Primary Headaches in HIV-Infected Patients

Authors

  • Seyed M. Mirsattari MD,

    1. From the Department of Internal Medicine, Sections of Neurology, University of Manitoba Health Sciences Centre, Winnipeg, MB, Canada (Dr. Mirsattari) and the
    Search for more papers by this author
  • Christopher Power MD,

    1. Department of Neurology and Medical Microbiology (Drs. Power and Nath), University of Manitoba Health Sciences Centre, Winnipeg, MB, Canada.
    Search for more papers by this author
  • Avindra Nath MD

    Corresponding author
    1. Department of Neurology and Medical Microbiology (Drs. Power and Nath), University of Manitoba Health Sciences Centre, Winnipeg, MB, Canada.
    Search for more papers by this author

Address all correspondence to Dr. Avindra Nath, Department of Neurology, University of Kentucky, Kentucky Clinic, Room L-445, Lexington, KY 40536-0284.

Abstract

Headache in patients with human immunodeficiency virus (HIV) infection may indicate life-threatening illnesses such as opportunistic infections or neoplasms. Alternatively, such patients may develop benign self-limiting headaches. Hence, defining the various types of headache in these patients is essential for proper management. This study describes the clinical characteristics of primary headaches occurring in a group of HIV-infected patients. Of 115 patients seen from 1990 to 1996, 44 (38%) had headaches. Primary headaches were present in 29 (66%) patients and secondary causes were identified in 15 (34%). Among those with primary headaches, migraine occurred in 22 (76%), tension-type headache in 4 (14%), and cluster headache in 3 (10%) patients. Half of those with migraine (n=ll), 1 patient with tension-type headache, and 1 patient with cluster headache developed chronic daily headaches which were severe and refractory to conventional headache or antiretroviral therapy. We conclude that primary headaches in patients with HIV infection are: (1) the commonest type of headache; (2) may present for the first time in individuals with severe immunosuppression; (3) usually bear no relationship to antiretroviral drug therapy; (4) polypharmacy, depression, anxiety, and insomnia are commonly associated comorbidities; (5) frequently do not respond to conventional management and carry a poor prognosis; and (6) do not require neuroradiological and/or cerebrospinal fluid evaluations.

Ancillary