19-§5-Headache

The 3 main causes of headache in an HIV hospice are curable diseases: CRYPTOCOCCOSIS, TOXOPLASMOSIS & CEREBRAL TB.  We have to exclude these 3 diseases before diagnosing other incurable causes of headache ( LYMPHOMA, CMV...)

Be alert if:

• Former CRYPTO or former TOXO patient...  Headache is often the first sign of relapse.
• No improvement with use of common pain killer
• Other neuro signs associated (convulsion, paralysis, loss of visual acuity...)

"Show me where you have pain"

• If patient points precisely to the temples on both sides you have to consider CRYPTO first (see 19-§1-Symmetrical Neuro Protocol), then TOXO and TB
• If patient points to one lateral point only, you have to consider TOXO first (see 19-§2-Asymmetrical Neuro Protocol), then TB (see 31-Tuberculosis Protocol)...
• If he shows a more diffuse area (temporal or not, symmetrical or not), we have to consider TOXO first, then TB, then CRYPTO

Some other indicators:

• If also has eye pain...  CRYPTO, CMV must be ruled out first (see 19-§1-Symmetrical Neuro Protocol)
• If chronic recurrent fever, loss of weight...  CEREBRAL TB more likely (see 31-Tuberculosis Protocol)
• If confused or sleepy it is "PROBABLY NOT" CRYPTO
• If acute+++, infectious signs+++, stiff neck+++, "normal meningitis" is also of course possible!  (See 19-§1-Symmetrical Neuro Protocol)
• Any history of migraines, cluster headaches, etc suggests these possible diagnoses...  (Nothing specific for HIV patients)