[2008] [THU0228] MIGRAINE IS AN INDEPENDENT RISK FACTOR FOR ARTERIAL THROMBOTIC EVENTS IN SYSTEMIC LUPUS ERYTHEMATOSUS

S. Appenzeller¹, C.B. Zeller², L.T.L. Costallat^{1 1}Internal Medicine; ²Statistics, UNICAMP, Campinas, Brazil

Background: Migraine is a common chronic, intermittent headache disorder that in some patients is accompanied by neurological symptoms, particularly visual symptoms, known as migraine with aura. Several population-based studies have linked migraine, and particularly migraine with aura, with increased risk of ischemic stroke. Recent prospective data suggest an association between migraine with aura and any ischemic vascular events, including coronary heart disease in general population.
Objectives: To determine if the presence of migraine and the duration of migraine is associated with arterial vascular events in systemic lupus erythematosus (SLE) patients.
Methods: Over the last 10 years period 327 of 749 patients followed in the Rheumatology Unit of the State University of Campinas were prospectively studied. Primary headache syndromes were assessed according to the criteria of the International Headache Society, previously validated in Brazil and also adopted by the ACR. All arterial thrombovascular events were confirmed by physician review of medical records. Confirmation included information obtained from clinical notes, discharge diagnoses, and positive diagnostic imaging procedures. We performed a multivariate model considering the presence or absence of migraine and arterial vascular events, adjusted for other risk factors associated for arterial thrombotic events such as the presence of hypertension, diabetes, antiphospholipid antibodies, lupus anticoagulant, family history of cardiovascular events, aspirin use and oral anticoagulation. Survival curves and Cox proportional hazards were determined to analyze the importance of the duration of migraine in the occurrence of arterial vascular events.
Results: Diagnostic criteria for migraine were met in 30.5% of SLE patients. Thirty-eight of these 100 (38%) patients had the diagnosis of migraine with aura. During the follow-up period identified 18 (5.5%) patients with arterial vascular thrombotic events at disease onset and 39 (11.9%) patients with arterial vascular thrombotic events during the follow-up period. Migraine was independently associated with the presence of antiphospholipid syndrome (p=0.001; Odds ratio (OR)=9.8; 95%confidence interval (CI)= 3.4-14.2) and with the occurrence of arterial thrombosis (p=0.003; OR=4.3; 95%CI=2.3-5.4). The frequency of migraine with aura was also associated with the occurrence of vascular events (r=0.7). On survival curves the duration of migraine was not an independent risk factor for the occurrence of arterial thrombotic events (p=0.006).
Conclusion: The presence and the frequency of migraine attacks, but not the duration of migraine was associated with arterial thrombotic events in our population. Longer follow-up studies are necessary to determine if the duration of migraines may independently influence the occurrence of thrombotic arterial events.

Ann Rheum Dis 2008;67(Suppl II):209

SLE, Sjögren's and APS Clinical aspects and treatment