Headache and systemic lupus erythematosus: A narrative review.

OBJECTIVE: To review the epidemiology, the differential diagnosis, and the clinical and laboratory factors associated with the care management of headaches in patients with systemic lupus erythematosus (SLE). BACKGROUND: SLE is a chronic autoimmune disease and in 12%-95% of patients, the nervous system is involved. Headache is a frequently reported, although nonspecific, symptom that may potentially represent serious underlying diagnoses. Primary headaches may also occur in these patients, thereby causing a negative and significant impact on their quality of life. METHODS: This is a narrative review. A literature review was conducted on the PubMed platform using the following terms: (1) headache and (2) lupus. All articles considered relevant were included. No limitations were imposed for the publication date. RESULTS: Headache is a frequent symptom in patients with SLE. Although its prevalence is similar to the general population, headaches nonetheless tend to have a greater negative impact on these patients. Patients with SLE are more likely to experience headache due to vascular diseases such as cerebral venous sinus thrombosis, stroke, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, and vasculitis. Aseptic meningitis, neuroinfections, intracranial neoplasms, and intracranial hypertension or hypotension may also be a cause of headache in these patients. Although used in disease activity scores, the concept of lupus headache is controversial. CONCLUSIONS: Headache is a frequent symptom in patients with SLE. An appropriate approach enables the potentially serious conditions, which are the causes of secondary headaches, to be recognized and treated, together with an appropriate diagnosis and treatment of primary headaches.

Characteristics of residency programs and residents' learning experience in Brazil: a multispecialty, nation-wide study.

Factors associated with the optimal physician resident learning are yet to be fully understood. We aimed to correlate the characteristics of residency programs with the learning perception of residents. This was a cross-sectional study using an online structured questionnaire published on social networks, enrolling physician residents from almost all specialties in Brazil. The collection tool was settled considering the current national standards of medical residency programs in Brazil and it was internally validated. The response rate was 71.4% (n = 1,419). The median age was 28 years (IQR = 27-30), 51.9% were from clinical areas and 69.9% from the first or second postgraduation year. Adequate quality of faculty supervision was reported by 50.9%; frequent supervision of assistance activities in 22.1%; proper structure for carrying out healthcare in 82.1%, formal appraisals in 81.8%, classroom activities more than three times a week in 12.3%. Learning was rated as satisfactory by 70.8%. We found an 'inverted-U' shape correlation between duty hours and learning - briefer and longer workloads were associated with unsatisfactory learning. The factors independently associated with learning satisfaction were quantity (OR = 10.79, 95%CI = 7.38-15.77) and quality (1.68, 1.19-2.37) of preceptorship, structure for healthcare (2.10, 1.44-3.08), formal evaluations (1.83, 1.26-2.67), and briefer workload (0.18, 0.04-0.90) and age (0.94, 0.89-0.99) (AUROC = 0.838, 95%CI = 0.816-0.860). We conclude that the perception of satisfactory learning was influenced by higher frequency and quality of faculty supervision, adequate structure for healthcare, formal assessments, and reduced duty hours and age. Regulatory institutions should reinforce strategies to guarantee the fulfillment of residency standards and faculties should receive continued formal training to maximize their teaching skills.

Cerebral and spinal cord changes observed through magnetic resonance imaging in patients with HTLV-1-associated myelopathy/tropical spastic paraparesis: a systematic review.

To verify brain and spinal changes using magnetic resonance imaging in patients with HTLV-1-associated myelopathy/tropical spastic paraparesis. This was a systematic review. The descriptors used were tropical spastic paraparesis and magnetic resonance image. The keyword HTLV-1-associated myelopathy was also used. Twenty-three articles were included: 16 detected brain changes and 18 detected spinal changes. White matter lesions were the most frequent finding in the brain. Brain injuries were most frequently identified in the periventricular region, in the subcortical region, in the centrum semiovale, in the brain stem, and corpus callosum. Atrophy was the most frequent finding of the spinal cord, affecting the thoracic and cervical regions, and was associated with a longer evolution of myelopathy. White matter lesions in these regions were also observed. Cortical white matter lesions and thoracic spinal cord atrophy were the most frequently reported changes in patients with HTLV-1-associated myelopathy.

Headache associated with COVID-19: Epidemiology, characteristics, pathophysiology, and management.

OBJECTIVE: To review data regarding the epidemiology, pathophysiology, characteristics, and management of COVID-19-associated headache. The persistence of headache after the acute phase of COVID-19 was also reviewed. BACKGROUND: Headache is a frequent symptom of COVID-19, and understanding its management is important for health-care professionals involved in treating the disease. METHOD: This is a narrative review. A literature review was conducted in the PubMed database with the following terms: "headache" and "COVID-19." All articles written in English that were considered relevant were included. RESULTS: Half of the patients who have COVID-19 present with headache, which occurs more frequently in younger patients; in those with previous primary headache or with previous migraine; and in those who have concomitantly presented with anosmia, ageusia, and myalgia. The headache usually begins early in the symptomatic phase, is bilateral, moderate to severe, and has a similar pattern to tension-type headache. All studies found the migraine pattern and the tension-type headache pattern to be frequent patterns. The possible pathophysiological mechanisms include direct viral injury, the inflammatory process, hypoxemia, coagulopathy, and endothelial involvement. Common analgesics and nonsteroidal anti-inflammatory drugs are the most commonly used drugs for headache in the acute phase of COVID-19. The headache may persist beyond the acute phase, and in such cases, there is an improvement over time. However, not all patients' headaches improve. It seems to be a greater proportion of patients whose headache improves in the first 3 months after the acute phase of the disease than after this period. COVID-19 may trigger new daily persistent headache. CONCLUSIONS: Headache is a clinically significant symptom of COVID-19. Although its characteristics in the acute phase of the disease are already well known, there is a need for studies on its management and persistence.

Pregnancy and neurologic complications of COVID-19: A scoping review.

While neurologic complications are frequently reported among patients with COVID-19 in the general population, they are unknown in pregnant women. This paper summarizes the case reports of pregnant women with confirmed SARS-CoV-2 infection plus a specified neurologic diagnosis. Until November 2021, 18 case reports were found. Both the central and peripheral nervous systems were equally affected: delirium (n = 1), posterior reversible encephalopathy syndrome (n = 4), cerebrovascular disease (n = 2), acute cerebral demyelinating disease (n = 1), acute necrotizing encephalopathy (n = 1), Guillain-Barré syndrome (n = 5), including one patient who also had vestibular neuritis, Bell's palsy (n = 3), and rhabdomyolysis (n = 1). The median maternal age was 32.5 (25-35) years, the median gestational age was 34 (30-36.5) weeks, and 38.9% presented previous medical conditions. Respiratory symptoms were reported in 76.5%, and 76.5% received immunotherapies to treat the COVID-19 or the neurologic complications. Half the women required admission to ICU and, more often, were those with central nervous system involvement (77.8% vs. 22.2%; Chi-square test, p = .018). For 64.7% of women, the most common method of delivery was surgical, although just one case was due to the neurologic complication. There were reports of one spontaneous abortion, two fetal deaths, and no maternal deaths. Only one case presented a poor neurologic outcome. It is possible that our findings are underestimated, considering that there are thousands of reports regarding neurologic complications in the general population with COVID-19.

Internet addiction, headache, and insomnia in university students: a cross-sectional study.

OBJECTIVE: There is controversy about whether there is an association between headache and internet addiction. Therefore, the objective was to assess whether there is an association between the headache, insomnia, and internet addiction. METHODS: This was a cross-sectional study with 420 university students. We used a semi-structured questionnaire, Headache Impact Test, Hospital Anxiety Depression Scale, Insomnia Severity Index, and Internet Addiction Test. RESULTS: 51.4% were men, the median age was 21 (19, 23), 399 (95.0%) suffered from headaches in the last year, 265 (63.1%) had migraine, 182 (43.3%) had migraine with aura, 119 (28.3%) had episodic tension-type headache, 84 (20%) had internet addiction, and 95 (22.6%) had insomnia. Internet addiction was associated with anxiety (OR = 2.3; 95% CI: 1.3, 4.0; p = 0.003), insomnia (OR = 3.0; 95% CI: 2.0, 4.6; p < 0.001), and migraine with aura (OR = 1.8; 95% CI: 1.1, 2.9; p = 0.066) (logistic regression). The severity of internet dependence is associated with the impact of headache (p = 0.047) and with the severity of insomnia (p < 0.001) (multiple linear regression). CONCLUSIONS: Internet addiction was associated with anxiety, migraine with aura, and insomnia. The severity of internet addiction is associated with the severity of the headache and with the severity of insomnia.

Premonitory and Accompanying Symptoms in Childhood Migraine.

PURPOSE OF REVIEW: To review the literature on the clinical characteristics of the symptoms other than headache that occurs during a migraine attack in childhood and adolescence. RECENT FINDINGS: Premonitory symptoms (42-67%) and postdrome phase (82%) are frequent. The most frequent auras were visual. There was no association between age or sex and the occurrence of auras. Cranial autonomic symptoms are also frequent (40-70%) and are most often bilateral. Most studies suggest that age is not associated with the frequency of nausea, vomiting, photophobia, and phonophobia. Cephalic cutaneous allodynia (15-37%) and osmophobia (20-53%) are common symptoms in children with migraine. Osmophobia has low sensitivity and high specificity for the diagnosis of migraine and is associated with the severity of the migraine. Migraine is a complex disease, and although headache is its best-known symptom, other symptoms also occur frequently during migraine attacks in children and adolescents.

Headache, anosmia, ageusia and other neurological symptoms in COVID-19: a cross-sectional study.

BACKGROUND: Neurological symptoms are frequent among patients with COVID-19. Little is known regarding the repercussions of neurological symptoms for patients and how these symptoms are related to one another. OBJECTIVES: To determine whether there is an association between the neurological symptoms in patients with COVID-19, and to characterize the headache. METHOD: This was a cross-sectional study. All hospital inpatients and health workers at the Hospital Universitario Oswaldo Cruz with a PCR-confirmed COVID-19 infection between March and June 2020 were considered for the study and were interviewed by telephone at least 2-months after the acute phase of the disease. These patients were identified by the hospital epidemiological surveillance department. A semi-structured questionnaire was used containing sociodemographic and clinical data and the ID-Migraine. RESULTS: A total of 288 patients was interviewed; 53.1% were male; with a median age of 49.9 (41.5-60.5) years; 91.7% presented some neurological symptom; 22.2% reported some neurological symptom as the symptom that troubled them most during COVID-19. Neurological symptoms were: ageusia (69.8%), headache (69.1%), anosmia (67%), myalgia (44.4%), drowsiness (37.2%), agitation (20.8%); mental confusion (14.9%), syncope (4.9%) and epileptic seizures (2.8%). Females, those who presented with fever, sore throat, anosmia/ageusia and myalgia also presented significantly more with headache (logistic regression). The most frequent headache phenotype was a non-migraine phenotype, was of severe intensity and differed from previous headaches. This persisted for more than 30 days in 18% and for more than 90 days in 10% of patients. Thirteen percent of those with anosmia and 11% with ageusia continued with these complaints after more than 90 days of the acute phase of the disease. Aged over 50 years, agitation and epileptic seizures were significantly associated with mental confusion (logistic regression). CONCLUSION: Headache is frequent in COVID-19, is associated with other symptoms such as fever, sore throat, anosmia, ageusia, and myalgia, and may persist beyond the acute phase of the disease.

Acute disseminated encephalomyelitis in a COVID-19 pediatric patient.

The authors present a case of acute disseminated encephalomyelitis in a COVID-19 pediatric patient with positive SARS-CoV2 markers from a nasopharyngeal swab. A previously healthy 12-year-old-girl presented with a skin rash, headache, and fever. Five days after that, she had an acute, progressive, bilateral, and symmetrical motor weakness. She evolved to respiratory failure. Magnetic resonance imaging (MRI) of the brain and cervical spine showed extensive bilateral and symmetric restricted diffusion involving the subcortical and deep white matter, a focal hyperintense T2/FLAIR lesion in the splenium of the corpus callosum with restricted diffusion, and extensive cervical myelopathy involving both white and gray matter. Follow-up examinations of the brain and spine were performed 30 days after the first MRI examination. The images of the brain demonstrated mild dilatation of the lateral ventricles and widespread widening of the cerebral sulci, complete resolution of the extensive white matter restricted diffusion, and complete resolution of the restricted diffusion in the lesion of the splenium of the corpus callosum, leaving behind a small gliotic focus. The follow-up examination of the spine demonstrated nearly complete resolution of the extensive signal changes in the spinal cord, leaving behind scattered signal changes in keeping with gliosis. She evolved with partial clinical and neurological improvement and was subsequently discharged.

Parkinson's Disease and Headaches: A Cross-Sectional Study.

OBJECTIVES: This study evaluated headaches among Parkinson's disease (PD) patients and whether there was any correlation between the motor symptoms and the severity of the headaches presented. BACKGROUND: Forty to 83% of PD patients are affected by pain. Despite this high prevalence of pain, only a few studies have addressed the headaches of these patients. METHODS: This was a cross-sectional study. Consecutive patients with Parkinson disease were included. Semi-structured interview; the Epworth sleepiness scale; the Hospital Anxiety and Depression Scale; the Unified Parkinson's Disease Rating Scale (UPDRS), Part III (motor examination); and the Hoehn and Yahr scale were used. RESULTS: About 46 patients were included, 52% were men, mean age was 66 ± 11 years. Forty-three patients had headaches, 12/46 (26%), migraines, 31/46 (67%) had tension-type headaches. We found no association between the headache frequency (median: 0.5; 0.5 to 7.5 vs 0.5; 0.5 to 8 days/3 months; P = .757) or intensity (median: 5; 4 to 8 vs 5.5, 4 to 9; P = .514) and the different stages of the PD (Hoehn and Yahr scale: ≤2.5 vs >2.5). There was no correlation between UPDRS score and the intensity (r = -0.099; P = .530) or frequency of headaches (r = -0.136; P = .373). No association was found between the grade of neck stiffness (0 vs 1 and 2 vs 3 and 4) and the headache frequency (Median: 0; 0 to 3 vs 3.5; 0 to 12.5 vs 0; 0 to 6 days/3 months; P = .074) or intensity (Median: 5; 3 to 9 vs 5; 4 to 6 vs 7; 4.5 to 9; P = .434). Twelve patients said that their headaches started after PD had been diagnosed. There was no difference regarding the frequency and characteristics of headaches and PD characteristics between these patients and the other patients with previous headaches. CONCLUSIONS: In this sample of PD patients, there is no association between headache and PD.

Osmophobia and Odor-Triggered Headaches in Children and Adolescents: Prevalence, Associated Factors, and Importance in the Diagnosis of Migraine.

OBJECTIVE: The objectives of this study are to study osmophobia and odor-triggered headaches among headache pediatric patients. BACKGROUND: Achieving the correct diagnosis for headaches in younger children can be challenging. The presence of osmophobia could constitute a helpful piece of information for making the correct diagnosis of headaches among adults. METHODS: This was a cross-sectional study. Children and adolescents with headaches who were seen consecutively at a pediatric outpatient service and had at least 1 headache attack over the previous 12 months were included. We used a semi-structured questionnaire, Pediatric Migraine Disability Assessment, State-Trait Anxiety Inventory, and Children's Depression Inventory. RESULTS: About 300 patients were included; 253 had migraine, 47 had a tension-type headache; 137 had osmophobia during headaches (135 were migraineurs). "Osmophobia during headaches" for diagnosing migraine: Sensitivity: 54.4% (95% CI: 48.2%-60.5%); specificity: 95.8% (95% CI: 85.8%-98.8%); positive predictive value (PPV): 98.5% (95% CI: 94.8%-99.6%); negative predictive value (NPV): 28.5% (95% CI: 22.0%-36.0%). Osmophobia was associated with higher intensity (OR: 2.90; 95% CI: 1.63, 5.15; P < .001) and duration of the headache (OR: 5.73; 95% CI: 2.29, 14.3; P < .001) and with vomiting (OR: 3.56; 95% CI: 1.83, 6.96; P < .001) (logistic regression). There were 62 patients (all of them migraineurs) with odor-triggered headaches: sensitivity for diagnosing migraine: 24.9% (95% CI: 19.9%-30.6%); specificity: 100% (95% CI: 92.4%-100%), PPV: 100% (95% CI: 94.8%-100%), NPV: 20% (95% CI: 16%-26.0%). Odor-triggered headaches were associated with higher intensity (OR: 3.47; 95% CI: 1.64, 7.35; P = .001) and duration of the headache (OR: 3.28; 95% CI: 1.37, 7.86; P = .001), vomiting (OR: 2.37; 95% CI: 1.19, 4.74; P = .014), and phonophobia (OR: 2.40; 95% CI: 1.08, 5.32; P = .031) (logistic regression). Osmophobia was associated with higher-impact migraine (OR: 4.65; 95% CI: 1.30, 16.6; P = .018) and emergency care (OR: 4.65; 95% CI: 1.81, 12.0; P = .001) (logistic regression). CONCLUSIONS: Osmophobia and odors as triggers for headaches are useful in diagnosing migraine and are markers for the severity of migraine in the pediatric population.

Headache in Medical Residents: A Cross-Sectional Web-Based Survey.

BACKGROUND: Although a common complaint and related to factors frequently present in medical residency such as psychological distress, depression, and anxiety, headache is an issue poorly explored among medical residents. METHODS: This was a cross-sectional study enrolling medical residents from all geographic regions of Brazil. We applied an online structured survey with demographic and residency program-related questions, as well as validated tools to assess burnout, diurnal somnolence, anxiety, depression, and migraine. RESULTS: The link to the survey received 1989 clicks, of which 1421 individuals completed the questionnaire (71.4% of all clicks). The prevalence of at least 1 headache attack in the last 3 months was 1236/1419 (87.1%); migraine occurred in 400/1419 (28.2%). Frequent headache attacks (headaches occurring daily or often) were associated with female sex (OR = 1.80 [95%CI = 1.36-2.37]), substantial weight gain (1.93 [1.38-2.70]), migraine (5.49 [4.16-7.24]), anxiety (1.45 [1.06-1.98]), depression (1.98 [1.47-2.67]), emotional exhaustion domain of burnout (1.49 [1.09-2.04]), and diurnal somnolence symptoms (1.32 [1.00-1.76]). Headaches with functional impact were associated with female sex (1.39 [1.10-1.74]), clinical training areas (1.32 [1.06-1.65]), anxiety (1.74 [1.38-2.21]), an unsatisfactory work-life balance (1.57 [1.17-2.09]), the emotional exhaustion component of burnout (1.49 [1.14-1.94]), and an unsatisfactory subjective learning curve (1.30 [1.02-1.67]). Migraine was associated with female sex (3.10 [2.34-4.13]), anxiety (2.53 [1.94-3.31]), more than 60 hours duty-hours in residency (1.66 [1.29-2.15]), psychological abuse from patients (1.42 [1.06-1.90]) and a clinical training area (1.34 [1.04-1.73]). CONCLUSION: Headaches among medical residents are frequent and are related not only to depression, anxiety, burnout, and diurnal somnolence, but also to aspects closely related to residency training such as the occurrence of mistreatment, longer duty-hours, a poor work-life balance, and an unsatisfactory learning curve.

Headaches Attributed to Ischemic Stroke and Transient Ischemic Attack.

INTRODUCTION: Although headaches attributed to ischemic strokes and transient ischemic attack occur frequently, they are often overlooked and underdiagnosed as manifestations of cerebrovascular disease. METHOD: This is a narrative review. RESULTS: The prevalence of headache attributed to ischemic stroke varies between 7.4% and 34% of cases and of headache attributed to transient ischemic attack, from 26% to 36%. Headache attributed to ischemic stroke is more frequent in younger patients, in migraineurs, in those who have suffered a larger stroke, a posterior circulation infarction, or a cortical infarction, and is less frequent in lacunar infarctions. The most common pattern of headache attributed to ischemic stroke is a mild to moderate bilateral pain, not associated with nausea, vomiting, photophobia, or phonophobia. This headache usually has a concomitant onset with focal neurologic deficit and improves over time. The few studies that have assessed the value of headache for a prognosis of ischemic strokes have demonstrated conflicting results. There are no clinical trials on pain management or prophylactic treatment of persistent headache attributed to ischemic stroke. CONCLUSION: Headache attributed to ischemic stroke is frequent and usually has a tension-type headache pattern. Its frequency varies according to the stroke's etiology. Further studies are required on pain management, prophylactic treatment, and characteristics of this headache.

Migraine and Markers of Carotid Atherosclerosis in Middle-Aged Women: A Cross-Sectional Study.

OBJECTIVE: This study evaluated the association between migraine and the markers of carotid artery disease. BACKGROUND: Migraine increases the risk of cardiovascular events, but its relationship with vascular dysfunction is unclear. METHODS: In this cross-sectional study, middle-aged women with no known cardiovascular diseases underwent clinical, neurological, and laboratory evaluations; pulse wave velocity (PWV) assessment; and carotid artery ultrasonography. We divided the participants based on the presence of migraine and, further, based on the type of migraine. Associations between migraine and carotid thickening (intima-media thickness >0.9 mm), carotid plaques, or arterial stiffening (PWV >10 m/s) were evaluated using a multiple regression analysis. RESULTS: The study comprised 112/277 (40%) women with migraine, of whom 46/277 (17%) reported having an aura. Compared to the non-migraineurs, the migraine with aura group had an increased risk of diffuse carotid thickening (3/46 [6.8%] vs 2/165 [1.3%], adjusted OR = 7.12, 95% CI 1.05-48.49). Migraine without aura was associated with a low risk of carotid plaques (3/66 [4.7%] vs 26/165 [16.7%], adjusted OR = 0.28, 95% CI 0.08-0.99) and arterial stiffening (21/66 [34.4%] vs 82/165 [51.2%], adjusted OR = 0.39, 95% CI 0.19-0.79). There were no correlations between migraine characteristics and arterial stiffness or carotid thickness measurements. CONCLUSION: Migraine with aura is associated with an increased risk of carotid thickening, and migraine without aura is associated with a low risk of carotid plaques and arterial stiffening.

Migraine and cerebrovascular diseases: Epidemiology, pathophysiological, and clinical considerations.

Migraine and cerebrovascular diseases are disabling disorders, which are possibly closely interrelated. Heterogeneous and scattered evidence in literature remains a challenge. We searched for systematic reviews including diverse cerebrovascular events in migraineurs and reported relevant original studies to update the evidence when necessary. The studies show that migraine is associated with increased risk of transient ischemic attacks, any stroke, and possibly hemorrhagic stroke. In addition, migraine with aura increases the risk of ischemic stroke and white matter abnormalities. Migraine without aura increases the risk of cervical artery dissection as a cause of ischemic stroke. Groups with specific risk profiles are women, young people, smokers, and oral contraceptive users. The pathophysiology of the association remains uncertain. However, genetic and environmental factors may be involved in intricate mechanisms responsible for oxidative stress, vascular dysfunction and, ultimately, vascular events. In conclusion, migraine is a potential risk factor for cerebrovascular diseases. Migraineurs should be carefully evaluated considering their vascular risk assessment based on current evidence, so that healthcare professionals can provide appropriate and individualized management of other cardiovascular risk factors, notably quitting smoking and restricting use of oral contraceptives.

Dialysis Headache: A Narrative Review.

BACKGROUND: Patients with chronic kidney disease who need dialysis often have poor quality of life. Dialysis headache is a frequent complication of hemodialysis and is often a challenge for nephrologists, neurologists, and headache specialists. METHOD: This was a narrative review. RESULTS: The prevalence of dialysis headache varies between 27% and 73%. Among the characteristics of this headache are the pulsatile pattern, frontal location, moderate to severe intensity, and onset a few hours after the beginning of dialysis. The headache may be accompanied by nausea and vomiting. The physiopathology of hemodialysis headache is still not completely understood. Some factors that seem to be associated with it are variations in urea, sodium, magnesium, blood pressure, and weight levels. The hematoencephalic barrier has an important role. Variations in electrolyte and urea levels occur in the systemic circulation during hemodialysis, but the cerebral concentrations of these substances are stable over the first few hours of the procedure. The flow of free water through the hematoencephalic barrier may lead to cerebral edema. Other potential pathophysiological factors include nitric oxide, calcitonin gene-related peptide, and substance P. There are recommendations for maintenance of volume and control over electrolytes and blood pressure and avoidance of caffeine for prevention of hemodialysis headache. However, there are no controlled studies of prophylactic or abortive hemodialysis headache treatment. CONCLUSION: Despite its prevalence, hemodialysis headache has been poorly studied, thus making it difficult to understand the pathophysiological mechanisms involved in its genesis. Current clinical management practices are therefore necessarily empiric with minimal to no evidence base.

HIV and Headache: A Cross-Sectional Study.

INTRODUCTION: The head and neck are the second most common locations for pain among HIV-positive individuals. Most studies were conducted among HIV patients at an advanced stage of the disease. METHODS: This was a cross-sectional study. Patients with HIV and CD4+ T lymphocyte counts >500 were included. Semi-structured interview, the Headache Impact Test (HIT-6), and the Hospital Anxiety and Depression Scale were used. RESULTS: Of the 119 cases included, 63% were men. The mean age was 35.5 ± 10.4 years. Among the patients, 103 (87%) had headaches, 53 (45%) had migraines, 50 (42%) had tension-type headaches, and 53 (45%) had substantial and severe impact of headaches. Eleven patients had headaches that started after they had been diagnosed with HIV. These patients had more migraines (72% vs 43%; P < 0.05), greater intensity (8 ± 2 vs 6 ± 2; P < 0.01), and impact (HIT-6: 60 ± 11 vs 51 ± 12; P = 0.02) of headaches compared to others HIV patients. There were no correlations between CD4 counts and the intensity, frequency, or impact of headaches. CONCLUSIONS: HIV-positive patients had a high frequency of headaches, which had a great impact on patients' lives. The pattern most often found was migraine. There was no correlation between CD4 counts and the severity of headaches.