What Are APS Headaches and What Can I Do to Manage Them?

Managing Headaches Associated with APS

APS Program Community Q&A Series

Yu (Ray) Zuo, MD, MSCS
Yu (Ray) Zuo, MD, MSCS

Headaches are common health conditions that can be associated with a variety of diseases and APS is no exception. In this edition of the APS Program Community Q&A Series, Dr. Yu (Ray) Zuo discusses headaches associated with APS and strategies to help you manage them.

People who have APS have an increased chance of having headaches - often migraine headaches, which can be accompanied by flashing lights, pins and needles sensations, nausea, and vomiting. One recent study of 1,000 APS patients from Europe reported that migraine headaches occurred in up to 20% of people with APS [1]. They often start in the teenage years, then disappear for one or two decades, only to return during a person’s 30’s and 40’s [2]. Migraines appear to be more prevalent in female patients with APS who also have lace-like rashes and arthritis [1]. Other studies have suggested that APS headaches can be associated with a prior history of stroke [3].

Many possible headache triggers have been suggested including hormonal fluctuations, emotional stress, physical activity, dietary influences, sleep disturbance, and environmental factors [4]. These triggers vary from patient to patient.

Although the association was first described by Dr. Graham R.V. Hughes over 30 years ago, the exact cause of APS headaches remains unknown. One preliminary study has suggested that they could be the result of abnormal platelets (the smallest circulating blood cells) causing an imbalance of nerve signaling molecules that disrupt normal blood vessel function in the brain [2].

While some people with APS have an improvement in headaches when they start anticoagulant medications such as warfarin, this is not true for everyone. Beyond anticoagulation, there are unfortunately no specific therapies available for APS headaches. Rather, current treatments aimed at minimizing symptoms and preventing future attacks with strategies and medications also used in the general population. Treatment plans will typically be tailored to the frequency and severity of your headaches, whether you have other associated symptoms such as nausea and vomiting, how disabling your headaches are, and other medical conditions you might have.

Here are some relatively simple strategies that may help you and your doctor manage your APS headaches:

  • Avoid bright light and loud noises - Adjust the brightness of your digital screen and rest your eyes often.
  • Pay attention to food - Certain foods and drinks, particularly those that contain alcohol, are common triggers of headaches.
  • Keep a headache diary - This can help identify the pattern and triggers of your headaches and will make avoiding them easier.
  • Eat well and sleep well - Fasting and skipping meals can trigger headaches and lack of sleep can aggravate symptoms.
  • Hydrate well - Drink plenty of water.
  • Manage stress - While we can’t always control stressful situations, we can control how we react to them. Relaxation techniques such as meditation, yoga, and Tai-Chi can help reduce stress.
  • Take care of your body - Implement a healthy diet, maintain proper nutrition, and exercise regularly.

In summary, headaches are not uncommon among APS patients. The exact causes are not fully understood. No targeted therapies are available for APS headaches and sometimes it takes time to find the best approach to treatment for each person. Fortunately, identifying specific triggers and modifying behaviors help a lot of people minimize the frequency and intensity of APS headaches.


  1. Cervera R, Boffa MC, Khamashta MA, Hughes GR. The Euro-Phospholipid project: epidemiology of the antiphospholipid syndrome in Europe. Lupus. 2009;18(10):889-93.
  2. Noureldine MHA, Haydar AA, Berjawi A, Elnawar R, Sweid A, Khamashta MA, et al. Antiphospholipid syndrome (APS) revisited: Would migraine headaches be included in future classification criteria? Immunol Res. 2017;65(1):230-41.
  3. Silvestrini M, Matteis M, Troisi E, Cupini LM, Zaccari G, Bernardi G. Migrainous stroke and the antiphospholipid antibodies. Eur Neurol. 1994;34(6):316-9.
  4. Martin VT, Behbehani MM. Toward a rational understanding of migraine trigger factors. Med Clin North Am. 2001;85(4):911-41.

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