, or vision changes should prompt urgent assessment. ^{[3] [1]}
• Imaging/CSF: Brain MRI or spinal fluid analysis is considered when neurologic symptoms are present; in studies, most lupus-related migraines did not show inflammatory changes on these tests. ^[5]

What to do if you have headaches and lupus

• For typical mild headaches, standard over‑the‑counter options such as acetaminophen or NSAIDs may help, though NSAIDs should be used carefully in lupus especially if you have kidney involvement and guided by your clinician. ^{[6] [7]}
• If headaches are frequent or severe, discuss preventive and acute migraine therapies with your clinician; these are often effective and can be tailored to your health profile. ^[4]
• Seek prompt care if headaches are new, rapidly worsening, or accompanied by neurologic symptoms or signs of a lupus flare; further evaluation for neuropsychiatric lupus may be needed. ^{[3] [1] [2]}
• Ongoing management of lupus with antimalarials or immunosuppressive therapies is adjusted based on overall disease activity, not on typical primary headaches alone. ^[6]

Key takeaways

• Headaches are common in lupus, and many are typical migraines or tension-type headaches that are not caused by lupus inflammation. ^{[2] [4]}
• Headaches tied to lupus activity usually come with additional neurologic signs or systemic flare features and may need urgent evaluation. ^{[3] [1] [2]}
• Studies show migraine in lupus often behaves like migraine in the general population and does not correlate with lupus activity or inflammatory biomarkers. ^{[4] [5]}