Dr. Silberstein, Director of the Jefferson Headache Center at Thomas Jefferson University, receives honorariums from Allergan, Avanir Pharmaceuticals, Curelator, Depomed, Dr. Reddy's Laboratories, eNeura, INSYS Therapeutics, Lilly USA, Supernus Pharmacerticals, Thernica and Trigemina for consulting. He is also the principal investigator for a clinical trials conducted by Alder Biopharmaceuticals, Amgen, electroCore Medical, Lily USA and Teva.)
In this article, the author investigates the current considerations of HIV, AIDS, and headache. He provides an updated epidemiology and pathophysiology of headache associated with HIV. He also addresses problems the clinician needs to consider in medical management, such as immune restoration inflammatory syndrome (IRIS). Lastly, he includes the latest practical approach in the work-up of HIV patients presenting with headache.
Historical note and terminology
Bredesen and colleagues provided 1 of the first descriptions of headache in individuals infected with the human immunodeficiency type 1 virus: "Our experience suggests that in the last 2 years, an epidemic of aseptic meningitis with prominent cranial nerve abnormalities and a prolonged course, affecting gay men in the third to fifth decades, has appeared" (Bredesen et al 1983).
By 1985, investigators had identified the human retrovirus HIV-1 as the agent causing the acquired immunodeficiency syndrome and had isolated HIV-1 from the blood and cerebrospinal fluid of patients clinically similar to those described by Bredesen (Ho et al 1985). In 1987, Hollander and Stringari characterized the clinical course of 14 individuals with HIV-1 infection and an unexplained lymphocytic cerebrospinal fluid pleocytosis. They termed this syndrome HIV-associated meningitis and stated that both the clinical presentation with predominant headache, rather than encephalopathy, and evidence of cerebrospinal fluid inflammation differentiated this syndrome from other HIV-related neurologic syndromes (Hollander and Stringari 1987).
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