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Headaches and HIV: 7 Causes To Consider

Medically reviewed by Barry S. Zingman, M.D.
Posted on August 28, 2023

No one enjoys a headache. Unfortunately, 52 percent of people worldwide experience headaches, and individuals with HIV are no exception.

Wondering why? Following are seven potential reasons you may have frequent headaches, along with some tips on how to cope with this annoying and painful symptom. While some of these reasons may sound scary, research shows the majority — 95 percent — of headaches experienced by people with HIV are not dangerous or life-threatening.

1. Tension Headaches

If your headache feels like a dull, aching pain; a buildup of pressure in your head; or tenderness in your head, neck, or shoulders, you may have a tension headache. About 40 percent of people worldwide experience tension headaches.

If you experience frequent tension headaches, your doctor may diagnose you with either episodic or chronic tension headaches. Tension headaches are considered episodic if you experience them less than 15 days out of the month. If you have a headache more often than that, you may have chronic tension headaches.

While there aren’t many large studies investigating tension headaches in people with HIV, a small study found that about 14 percent of people with HIV have experienced episodic or chronic tension headaches.

2. Migraine

Migraine attacks are extremely painful headaches that cause pulsing or throbbing pain, often only on one side of your head. The pain may make you more sensitive to bright light and loud sounds, and it might be bad enough to make you feel nauseous. If your head hurts so badly that it interferes with your ability to function, you may be experiencing a migraine. Researchers are still working to understand the exact causes of migraine headaches, and it’s believed that inflammation in your brain’s blood vessels may play a role.

Migraine headaches are less common in the general population than tension headaches, with only about 10 percent of people worldwide reporting experiencing migraines. However, one small study found that 45 percent of participants with HIV reported migraine headaches. The inflammation caused by HIV may be similar to that caused by migraine, so these types of headaches may be more common in people with HIV.

“Woke up today with a bad migraine,” one myHIVteam member wrote. Another said, “Got a migraine and went for a checkup. Now I’m relaxing while I wait for my head to cool down.”

3. Sinusitis and Upper Respiratory Infections

The congestion in your head caused by an upper respiratory infection like sinusitis (an infection in your sinuses) can cause headaches, along with fever, sore throat, runny nose, or a cough. HIV may weaken your immune system, making you more likely to catch one of these infections, so be sure to talk to your doctor if your headache comes with other symptoms.

“I have bronchitis and sinusitis today,” one myHIVteam member wrote. Another said, “My doctor gave me some antibiotics for sinusitis.” Headaches caused by upper respiratory infections will go away when your body gets over the infection.

4. Side Effects of Medications

Some HIV medications used in antiretroviral therapy — such as tenofovir, zidovudine (as found in Combivir), and efavirenz (as found in Atripla) — can cause headaches as a side effect. If you start taking a new HIV medicine and notice that you've started getting headaches, talk to your health care provider.

They can figure out if the medication is causing the problem. You may need to make changes to your treatment plan to avoid headaches. Do not stop taking a medication unless your doctor tells you to. Even with side effects, the medication is helping treat HIV.

5. Dehydration

Dehydration, or not having enough water in your body, can be a sneaky cause of headaches. To avoid dehydration headaches, focus on staying hydrated throughout the day. Carry a water bottle with you. Watch out for signs of dehydration, such as dark-colored urine, dizziness, or dry mouth.

Diarrhea is one of the common symptoms of HIV, and people with chronic diarrhea may be more susceptible to dehydration. Remember to continue sipping water under your doctor’s care, even if you are experiencing nausea or diarrhea, to prevent dehydration.

6. Opportunistic Infections

Advanced HIV, especially if HIV has progressed to AIDS, can make you more vulnerable to certain infections. Called opportunistic infections, they usually wouldn't cause problems for people with healthy immune systems. If these infections get into your nervous system, they can cause headaches.

Some of the potential opportunistic infections include cryptococcal meningitis caused by a fungus, cerebral toxoplasmosis caused by a parasite, tuberculosis meningitis caused by a bacteria, or progressive multifocal leukoencephalopathy caused by a virus.

You can avoid opportunistic infections by staying on top of your HIV treatment because most opportunistic infections occur when HIV is not well controlled. Treatment helps keep your immune system strong so it can fight off potential infections. Additionally, the Centers for Disease Control and Prevention (CDC) recommends people with HIV avoid eating raw, undercooked, or unpasteurized foods or drinking untreated water.

Opportunistic infections are less common now that effective HIV treatments are available, but they can be serious and require immediate medical attention. Talk with your doctor right away if your headaches are severe or come with other symptoms like confusion, seizures, or a fever.

7. Stroke

People with uncontrolled HIV have a higher risk of stroke, or an interruption in the blood flow to the brain that causes brain cells to die. Even when HIV is well treated, people with HIV who are aging have the same stroke risk that all older people do.

A very bad headache can be a sign of a stroke. Other signs include drooping on one side of the face, slurred speech, and an inability to lift both arms. If you have these signs, seek emergency medical attention immediately. The sooner you get care, the better your chance of recovery.

Coping With Headaches and When To Seek Help

Most headaches are not dangerous. There are things you can do at home to help ease the pain:

  • Avoid triggers — Keep track of things that might cause your headaches. It could be certain foods, things in your environment, or stressful situations. Making a list can help you identify and avoid triggers.
  • Stay hydrated — Drink plenty of water throughout the day to avoid dehydration.
  • Try to reduce your stress — One myHIVteam member got it right when they said, “Stress definitely gives me headaches.” Try to reduce your stress by practicing deep breathing, meditation, or yoga.
  • Take over-the-counter pain relievers — For occasional headaches, you can try medicines like acetaminophen or ibuprofen. But always check with your doctor first, as some medications may not be safe for people with HIV.
  • Ask about prescription medications — If your headaches happen often and bother you a lot, talk to your doctor. They might suggest stronger medicines to help.

When To Seek Help

Most headaches can be managed with simple remedies, but there are a few signs that it’s time to seek medical attention:

  • Sudden, severe headache — If you suddenly get a very bad headache and feel confused, have trouble speaking, or have weakness on one side of your body, get medical help right away. It could be a sign of a serious problem.
  • Frequent or long-lasting headaches — If you have headaches often or they don't go away with over-the-counter medicines, talk to your doctor. They can figure out what's going on and help you feel better.
  • New medication side effects — If you start taking new HIV medications and notice more headaches or other strange symptoms, tell your doctor right away. They can check if the medicine is causing the problem and find a solution.

Talk With Others Who Understand

On myHIVteam, the social network for people with HIV and their loved ones, more than 37,000 members come together to ask questions, give advice, and share their stories with others who understand life with HIV.

Do you experience headaches? What works to ease them? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on August 28, 2023
    All updates must be accompanied by text or a picture.

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    Barry S. Zingman, M.D. specializes in HIV/AIDS medicine and general infectious disease. Review provided by VeriMed Healthcare Network. Learn more about him here
    Catherine Leasure, Ph.D. is a Ph.D. candidate currently studying at Vanderbilt University in Nashville, Tennessee. Learn more about her here

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