What you need to know about migraine in Hughes syndrome patients

Abstract

Background: Headache, often migrainous, is common in patients with antiphospholipid antibodies, whether or not they meet Sydney criteria for a definite diagnosis of Hughes syndrome. Migraine may be a harbinger of stroke in this patient population and even refractory migraine may be highly responsive to antithrombotic therapy in this clinical context.

Purpose: To summarize what is known to date about managing this important manifestation of the immune-mediated hypercoagulable Hughes syndrome.

Results: We provide a suggested management algorithm for refractory headache in this unique patient population.

Conclusion: Most neurologists don't see or recognize many aPL-positive patients in their practice, so hematologists and rheumatologists who see these patients should recognize that refractory headache may be a manifestation of their immune-mediated hypercoagulable disorder and understand that the potential risks of not addressing this issue may be high.

Keywords: Hughes syndrome; antiphospholipid antibodies; antiphospholipid syndrome; antithrombotic therapy; migraine.