Headaches are a very common complaint among people with HIV, with over half of patients reporting them at some point during the course of the disease. Understanding its symptoms is crucial for early diagnosis and effective management. While HIV can directly cause headaches, persistent or “everyday” symptoms are typically due to secondary factors, such as the body’s reaction to the virus, other infections, or medication side effects. Any new, severe, or persistent headache pattern requires immediate medical evaluation to determine the underlying cause.
Headaches During Acute HIV Infection
Headaches are frequently reported during the seroconversion period, the acute phase of HIV infection that typically occurs within two to four weeks after exposure. This period is characterized by a high viral load as the body mounts its initial immune response to the virus. Many of the symptoms during this phase, including headaches, resemble a severe case of influenza or mononucleosis.
The headache can range from general discomfort to a more distinct pattern associated with acute aseptic meningitis. The body’s inflammatory reaction can cause meningeal irritation, leading to symptoms like a stiff neck, sensitivity to light (photophobia), and pain behind the eyes. These acute symptoms are usually self-limiting, resolving within one to two weeks as the body transitions into the chronic, often asymptomatic, phase of infection.
Headaches in the Chronic and Advanced Stages
In people with established HIV infection, headaches occurring in the chronic or advanced stages are typically caused by secondary conditions. For patients with well-controlled HIV and a healthy immune system (high CD4 count), most headaches are primary headache disorders, such as chronic migraine or tension-type headaches, which are common in the general population. People with HIV may experience these primary headache types at a higher rate.
A persistent or new-onset headache in the setting of advanced infection, characterized by a low CD4 count (typically below 200 cells/µL), suggests a serious complication, such as a Central Nervous System (CNS) opportunistic infection. These infections take advantage of the compromised immune system and can cause severe, recurring headaches.
CNS Opportunistic Infections
Cryptococcal Meningitis is a fungal infection that leads to inflammation and increased pressure within the skull. It often presents as a constant headache with gradual onset, fever, and nausea.
Cerebral toxoplasmosis is a parasitic infection that can create space-occupying lesions or abscesses in the brain. Headaches caused by these lesions may be accompanied by focal neurological deficits or confusion.
Progressive Multifocal Leukoencephalopathy (PML), caused by the JC polyomavirus, is another infection that can affect the brain and present with headache. The severity of the underlying HIV disease, indicated by a low CD4 cell count, is associated with the severity and frequency of headache.
Headaches Related to Antiretroviral Therapy
Antiretroviral Therapy (ART) is the standard treatment for HIV, and while it dramatically improves health outcomes, it can introduce headaches as a side effect. Headaches are a common symptom reported when people first start an ART regimen or when their medication is changed. In most cases, these headaches are transient, resolving within the first few weeks as the body adjusts to the new drugs. If the symptom persists, a medication change may be necessary.
A headache may also signal the onset of Immune Reconstitution Inflammatory Syndrome (IRIS). IRIS occurs after ART initiation when the recovering immune system overreacts to a pre-existing underlying infection. Headaches in this context are due to the resulting inflammation and can be a sign of CNS IRIS.
Non-HIV Related Causes
People living with HIV may experience headaches due to other non-HIV-specific factors, such as stress, anxiety, or depression, which are prevalent conditions in this population. Common issues like dehydration, often exacerbated by gastrointestinal side effects like diarrhea, can also be a cause of headache. Substance use and certain medication interactions can also trigger or worsen headache patterns, making a thorough evaluation necessary.
When to Seek Medical Attention for Headaches
Anyone experiencing headaches should be aware of “red flag” symptoms that suggest a potentially life-threatening condition, particularly in the context of HIV infection. Any headache described as the “worst headache of your life” and having a sudden, thunderclap onset requires immediate emergency medical attention. This type of acute onset can indicate a stroke or bleeding around the brain.
Other concerning signs include a new headache accompanied by:
- Persistent fever or a stiff neck.
- Changes in mental status, such as confusion, excessive drowsiness, or personality changes.
- Focal neurological deficits, like weakness or numbness on one side of the body.
- Difficulty speaking or vision changes.
These symptoms are particularly significant in people with lower CD4 counts, as they may signal a severe CNS opportunistic infection that requires prompt diagnosis and treatment. Any headache that is new, worsening, or fails to improve with typical over-the-counter pain relievers should be discussed with an HIV specialist or primary care provider. A persistent, daily headache pattern requires investigation to rule out serious underlying causes or to adjust an antiretroviral regimen.