The impact of HIV infection on primary headache. Unexpected findings from retrospective, cross-sectional, and prospective analyses

Headache is one of the most important factors influencing the quality of li fe in patients infected with the human immunodeficiency virus type 1 (HIV). However, only symptomatic headache but not changes or primary headache typ es during HIV infection have been studied to date. Therefore, we aimed to d etermine the impact of an HIV infection on frequency and semiology of diffe rent primary headache types. Patients with confirmed HIV type 1 infection u nderwent a neurological examination, neuroimaging or EEG, and a standardize d interview. Time pattern and symptoms of headaches (cross-sectional analys is), changes of headaches preexisting to their infection (longitudinal retr ospective analysis), and changes of primary headaches during a 2-year follo w-up (longitudinal prospective analysis) were evaluated as were the correla tions between these headache patterns and different markers of HIV infectio n. One hundred thirty-one consecutive HIV-infected patients without evidenc e of a cerebral manifestation except mild encephalopathy were enrolled. The point prevalence of migraine was 16.0% (confidence interval (CI) 10.1-25.4 %), of headache with a semiology of tension-type headache 45.8% (CI 33.7-62 .2%), and of other headache types 6.1% (CI 3.0-12.5%). During the natural c ourse of infection, the migraine frequency significantly decreased in the r etrospective and in the prospective analyses, whereas the frequency of the headache with a semiology of tension-type headache significantly increased in all three analyses. In 20% of all patients, the tension-type headache co uld be considered as symptomatic due to the infection but not due to focal or general cerebral lesions. Changes of primary headache were significantly associated with different stages of the infection and with the presence of mild encephalopathy but not with antiretroviral treatment or CD4 cell coun t. HIV infection seems to be associated with a progressive decrease in migr aine frequency and intensity which probably is related to the immunological state of the patients. Tension-type headache becomes more frequent during HIV infection. However, this can in part be related to secondary headache c aused by the HIV in less than 50% of patients with tension-type headache. T he progressing immunological deficiency of HIV-infected patients seems to i nfluence pain processing of primary headache types in different ways. (C) 2 000 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.