Sometimes systemic lupus does affect the brain and the peripheral nerves. It’s a very severe manifestation of lupus. The old American College of Rheumatology criteria in the definition of what is considered to be brain lupus included headaches. Now this led to a lot of confusion for many years because patients would be treated for these headaches as if they were part of lupus. Studies since have shown that headaches in lupus patients are not more common than in the general population. The most common types of headaches that lupus patients have are migraines, migraines will get better if you give patients corticosteroids but there are much better ways of treating them and they really shouldn’t be considered part of lupus. There are some specific kinds of headaches that patients with lupus get. Namely inflammation of the linings of the brain, they can get dural sinus thrombosis so work up for those rare kinds of headache that lupus patients get, is reasonable. But considering the headache itself a manifestation of brain lupus and treating patients with medications that have significant side effects like cyclophosphamide or pulse doses of steroids like intravenously is never warranted.