Primary headaches in HIV-infected patients

Headache in patients with human immunodeficiency virus (HIV) infection may indicate life-threatening illnesses such as opportunistic infections or neo plasms. Alternatively, such patients may develop benign self-limiting heada ches. Hence, defining the various types of headache in these patients is es sential for proper management. This study describes the clinical characteri stics of primary headaches occurring in a group of HIV-infected patients. O f 115 patients seen from 1990 to 1996, 44 (38%) had headaches. Primary head aches were present in 29 (66%) patients and secondary causes were identifie d 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%) pa tients. Half of those with migraine (n=11), 1 patient with tension-type hea dache, and 1 patient with cluster headache developed chronic daily headache s which were severe and refractory to conventional headache or antiretrovir al therapy. We conclude that primary headaches in patients with HIV infecti on are: (1) the commonest type of headache; (2) may present for the first t ime in individuals with severe immunosuppression; (3) usually bear no relat ionship to antiretroviral drug therapy; (4) polypharmacy, depression, anxie ty, and insomnia are commonly associated comorbidities; (5) frequently do n ot respond to conventional management and carry a poor prognosis; and (6) d o not require neuroradiological and/or cerebrospinal fluid evaluations.