Evers S, Wibbeke B, Reichelt D, Suhr B, Brilla R, Husstedt I
Department of Neurology, University of Münster, Albert-Schweitzer-Strasse 33, D-48129, Münster, Germany.
Pain. 2000 Mar;85(1-2):191-200. doi: 10.1016/s0304-3959(99)00266-3.
Headache is one of the most important factors influencing the quality of life in patients infected with the human immunodeficiency virus type 1 (HIV). However, only symptomatic headache but not changes or primary headache types during HIV infection have been studied to date. Therefore, we aimed to determine the impact of an HIV infection on frequency and semiology of different primary headache types. Patients with confirmed HIV type 1 infection underwent a neurological examination, neuroimaging or EEG, and a standardized interview. Time pattern and symptoms of headaches (cross-sectional analysis), changes of headaches preexisting to their infection (longitudinal retrospective analysis), and changes of primary headaches during a 2-year follow-up (longitudinal prospective analysis) were evaluated as were the correlations between these headache patterns and different markers of HIV infection. One hundred thirty-one consecutive HIV-infected patients without evidence of a cerebral manifestation except mild encephalopathy were enrolled. The point prevalence of migraine was 16.0% (confidence interval (CI) 10.1-25.4%), of headache with a semiology of tension-type headache 45.8% (CI 33.7-62.2%), and of other headache types 6.1% (CI 3.0-12.5%). During the natural course of infection, the migraine frequency significantly decreased in the retrospective and in the prospective analyses, whereas the frequency of the headache with a semiology of tension-type headache significantly increased in all three analyses. In 20% of all patients, the tension-type headache could be considered as symptomatic due to the infection but not due to focal or general cerebral lesions. Changes of primary headache were significantly associated with different stages of the infection and with the presence of mild encephalopathy but not with antiretroviral treatment or CD4 cell count. HIV infection seems to be associated with a progressive decrease in migraine frequency and intensity which probably is related to the immunological state of the patients. Tension-type headache becomes more frequent during HIV infection. However, this can in part be related to secondary headache caused by the HIV in less than 50% of patients with tension-type headache. The progressing immunological deficiency of HIV-infected patients seems to influence pain processing of primary headache types in different ways.
头痛是影响1型人类免疫缺陷病毒（HIV）感染者生活质量的最重要因素之一。然而，迄今为止，仅对有症状的头痛进行了研究，而未对HIV感染期间的头痛变化或原发性头痛类型进行研究。因此，我们旨在确定HIV感染对不同原发性头痛类型的发作频率和症状学的影响。确诊为1型HIV感染的患者接受了神经系统检查、神经影像学检查或脑电图检查以及标准化访谈。评估了头痛的时间模式和症状（横断面分析）、感染前就已存在的头痛变化（纵向回顾性分析）以及2年随访期间原发性头痛的变化（纵向前瞻性分析），以及这些头痛模式与HIV感染的不同标志物之间的相关性。连续纳入了131例无除轻度脑病外脑部表现证据的HIV感染患者。偏头痛的点患病率为16.0%（置信区间（CI）10.1 - 25.4%），具有紧张型头痛症状学的头痛患病率为45.8%（CI 33.7 - 62.2%），其他头痛类型的患病率为6.1%（CI 3.0 - 12.5%）。在感染的自然病程中，回顾性分析和前瞻性分析中偏头痛频率均显著降低，而具有紧张型头痛症状学的头痛频率在所有三项分析中均显著增加。在所有患者中，20%的紧张型头痛可被认为是由感染引起的症状性头痛，而非由局灶性或全身性脑部病变所致。原发性头痛的变化与感染的不同阶段以及轻度脑病的存在显著相关，但与抗逆转录病毒治疗或CD4细胞计数无关。HIV感染似乎与偏头痛频率和强度逐渐降低有关，这可能与患者的免疫状态有关。在HIV感染期间，紧张型头痛变得更加频繁。然而，在不到50%的紧张型头痛患者中，这部分可能与HIV引起的继发性头痛有关。HIV感染患者不断进展的免疫缺陷似乎以不同方式影响原发性头痛类型的疼痛处理。
