Migraine during systemic lupus erythematosus: Findings from brain single photon emission computed tomography

Flavio Nobili, Alessandro Mignone, Edoardo Rossi, Silvia Morbelli, Arnoldo Piccardo, Francesco Puppo, Francesco Indiveri, Gianmario Sambuceti, Guido Rodriguez

Research output: Contribution to journalArticlepeer-review


Objective. Headache in systemic lupus erythematosus (SLE) is controversial, as is evidence of brain impairment in patients with SLE and headache. Perfusion single photon emission computed tomography (SPECT) was performed to investigate brain impairment in SLE patients with migraine-like headache either from the period of diagnosis or later in the course of diseuse. Methods. Eighteen patients with SLE (mean age 40.8 ± 13.6 yrs) matching these characteristics underwent brain SPECT with 99mTc-HMPAO in the interictal period. Electroencephalography (EEG) and magnetic resonance imaging (MRI) were performed in 12 and 10 patients, respectively. SPECT was analyzed through visual and asymmetry combined analysis as well as by voxel-based statistical analysis compared to a control group of matched healthy subjects (statistical threshold: p = 0.01). Results. Focal hypoperfusion was evidenced in 15 (83%) patients, often matching the main side of pain location, whereas EEG and MRI each gave a positive result in 50% of cases. Using voxel-based analysis, significant hypoperfusion was found in 8 (44%) patients, either lateralized to one side or localized to the anterior cingulute cortex, independent of pain location. Conclusion. Brain perfusion SPECT is a sensitive tool for identifying brain impairment in SLE-related migraine, although the mechanisms of brain damage remain to be elucidated. Besides confirming focal hypoperfusion in some patients, in 4 patients statistical analysis revealed interictal hypofunction of the anterior cingulute cortex, a key structure for cortical elaboration of pain in the midline network.

Original languageEnglish
Pages (from-to)2184-2191
Number of pages8
JournalJournal of Rheumatology
Issue number11
Publication statusPublished - Nov 2006


  • Brain perfusion
  • Electroencephalography
  • Headache
  • Magnetic resonance imaging
  • Migraine
  • Single photon emission computed tomography
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology
  • Immunology


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