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About 20% of patients with lupus have migraine-like headaches. The following list outlines a program designed to mitigate such headaches. This list is taken directly from a handout prepared by Dr. David Buchholz, MD.

Foods to Avoid:

• Caffeine: Coffee, tea (hot or iced), cola; even decaf coffee and tea may be a problem; try caffeine-free herbal tea
• Chocolate
• Cheese: Avoid all cheeses except American, cream, and cottage cheese. Avoid cheese-containing foods such as pizza and macaroni-and-cheese.
• Monosodium glutamate (MSG): Chinese restaurant food, many snack foods and prepared foods, Accent and other seasoning products; MSG may be labeled as hydrolyzed vegetable/soy/plant protein, natural flavorings, yeast extract, Kombu, “broth,” “stock,” and others; read labels – note: “hydrogenated” is OK)
• Certain Dairy Products: Yogurt, sour cream, and buttermilk.
• Nuts: All, including nut butters (e.g., peanut butter)
• Processed meats: Those that are aged, canned, cured, marinated, tenderized, or contain nitrates or nitrites; includes hot dogs, sausage, bacon, salami, bologna
• Alcohol and vinegar: Especially red wine, champagne, and dark/heavy drinks; vodka is best tolerated; white vinegar is OK
• Citrus fruits and juices: No oranges, grapefruits, lemons, limes, pineapples, or juices from these fruits. Vitamin C and citric acid are OK
• Certain other fruits: Avoid bananas, raisins, red plums, canned figs, and avocados.
• Certain vegetables: Avoid lima, fava, and navy beans, and pea pods, sauerkraut, and onions.
• Certain bread products: No yeast-risen bread products less than one day old – such as those from bakery, doughnut shop, or home
• Aspartame (Nutrasweet)

Over-the-counter Medications to Avoid

• Caffeine-containing medications: Excedrin, Anacin, etc.
• “Sinus”/decongestant medications: Actifed, Sudafed, Dimetapp, Sine-Aid, Dristan, and all other “sinus” and cold products that contain decongestants; plain antihistamines without decongestants are OK

Notes

• The migraine prevention program may not be maximally effective until you have been on it for at least 1 month. Caffeine withdrawal may be associated with temporarily increasing headaches.
• In some cases, this dietary program alone may not adequately control migraine symptoms. In such cases, avoidance of certain other medications (e.g., birth control pills) and addition of migraine-preventive medication may be advisable.
• Even if you take migraine medication, you should follow this program. Without this program, migraine-preventive medication may not work to its full potential.
• You should strictly follow this program until your migraine symptoms are adequately controlled. Then, you may wish to ‘experiment’ with an item you have been avoiding, one item at a time, so that you can assess its individual effect on your symptoms. If eating or drinking an item is associated with recurrent symptoms, you should continue avoiding that item. Dietary triggers can act 1-2 days after consumption.
• Take a high-potency multivitamin daily.

Source

David Buchholz, MD. “Migraine (Headache) Prevention Program.” 2001.

Erythrocyte is another word for red blood cell. The erythrocyte (or, red blood cell) sedimentation rate (ESR) is a test that measures the amount of inflammation in your body. For the test, blood is drawn from a vein in your arm into a special tube. The rate of fall (sedimentation) of red blood cells is then measured, as the red blood cells become sediment at the bottom of the tube, leaving blood plasma at the top of the column. The results are reported in terms of how many millimeters of clear blood plasma are present at the top of the column after one hour. Usually red blood cells fall slowly so that there is little clear plasma left at the top. However, when the blood contains higher amounts of certain proteins involved in inflammation, namely fibrinogen and immunoglobulins (antibodies), the red blood cells fall more rapidly, resulting in an increased ESR. Therefore, sedimentation rate increases with more inflammation. A normal ESR is usually about 0-20 millimeters per hour in females and 0-12 millimeters per hour in males. The ESR is nonspecific, meaning that it does not tell your doctor exactly where the inflammation is occurring in your body and is thus not a very strong indicator of lupus activity.

Sources

• “ESR.” Lab Tests Online. 8 April 2009. American Association for Clinical Chemistry. 12 July 2009. <http://labtestsonline.org/understanding/analytes/esr/test.html#how>.
• “ESR.” Medline Plus. 7 May 2009. US National Library of Medicine and National Institutes of Health. 12 July 2009. <http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm>.
• Shiel, William C. “Sedimentation Rate.” Medicine Net.com. 25 April 2008. MedicineNet, Inc. 12 July 2009. <http://www.medicinenet.com/sedimentation_rate/article.htm>.

Creatine phosphokinase (a.k.a., creatine kinase, CPK, or CK) is an enzyme (a protein that helps to elicit chemical changes in your body) found in your heart, brain, and skeletal muscles. When muscle tissue is damaged, CPK leaks into your blood. Therefore, high levels of CPK usually indicate some sort of stress or injury to your heart or other muscles. To test CPK, blood is drawn from a vein in your arm

In the hospital, a person’s CK-MB level is often checked when they exhibit signs of heart attack. However, in lupus treatment, an elevated CPK may suggest muscle inflammation due to disease activity or an overlapping condition. CPK levels can also be high after strenuous exercise, so your doctor may wish to recheck your CPK after several days of rest. If your CPK is high with no exercise or remains high with rest, your doctor may order additional tests to determine which type (isoenzyme) of CPK is elevated. This information will help her/him to determine the source of the damage (skeletal muscles, heart, or brain). Certain medications, such as statins, can cause increases in CPK, so be sure to tell your doctor about any medications you currently take.

Sources

• “CK.” Lab Tests Online. 8 April 2009. American Association for Clinical Chemistry. 12 July 2009 <http://labtestsonline.org/understanding/analytes/ck/test.html>.
• “Creatine phosphokinase test.” Medline Plus. 19 Feb 2009. US National Library of Medicine and National Institutes of Health. 12 July 2009 <http://www.nlm.nih.gov/medlineplus/ency/article/003503.htm>.

The Coombs’ test is used to detect antibodies that act against the surface of your red blood cells. The presence of these antibodies indicates a condition known as hemolytic anemia, in which your blood does not contain enough red blood cells because they are destroyed prematurely. A healthy red blood cell lives for about 120 days; in people with hemolytic anemia, red blood cells are destroyed long before the 120-day marker. Sometimes, bone marrow can compensate for the early destruction of red blood cells by working overtime to make more of them. However, this extra effort may not be enough to combat hemolytic anemia.

Hemolytic anemia can either be inherited genetically or acquired. An acquired form, autoimmune hemolytic anemia (AIHA), is present in about 10% of people with lupus and results from an immune system attack on your red blood cells. People with AIHA may experience weakness, dizziness, fevers, and a yellowed complexion. Treatment calls for high doses of steroids such as prednisone, which may be supplemented with immunosuppressive medications such as azathioprine (Imuran).

There are two types of Coombs’ tests: direct and indirect. The direct Coombs’ test, also known as the direct antiglobulin test, is the test usually used to identify hemolytic anemia. [The indirect Coombs’ test is used only in prenatal testing of pregnant women and in testing blood prior to a transfusion.] For the direct Coombs’ test, blood is drawn from the vein in your arm and then “washed” to isolate your red blood cells. The red blood cells are then incubated (combined in a controlled environment) with a substance called Coombs’ reagent. If the red blood cells clump together (a process called “agglutination”), then the Coombs’ test is said to be positive.

Sources

• “Direct Antiglobulin Test.” Lab Tests Online. 8 April 2009. American Association for Clinical Chemistry. 12 July 2009 <http://labtestsonline.org/understanding/analytes/antiglobulin_direct/test.html>.
• “Coombs’ test.” Medline Plus. 8 April 2009. US National Library of Medicine and National Institutes of Health. 12 July 2009. <http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003344.htm>.