Differential diagnosis and therapy of headache in HIV infection

HEADACHE AND HIV INFECTION: Headache is one of the most common pain syndromes in HIV infection. The prevalence of headache in HIV infected patients in the published cross-sectional and longitudinal studies is between 3.8% and 47.4% depending on the study methodology and the study subpopulation. In this review, we analyse these cross-sectional and longitudinal studies and the case reports of headache in HIV infection. Both primary headache, such as migraine or tension-type headache, and secondary headache, e. g. caused by opportunistic infections or neoplasms, can be observed. In addition, there is a so-called "HIV headache" which develops de novo during the HIV infection, the cause of this headache type is still unclear. Migraine shows an amelioration during the course of the HIV infection whereas tension-type headache shows a deteriotation. In some patients, however, tension-type headache cannot be differentiated from HIV-headache. THERAPY: The therapeutic management of headache during the HIV infection is the same as in non-infected subjects. However, tricyclic antidepressants and steroids as headache prophylactic agents are often more effective than in non-infected subjects and should be prescribed more generously. Some pharmacological interactions have to be considered, e. g. NSAID might increase the toxicity of antiretroviral substances.