Primary headaches in juvenile-onset systemic lupus erythematosus: A preliminary case control study using ICHD-3 criteria.

IntroductionHeadache is one of the most frequent neurological symptoms in SLE; however, its definition and relationship with the disease remain unclear. Distinguishing whether a headache is attributable to lupus or represents a primary headache disorder can be challenging. This preliminary study aimed to investigate the prevalence, frequency, and associated clinical factors of primary headaches in juvenile-onset SLE (jSLE) compared to healthy peers.MethodsThis cross-sectional case-control study included 32 children with jSLE and 38 age- and sex-matched healthy controls, who were evaluated between July and September 2025. Headache characteristics were assessed using a standardized questionnaire and classified according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). All participants underwent neurological and fundoscopic examinations. Clinical, laboratory, and treatment-related parameters including disease activity (SLEDAI-2K), cumulative dose of systemic corticosteroids, and autoantibody profiles were compared between jSLE patients with and without primary headache.ResultsPrimary headache was observed in 31.3% of jSLE patients (10/32) and 10.5% of controls (4/38) (p = 0.03). Among jSLE patients with headache, migraine without aura (60%) and tension-type headache (40%) were the predominant subtypes. Compared with those without headache, patients with headache had higher BMI z-scores (p = 0.03), shorter sleep duration (p = 0.03), more frequent antiphospholipid antibody positivity (p = 0.04), and higher cumulative corticosteroid doses (p = 0.02). Disease activity and duration did not differ significantly.ConclusionPrimary headaches, particularly migraine, are more frequent in pediatric lupus compared to healthy controls. Their associations with BMI, sleep, antiphospholipid antibodies, and corticosteroid exposure suggest multifactorial origins rather than direct links to disease activity. These findings highlight the need for larger, prospective studies to clarify underlying mechanisms.