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Pathophysiological Mechanisms of Headache in Patients With HIV

Authors

  • Shivang G. Joshi MD, MPH, BPharm,

    1. Department of Neurology, New England Regional Headache Center, University of Massachusetts Medical School, Worcester, MA, USA
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  • Tracey A. Cho MD

    Corresponding author
    1. Department of Neurology, Harvard Medical School, Neurology-Infectious Diseases Program, Massachusetts General Hospital, , Boston, MA, USA
    • Address all correspondence to T.A Cho, Department of Neurology, New England Regional Headache Center, University of Massachusetts Medical School, 85 Prescott Street, Suite 101, Worcester, MA, 01605, USA.

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Errata

This article is corrected by:

  1. Errata: Erratum Volume 54, Issue 7, 1271, Article first published online: 16 July 2014

  • Conflict of Interest: None.

Abstract

Background

The pathophysiology of human immunodeficiency virus (HIV) is complex. The etiology of headache in the HIV population is often multifactorial, and attributing causality to specific pathophysiological mechanisms is challenging. Headaches can occur any time during the infection and may be primary (as in non-HIV-infected patients) or secondary (either from HIV directly or due to opportunistic disease).

Discussion

Direct HIV related headaches are due to the underlying viral pathophysiology. For example, acute meningitis can be seen during HIV-1 seroconversion. Headaches can occur during symptomatic HIV and also after an AIDS-defining illness. Late-stage HIV headache can occur without any pleocytosis. A correlation between viral load and neurological symptoms including headache has been suggested. There may be similar mechanisms involving migraine, tension-type headache, and HIV infection.

Conclusion

Secondary HIV headaches can be related to opportunistic infections, malignancy, medications used to treat HIV, and immune restoration inflammatory syndrome.

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