'Lupus headache': results from a prospective, international, inception cohort study
Bibliographic record
Abstract
'Lupus headache' is controversial but included in measures of global SLE disease activity. We examined the frequency, characteristics and associations of 'lupus headache' in a large, prospective, inception cohort of SLE patients. The study was conducted by an international network of 30 academic medical centers. Annual assessments were performed for 19 neuropsychiatric (NP) syndromes, which included five types of headache using the International Headache Society (IHS) criteria. Additional data were demographic and clinical variables, SLEDAI-2K, which includes 'lupus headache' as a standalone variable, SLICC/ACR damage index and self-report mental (MCS) and physical (PCS) component summary scores of the SF-36. Statistical analysis used linear regression models with generalized estimating equations. Of 1,732 enrolled patients, 89% were female. Race/ethnicity was Caucasian (48%), African (16%), Asian (16%), Hispanic (16%) and other (4%). At enrollment, the mean ± SD age was 34.6 ± 13.4 years, disease duration was 5.6 ± 4.8 months and follow up was 3.8 ± 3.1 years. Twenty-six (1.5%) patients had 'lupus headache' at 27 (0.36%) of 7,523 assessments with the following IHS classification: migraine ( n = 13), tension headaches ( n = 8), intractable nonspecific headaches ( n = 5), cluster headaches ( n = 1) and intracranial hypertension ( n = 1). In 5/27 (18.5%) assessments there were concurrent NP events. 'Lupus headache' was reported at both enrollment ( n = 14) and follow-up ( n = 13) assessments, in patients from all racial/ethnic groups in 15 of 30 (50%) sites located in eight of 11 countries. The estimated mean (± SE) SLEDAI-2K scores, without the 'lupus headache' variable, for visits with no headache ( n = 6,019), a nonlupus headache ( n = 1,330) and both a nonlupus headache and 'lupus headache' ( n = 27) were 3.8 ± 0.08, 3.6 ± 0.18 and 7.2 ± 1.40 respectively ( P = 0.034). Concurrent SF-36 MCS scores were 47.8 ± 0.28, 42.6 ± 0.56 and 39.4 ± 2.41 ( P < 0.001) and PCS scores were 42.6 ± 0.30, 38.1 ± 0.53 and 32.4 ± 1.76 ( P < 0.001). SLEDAI-2K scores, without the 'lupus headache' variable, for patients with and without 'lupus headache' were 7.2 ± 1.40 versus 3.7 ± 0.08 ( P = 0.035). In 5/26 (19.2%) patients, 'lupus headache' was the sole contributor to the SLEDAI-2K score. Concurrent SF-36 MCS and PCS scores for patients with and without 'lupus headache' were 39.4 ± 2.41 versus 46.8 ± 0.27 ( P = 0.002) and 32.4 ± 1.76 versus 41.7 ± 0.28 ( P < 0.001) respectively. 'Lupus headache' was infrequent, associated with higher global disease activity and a lower HRQoL. It was not reproducibly aligned with a uniform IHS classification of headache (for example, intractable headache). The lack of consistency in diagnosing 'lupus headache', even by experienced clinicians, indicates a need to better define 'lupus headache' and to reach consensus on whether it is truly a standalone manifestation of NP SLE.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".