The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 4: PainHeadacheHeadache is extremely common in the HIV/AIDS patient and can pose a diagnostic dilemma forproviders26in thatpicasthe underlying cause may range from benign stress and tension to life-threateningcentral nervous system infection. 10 The differential diagnosis of headache in patients with HIVdisease includes: 26• HIV encephalitis and atypical aseptic meningitis• Opportunistic infections of the nervous system• AIDS-related central nervous system neoplasms• Sinusitis• Tension• Migraine• Headache induced by medication (particularly AZT)Toxoplasmosis and cryptococcal meningitis are the two most commonly encountered opportunisticinfections of the central nervous system that cause headaches in patients with HIV disease. Otheropportunistic infections of the central nervous system that can present as headache in the AIDSpatient include:• CMV• Herpes simplex virus and herpes zoster• Progressive multifocal leukoencephalopathy (papovavirus)• Candida albicans• Mycobacterium tuberculosis• Mycobacterium avium intracellulare (MAI)• NeurosyphilisOne of the most common causes of headache without focal findings is sinusitis. Opportunisticcancers of the central nervous system include central nervous system lymphoma, metastaticsystemic lymphoma, and metastatic intracranial KS. These can present, particularly in theimmunocompromised patient with HIV disease, with signs of increased intracranial pressure withor without focal neurological signs, as well as fever and meningismus.More benign causes of headache in the patient with HIV disease include AZT-induced headache;tension headache; migraine with or without aura; and unclassifiable or idiopathic headache. Eversand colleagues in 1999 concluded that the progressing immunological deficiency of HIV-infectedpatients seems to influence the pain processing of headache in different ways. 27 During that naturalcourse of infection, the migraine frequency significantly decreased, while the frequency of tensiontype headaches increased. 27IVNeuropathiesNeuropathic pain occurs in about 40% of AIDS patients. 6 While several types of peripheral neuropathyhave been described in patients with HIV/AIDS (see Table 4-4), the most common painful neuropathyencountered is the predominantly sensory neuropathy (PSN) of AIDS. Other potentiallypainful neuropathies in HIV/AIDS patients, however, can be caused by the following:U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 91