Issy's Lupus Information Center

Lupus Facts III

Headaches and Other Neurological Symptoms

Compared to the general population, twice as many individuals with SLE experience migraine-type headaches on a regular basis. Many patients began experiencing these headaches in childhood or adolescence, along with "growing pains", frequent sore throats, and easily-sprained joints. It is important to note that growing is not painful. When a child suffers from recurring pain which is put off as "growing pains", there IS a cause. While it may not be lupus, just keep in mind that growing doesn't hurt or all children would be in constant pain.

Like migraines, Lupus headaches are sensitive to light, sound, and motion, can last anywhere from 12 to 72 hours, and are often accompanied by vomiting, blue lips, and vertigo. Migraine and lupus headaches are much more severe than the average tension or sinus headache, resulting from the dilation of cerebral blood vessels, but the cause is unknown. Such headaches are particularly common in patients with the Anticoagulant Syndrome and Raynaud's Phenomenom. The instability in the dilating and constricting of blood vessels may result from a defect in local autonomic nervous system control. The one major difference which sets Lupus headaches apart from non-lupus migraines is their responsiveness to steroids. While taking Prednisone, lupus patients report a dramatic decrease or even elimination of headaches.

Headaches are but one of the many neurological manifestations found in SLE. Central Nervous System (CNS) involvment may stop at headaches and fogged memory, or it can escalate to psychosis, seizures, and comma. These cases are far less common and most experience problems somewhere in the mid-range.
      * Altered Behavior (including psychosis, organic brain syndrome, seizures, depression, and confusion) are changes noticable to friends and family and are caused by lupus directly affecting the central nervous system in what is called "CNS Vasculitis", or can be a reaction to certain medications.
      * Cognitive Dysfunctions are much more common in lupus patients, which are usually subtle and often noticed only by the patient. Such problems as not thinking clearly, impaired memory, and poor concentration are classified under this catagory and usually derive from a blood flow abnormality.

Such reports from undiagnosed lupus patients as headaches, difficutly concentrating, depression, anxiety attacks, "nervousness", and insomnia only increases the chances of being given anti-depressant medications and referred for psychological treatment. In addition, hormonal changes and emotional stress activate the immune system, triggering a flare of the disease. Therefore, the week preceding menstration, in which the female body under-goes hormonal changes, as well as emotionally-upsetting occurances in the patient's life can bring about actual physiological illnesses, which are often minimized as mere PMS or an inability to cope with stress. However, these are very real, neurological symptoms of SLE.

One of the most over-looked symptoms in SLE is anxiety attacks -- or, "panic attacks", often coupled with Agoriphobia and Claustrophobia. It is interesting to note that a great many reported cases indicated problems especially while driving or riding in vehicles, as well as occurances in public places. These individuals commonly experience light-headedness and vertigo. Differing from dizziness, vertigo is not limited to a "spinning" sensation, but includes any type of moving sensation, such as floating, falling, horizontal movement, or vibrating sensations. Panic attacks are a sudden, unrealistic sense of impending doom which occurs for no appearent reason. The body's natural "fight or flight" response is triggered, in which extra adrenalin is released for combating threatening situations. The heart pounds, pulse races, thoughts speed dramatically, and the person usually experiences nausea and/or diarrhea, brought on by a sense of immediate danger, though no danger is present. The two prevalent thoughts which occur in every victim's mind are, "I am dying or going crazy." These episodes seem to come on without provocation, though the patient generally finds some occurance in their life which they blame for these episodes, thus labeling them as "post-traumatic stress disorder". In the cases where SLE is found, these attacks are actually manifestations of Autonomic Nervous System involvement, and are similar to simple seizures, rather than psychological instablity.

Both, the Central Nervous System and the Peripheral Nervous System can be affected by SLE.

  • CENTRAL NERVOUS SYSTEM: (CNS) Includes the brain and spinal cord.

    TIAs or Multiple Sclerosis?

    TIA (Transient Ischemic Attack) is a "pre-cursor" to a stroke. These are warning signs of a blood clot and that a full stroke is quite possible. In lupus patients, this is usually due to the Anticoagulant Syndrome. Symptoms include headaches, dizziness, confusion, numbness, tingling, blurred or sudden loss of vision, loss of bladder and bowel control (which can either be incontinence or retention), poor coordination, difficulty walking, and a "dropped" arm or foot (loss of use).
    These are also the symptoms of MS (Multiple Sclerosis). Brain imaging and spinal fluid evaluations usually help differentiate the two.
    Multiple Sclerosis and Myasthenia Gravis are autoimmune disorders of the central nervous system and both have an increased incidence among lupus patients. Myasthenia gravis causes rapid muscle pain and weakness with repetitive tasks.

  • PERIPHERAL NERVOUS SYSTEM: (PNS) Those nerves not included in the brain and spinal cord --
          * Sensory Nerves: controlling body sensations, such as the sense of touch and feeling in the skin. Abnormalities include any altered sensations, such as hot and cold sensations on a certain area of the skin (without actual change in body temperature), tingling, pins and needles, vibratory sensations, and loss of feeling on the skin. Other strange sensations, including various forms of vertigo, are problems of the CNS.

          * Motor Nerves: controlling muscle strength and movement.
    (see Peripheral Neuropathy below)

          * Autonomic Nerves: regulates adrenalin release, the tone of local blood vessels, and muscular contractions. These nerves control our "fight or flight" responses to stress, including sweating, bladder and bowel functions, slow or rapid breathing and heart rate, feelings of hot and cold, and burning sensations. "Panic" or "Anxiety" Attacks, as described earlier in this section, are caused in Lupus patients by impaired autonomic nerves. Inadequately studied in SLE, these problems cause more emotional distress to the patient than any other symptoms of the disease.

  • NEURITIS: is the "inflammation" of a nerve, often causing excruciating, sharp or burning pain. The pain comes and goes with movement of or touch to the affected area. A condition is said to be "neuritis" when nerve inflammation exists without actual nerve damage. Treatment for neuritis is steroids, which resolves the problem. Recurring episodes lead to permanent nerve damage which is no longer responsive to steroid treatment. (Nerve damage is called "Neuropathy")

  • NEURALGIA: is the term used to label the "pain" from a damaged nerve. In lupus patients, the pain tends to be chronic and severe, sharp and hard to bear. It is a "shooting" pain which travels along the pathway of the affected nerve. It usually only lasts a few seconds, but several attacks may occur in quick succession, or repeatedly over a course of time. Depending upon the location and severity, treatments include pain medications, drugs that change nerve conduction (such as anti-convulsants), and surgery.

  • PERIPHERAL NEUROPATHY: is "damage" to a peripheral nerve, characterized by a tingling sensation which tends to slowly spread from the extremities to the trunk. Numbness may also occur in the same fashion. Often, the skin becomes very sensitive to touch accompanied by neuralgic pain. Sometimes there is a gradual weakening of muscle power. You may experience a complete numbness or a lack of sensation in the skin. Local nerve palsies can also result, where the use of a hand, arm, foot, or leg is lost or severely impaired (called "dropped" which also occurs in Multiple Sclerosis) There is no direct treatment for peripheral neuropathy, but when it is caused by an underlying disorder, such as SLE, more aggressive lupus treatments usually slow or halt the progression of the neuropathy.

          * It is interesting to note that many lupus patients experience flares of disease activity when exposed to certain chemicals (such as the propellents in aerosol sprays, strong perfume odors, and househould cleaning products). Likewise, peripheral neuropathy can sometimes be traced to exposure to certain chemicals, especially arsenic, mercury, lead, and insecticides. While it is doubtful that we have come in contact with any of the first three toxins mentioned, we all have been exposed to insecticides. { Return to "Motor Nerves" above. }

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