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Human immunodeficiency virus-related headache

Centre for Immunology and Department of Neurology (Dr. Brew and J. Miller), St. Vincent's Hospital, Sydney, Australia, and the National Centre in HIV Epidemiology and Clinical Research (Dr. Brew), Darlinghurst, Sydney, Australia.

We retrospectively assessed the frequency and clinical characteristics of headache occurring in human immunodeficiency virus (HIV)-infected patients in whom we had excluded all other causes, and determined the frequency of a similar headache in an HIV-negative group. Over a 1-year period, the HIV-related headache occurred in 2.8% of total admissions to the HIV service as opposed to 0.2% of admissions to the neurology service. The affected patients had advanced HIV infection (CD4+ cell count = 58.9 ± 80.3; normal, >500 X 10^–6/1). The headache had features similar to those ascribed to HIV aseptic meningitis and was not related to the presence of AIDS dementia complex or its subsequent development over a 6-month follow-up. We propose that this is a distinct clinical entity related to HIV infection that is similar, if not identical, to HIV aseptic meningitis except for the lack of a CSF pleocytosis, probably reflecting the lymphocyte depletion that is characteristic of the more advanced state of HIV infection.

Address correspondence and reprint requests to Dr. Bruce J. Brew, National Centre in HIV Epidemiology and Clinical Research, 376 Victoria Street, Darlinghurst, Sydney, Australia 2010.

Received August 5, 1992. Accepted for publication in final form October 14, 1992.