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Linfield RY, Nguyen NN, Laprade OH, Holodniy M, Chary A. An update on drug-drug interactions in older adults living with human immunodeficiency virus (HIV). Expert Rev Clin Pharmacol 2024; 17:589-614. [PMID: 38753455 PMCID: PMC11233252 DOI: 10.1080/17512433.2024.2350968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION People with HIV are living longer due to advances in antiretroviral therapy. With improved life expectancy comes an increased lifetime risk of comorbid conditions - such as cardiovascular disease and cancer - and polypharmacy. Older adults, particularly those living with HIV, are more vulnerable to drug interactions and adverse effects, resulting in negative health outcomes. AREA COVERED Antiretrovirals are involved in many potential drug interactions with medications used to treat common comorbidities and geriatric conditions in an aging population of people with HIV. We review the mechanisms and management of significant drug-drug interactions involving antiretroviral medications and non-antiretroviral medications commonly used among older people living with HIV. The management of these interactions may require dose adjustments, medication switches to alternatives, enhanced monitoring, and considerations of patient- and disease-specific factors. EXPERT OPINION Clinicians managing comorbid conditions among older people with HIV must be particularly vigilant to side effect profiles, drug-drug interactions, pill burden, and cost when optimizing treatment. To support healthier aging among people living with HIV, there is a growing need for antiretroviral stewardship, multidisciplinary care models, and advances that promote insight into the correlations between an individual, their conditions, and their medications.
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Affiliation(s)
| | - Nancy N. Nguyen
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Olivia H. Laprade
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Mark Holodniy
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
| | - Aarthi Chary
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
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Dhiman NR, Joshi D, Singh R, Gyanpuri V, Kumar A. Post-COVID-19 headache- NDPH phenotype: a systematic review of case reports. FRONTIERS IN PAIN RESEARCH 2024; 5:1376506. [PMID: 38808005 PMCID: PMC11130372 DOI: 10.3389/fpain.2024.1376506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
Background and objectives Post-acute COVID-19 syndrome or "long COVID" affects patients even after the recovery from Covid infection in various ways. Persistent headache or New Daily Persistent Headache (NDPH) is one of such symptoms. In this review, we will discuss about the case-reports of post covid-19 headache- NDPH phenotype both after and in the course of COVID-19 infection. Methods Case reports/studies talked about patients having NDPH around the disease either immediately or late post COVID were included. Data was taken from the source and synthesised on a qualitative basis. Results Literature search showed 3,538 articles, out of which 12 were screened as per the eligibility criteria and finally, 4 case reports on NDPH and Covid-19 were chosen for analysis from the database and by human search. All case reports justify the criteria for acceptability in quality for this systematic review. Conclusion NDPH in and around Covid 19 infection is something that is currently an ingenious debated topic in the scientific community. More case studies should be written and published on the same subject so that a large systematic review could be conducted. Trial Registration Information The review is registered in Prospero with no. Identifier (CRD42022354912). Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO (CRD42022354912).
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Affiliation(s)
| | - Deepika Joshi
- Department of Neurology, Banaras Hindu University, Varanasi, India
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Kim C, Chomba M, Phiri A, Fwoloshi S, Claassen CW, Hachaambwa L, Saylor D. Primary headache disorders among people living with HIV in Lusaka, Zambia. J Neurol Sci 2024; 459:122976. [PMID: 38531241 DOI: 10.1016/j.jns.2024.122976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE We completed a cross-sectional survey study to determine headache prevalence and its association with HIV characteristics among people living with HIV (PLHIV) in Lusaka, Zambia. BACKGROUND Headaches are common but their association with HIV status is unknown. METHODS The HARDSHIP survey, a headache epidemiology questionnaire previously validated in Zambia, was distributed during a 3-month period to 3666 consecutive adult PLHIV attending routine clinic appointments at the Adult Infectious Diseases Centre at the University Teaching Hospital in Lusaka, Zambia. HIV disease characteristics were abstracted from their charts. RESULTS 1015 (27.7%) participants responded to the survey. Adjusted for age, 64% reported having a headache within the last year unrelated to another illness. Among participants, 201 met criteria for migraine (20%), 259 for tension-type headache (26%), 18 for probable medication-overuse headache (2%), and 121 for undetermined headache (12%). Prevalence for tension-type headache was significantly higher than that of migraine (P < 0.001). After adjusting for age and sex, higher CD4 counts were associated with migraine. No other associations were observed between overall headache or headache type with HIV disease characteristics including CD4 count, viral load, antiretroviral regimen, and time since HIV diagnosis. CONCLUSIONS Headaches are highly prevalent among this cohort of PLHIV in Zambia. Optimizing headache treatment and integrating it into routine HIV care may improve quality of life for a substantial proportion of PLHIV in Zambia.
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Affiliation(s)
- Curi Kim
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mashina Chomba
- Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Arnold Phiri
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Sombo Fwoloshi
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Cassidy W Claassen
- Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Department of Medicine, University Teaching Hospital, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lottie Hachaambwa
- Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Department of Medicine, University Teaching Hospital, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deanna Saylor
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Mortel D, Kawatu N, Steiner TJ, Saylor D. Barriers to headache care in low- and middle-income countries. eNeurologicalSci 2022; 29:100427. [PMID: 36212617 PMCID: PMC9539775 DOI: 10.1016/j.ensci.2022.100427] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Headache disorders are a common cause of disability globally and lead not only to physical disability but also to financial strain, higher rates of mental health disorders such as depression and anxiety, and reduced economic productivity which negatively impacts gross domestic product (GDP) on a national scale. While data about headache are relatively scarce in low- and middle-income countries (LMICs), those available suggest that headache disorders occur on a similar scale in LMICs as they do in high-income countries. In this manuscript, we discuss common clinical, political, economic and social barriers to headache care for people living in LMICs. These barriers, affecting every aspect of headache care, begin with community perceptions and cultural beliefs about headache, include ineffective headache care delivery systems and poor headache care training for healthcare workers, and extend through fewer available diagnostic and management tools to limited therapeutic options for headache. Finally, we review potential solutions to these barriers, including educational interventions for healthcare workers, the introduction of a tiered system for headache care provision, creation of locally contextualized diagnostic and management algorithms, and implementation of a stepped approach to headache treatment.
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Leone M, Giani L, Phaka M, Uluduz D, Tayyar Ş, Kamponda M, Tolno VT, Guidotti G, Marazzi MC, Steiner TJ. Burden of headache in a HIV-positive population of sub-Saharan Africa. Cephalalgia 2022; 42:918-925. [PMID: 35331013 PMCID: PMC9315167 DOI: 10.1177/03331024221088994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND About 26 million people are living with HIV in sub-Saharan Africa. The DREAM programme in sub-Saharan Africa provides free healthcare for HIV/AIDS and a range of chronic non-communicable diseases. HIV is a risk factor for neurological non-communicable diseases including stroke and epilepsy, which themselves are associated with headache, and HIV may be a direct risk factor for headache. We investigated the prevalence and burden of headache in a HIV+ population in sub-Saharan Africa. METHODS At the DREAM Centre in Blantyre, Malawi, a low-income country with a population of 19 million and 9.2% HIV prevalence, a structured questionnaire was administered by a trained lay interviewer to consecutively attending HIV+ patients aged 6-65 years. All were monitored with regular viral load detection. RESULTS Of 513 eligible patients invited, 498 were included (mean age 34.1 ± 12.8 years; 72% females; 15 declined). All were on antiretroviral treatment, with viral load undetectable in 83.9%. The 1-year prevalence of headache was 80.3% (females 83.6%, males 71.9%); 3.8% had ≥15 headache days/month, 1.4% had probable medication-overuse headache. Mean overall headache frequency was 4.4 ± 5.4 days/month. Those reporting headache lost means of 2.3% of paid workdays and 3.3% of household workdays because of headache. Only one third had sought advice for their headache. CONCLUSIONS Headache is very prevalent among HIV+ patients in Malawi, imposing additional burden and costs on individuals and the community. Management of headache disorders should be implemented in HIV centres, as it is for other chronic non-communicable diseases.
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Affiliation(s)
- Massimo Leone
- Neuroalgology Unit, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | - Luca Giani
- Neurorehabilitation Department, IRCCS Istituti Clinici Scientifici Maugeri di Milano, Milan, Italy
| | - Monica Phaka
- DREAM Program, Health Department, Blantyre, Malawi
| | - Derya Uluduz
- Neurology Department, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Şaşmaz Tayyar
- Public Health Department, Mersin University School of Medicine, Mersin, Turkey
| | | | | | - Giovanni Guidotti
- Health Department, Azienda Sanitaria Locale (ASL) Roma 1, Regione Lazio, Rome, Italy
| | | | - Timothy J Steiner
- Division of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Brain Sciences, Imperial College London, London, UK
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Perzia BM, Dunaief JL, Dunaief DM. Chronic migraine reversal and prevention with the LIFE diet: a nutrient dense whole food plant-based diet (WFPBD). BMJ Case Rep 2021; 14:e243987. [PMID: 34794983 PMCID: PMC8689122 DOI: 10.1136/bcr-2021-243987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 60-year-old man who struggled with frequent migraines for 12.5 years, which were refractory to all conventional therapies. Six months before initial consultation, these migraines become chronic. The patient was then advised to follow the Low Inflammatory Foods Everyday (LIFE) diet, a nutrient-dense, dark green leafy vegetable-rich, whole food plant-based diet. Within 2 months, his headache frequency declined from 18 to 24 headache days per month to 1, and he discontinued his preventive and abortive migraine medications. After 3 months, the patient had no headaches. These results far exceed the goal of migraine treatment with medication, which is to reduce migraine frequency by >50% per month. In addition, the results were durable; this patient has been migraine-free for 7.5 years. Serum beta-carotene more than tripled after the patient started the LIFE diet, consistent with its high content of dark green leafy vegetables. Weight, high-sensitivity C-reactive protein (hsCRP), complete blood count (CBC), hydration status, sodium and other electrolytes remained constant throughout the study.
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Affiliation(s)
- Brittany Marie Perzia
- Stony Brook University Health Sciences Center School of Medicine, Stony Brook, Long Island, New York, USA
| | - Joshua L Dunaief
- Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Abstract
Purpose of Review Headache is a common symptom of COVID-19 with emerging literature being published on the subject. Although it may seem unspecific, scientific evidence has allowed a better definition of this headache type, revealing relevant associations with other COVID-19 symptoms and prognoses. We therefore sought to highlight the most remarkable findings concerning headache secondary to COVID-19, specifically focusing on epidemiology, characteristics, pathophysiology, and treatments. Recent Findings The real prevalence of headache as a symptom of COVID-19 is still unclear ranging from 10 to 70%. Headache mainly has a tension-type-like phenotype, although 25% of individuals present with migraine-like features that also occur in patients without personal migraine history. This finding suggests that a likely pathophysiological mechanism is the activation of the trigeminovascular system. SARS-CoV-2 neurotropism can occur by trans-synaptic invasion through the olfactory route from the nasal cavity, leading to anosmia which has been associated with headache. SARS-CoV-2 protein has been found not only in olfactory mucosa and bulbs but also in trigeminal branches and the trigeminal ganglion, supporting this hypothesis. However, other mechanisms such as brain vessels inflammation due to SARS-CoV-2 damage to the endothelium or systemic inflammation in the context of cytokine storm cannot be ruled out. Interestingly, headache has been associated with lower COVID-19 mortality. No specific treatment for COVID-19 headache is available at present. Summary Studies show that investigating COVID-19 headache represents an opportunity not only to better understand COVID-19 in general but also to advance in the knowledge of both secondary and primary headaches. Future research is therefore warranted.
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Al-Hashel JY, Abokalawa F, Alenzi M, Alroughani R, Ahmed SF. Coronavirus disease-19 and headache; impact on pre-existing and characteristics of de novo: a cross-sectional study. J Headache Pain 2021; 22:97. [PMID: 34418950 PMCID: PMC8380111 DOI: 10.1186/s10194-021-01314-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/08/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease-19 is caused by the severe acute respiratory syndrome coronavirus 2 Headache is a common symptom during and after Coronavirus disease-19. We aimed to study headache character in relation to COVID-19. METHODS This was a cross-sectional study. Patients who had Coronavirus disease-19, confirmed by reverse transcription polymerase chain reaction technique and presented to the headache clinic within 3 months after the onset of infections were identified to the study. Study included patients diagnosed as primary headache disorders according to The International Classification of Headache Disorders, 3rd edition. Participants were grouped into categories according to having previous or de novo headache. Descriptive data, paired sample t-test and the chi-squared test (X2) were used for statistical analyses of the data. RESULTS A total of 121 patients were included in this study. Their mean age was 35.29 + 9.54 and most of them were females (83.5%). Prior to Coronavirus disease-19 infections, 78 (64.5%) had migraine and 11(9.1%) experienced a tension-type headache while 32 (26.4) reported de novo headache post Coronavirus disease-19. Patient had significant increase in headache days 11.09 ± 8.45 post Coronavirus disease-19 compared with 8.66 ± 7.49 headache days before Coronavirus disease-19 infection (p < 0.006). Post Coronavirus disease-19, the usage of analgesic increased significantly by the patient with migraine (2.31 ± 1.65 vs 3.05 ± 2.09, p = 0.002) while the patient with tension type headache had statistically significant increase in severity (5.556 ± 1.86 vs 7 ± 2.25, p = 0.033) and frequency (7 ± 6.29 vs 12.72 ± 7.96, p = 0.006) of headache attacks. Bi-frontal and temporal headache are the most reported (40.6% each) headache site among de novo headache group. Patients younger than 40 years had longer duration of the headache attack (18.50 ± 16.44 vs 5.5 ± 9.07, p = 0.045) post COVID-19. Male patients compared to females (8.66 ± 1.15 versus 5.93 ± 2.01 p = 0.04) had more severe headache post Coronavirus disease-19. De novo headache resolved within 1 month in most of patients (65.3%). CONCLUSION Primary headache get worse after Coronavirus disease-19. De novo primary headache is frequent post Coronavirus disease-19 and resolve within 1 month. Headaches related to Coronavirus disease-19 are severe, present as migraine phenotype. Young male patients with Coronavirus disease-19 tend to have worse headache.
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Affiliation(s)
- Jasem Youssef Al-Hashel
- Neurology Department, Ibn Sina Hospital, P.O. Box 25427, 13115 Safat, Kuwait
- Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110 Safat, Kuwait
| | - Fathi Abokalawa
- Neurology Department, Ibn Sina Hospital, P.O. Box 25427, 13115 Safat, Kuwait
| | - Maram Alenzi
- Internal Medicine Department, Farwaniyah Hospital, Kuwait city, Kuwait
| | - Raed Alroughani
- Division of Neurology, Amiri Hospital, Arabian Gulf Street, 13041 Sharq, Kuwait
| | - Samar Farouk Ahmed
- Neurology Department, Ibn Sina Hospital, P.O. Box 25427, 13115 Safat, Kuwait
- Neuropsychiatry department, Faculty of Medicine, Al-Minia University, P.O. Box 61519, Minia City, 61111 Egypt
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Abstract
Headache is one of the most disabling conditions in the world. Despite plentiful evidence supporting rehabilitation strategies, headache is significantly underassessed and undertreated. Obstacles to headache care include lack of available expertise in headache management, few available resources for effective assessment and treatment, and cost and disability that preclude treatment seeking in patients with headache. Telerehabilitation can allow providers to access expert consultation and gives patients easier access to assessment and treatment. This article covers existing telerehabilitation options for headache management and explores the strength of evidence supporting these approaches. Risks of telerehabilitation and recommendations for future development are discussed.
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Affiliation(s)
- Don McGeary
- Department of Rehabilitation Medicine, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Cindy McGeary
- Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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Gonzalez-Martinez A, Fanjul V, Ramos C, Serrano Ballesteros J, Bustamante M, Villa Martí A, Álvarez C, García Del Álamo Y, Vivancos J, Gago-Veiga AB. Headache during SARS-CoV-2 infection as an early symptom associated with a more benign course of disease: a case-control study. Eur J Neurol 2021; 28:3426-3436. [PMID: 33417287 DOI: 10.1111/ene.14718] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Headache is an important manifestation during SARS-CoV-2 infection. In this study, the aim was to identify factors associated with headache in COVID-19 and headache characteristics. METHODS This case-control study includes COVID-19 hospitalized patients with pneumonia during March 2020. Controls comprise COVID-19 patients without headache and the cases are COVID-19 patients with headache. Demographic, clinical and laboratory data were obtained from the medical records. Headache characteristics were evaluated by semi-structured telephonic interview after discharge. RESULTS Of a total of 379 COVID-19 patients, 48 (13%) developed headache. Amongst these, 30 (62%) were men and the median age was 57.9 (47-73) years. Headache was associated with younger age, fewer comorbidities and reduced mortality, as well as with low levels of C-reactive protein, mild acute respiratory distress syndrome and oropharyngeal symptoms. A logistic multiple regression model revealed that headache was directly associated with D-dimer and creatinine levels, the use of high flow nasal cannula and arthromyalgia, whilst urea levels, beta-lactamic treatment and hypertension were negatively associated with headache. COVID-19-associated headache characteristics were available for 23/48 (48%) patients. Headache was the onset symptom in 8/20 (40%) patients, of mild or moderate intensity in 17/20 (85%) patients, with oppressive characteristics in 17/18 (94%) and of holocranial 8/19 (42%) or temporal 7/19 (37%) localization. CONCLUSIONS Our results show that headache is associated with a more benign SARS-CoV-2 infection. COVID-19-associated headache appears as an early symptom and as a novel headache with characteristics of headache attributed to systemic viral infection. Further research addressing the underlying mechanisms to confirm these findings is warranted.
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Affiliation(s)
- Alicia Gonzalez-Martinez
- Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Víctor Fanjul
- Biostatistician at Savana and Headache Unit Collaborator at Department of Neurology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Ramos
- Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Headache Unit, Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Jorge Serrano Ballesteros
- Internal Medicine Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Marta Bustamante
- Internal Medicine Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Almudena Villa Martí
- Internal Medicine Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Claudia Álvarez
- Internal Medicine Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Yaiza García Del Álamo
- Internal Medicine Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - José Vivancos
- Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Ana Beatriz Gago-Veiga
- Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Headache Unit, Neurology Department, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
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11
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Rocha-Filho PAS, Magalhães JE. Headache associated with COVID-19: Frequency, characteristics and association with anosmia and ageusia. Cephalalgia 2020; 40:1443-1451. [PMID: 33146035 PMCID: PMC7645592 DOI: 10.1177/0333102420966770] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/05/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the frequency and characteristics of headache in patients with COVID-19 and whether there is an association between headache and anosmia and ageusia. METHODS This was a cross-sectional study. Consecutive patients admitted to hospital with COVID-19, confirmed by reverse transcription polymerase chain reaction (RT-PCR) technique, were assessed by neurologists. RESULTS Seventy-three patients were included in the study, 63% were male; the median age was 58 years (IQR: 47-66). Forty-seven patients (64.4%) reported headaches, which had most frequently begun on the first day of symptoms, were bilateral (94%), presenting severe intensity (53%) and a migraine phenotype (51%). Twelve patients (16.4%) presented with headache triggered by coughing. Eleven (15%) patients reported a continuous headache. Twenty-eight patients (38.4%) presented with anosmia and 29 (39.7%) with ageusia. Patients who reported hyposmia/anosmia and/or hypogeusia/ageusia experienced headache more frequently than those without these symptoms (OR: 5.39; 95% CI:1.66-17.45; logistic regression). Patients with anosmia and ageusia presented headache associated with phonophobia more often compared to those with headache without these complaints (Chi-square test; p < 0.05). Headache associated with COVID-19 presented a migraine phenotype more frequently in those experiencing previous migraine (p < 0.05). CONCLUSION Headaches associated with COVID-19 are frequent, are generally severe, diffuse, present a migraine phenotype and are associated with anosmia and ageusia.
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Affiliation(s)
- Pedro Augusto Sampaio Rocha-Filho
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil; Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - João Eudes Magalhães
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil; Faculdade de Ciências Médicas, Universidade de Pernambuco (UPE), Recife, Brazil
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12
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Sampaio Rocha-Filho PA, Voss L. Persistent Headache and Persistent Anosmia Associated With COVID-19. Headache 2020; 60:1797-1799. [PMID: 32790179 PMCID: PMC7436496 DOI: 10.1111/head.13941] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Pedro Augusto Sampaio Rocha-Filho
- Department of Neuropsychiatry, Universidade Federal de Pernambuco (UFPE), Recife, Brazil.,Headache Clinic, Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil
| | - Lara Voss
- Emergency Department, Hospital Getulio Vargas, Recife, Brazil
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Abstract
Purpose: To review the broad spectrum of clinical neuro-ophthalmic presentations associated with human immunodeficiency virus (HIV) infection. Methods: Critical review of the literature regarding neuro-ophthalmic consequences of HIV infection and its sequelae. Results: Neuro-ophthalmological diseases are common in both asymptomatic HIV-positive patients and those who profound immunosuppression with acquired immune deficiency syndrome (AIDS). Neuro-ophthalmic manifestations of HIV infection can involve the afferent or efferent visual pathway. Common clinical presentations include headache, papilledema, chorioretinitis, optic nerve involvement, meningitis, and cranial nerve palsies. Other neuro-ophthalmic manifestations include involvement of the visual pathway in the brain producing visual field defects such as occur in progressive multifocal encephalopathy. Pupil abnormalities have also been reported. Discussion: Neuro-ophthalmic consequences of HIV are important to recognize as it is critical to identify underlying neoplastic or infectious diseases which could be amenable to treatment.
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Affiliation(s)
- Lynn K Gordon
- Department of Ophthalmology Stein Eye Institute, David Geffen School of Medicine at UCLA , Los Angeles, CA, USA
| | - Helen Danesh-Meyer
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland , Auckland, New Zealand
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14
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Sohail S, Nakigozi G, Anok A, Batte J, Kisakye A, Mayanja R, Nakasujja N, Robertson KR, Gray RH, Wawer MJ, Sacktor N, Saylor D. Headache prevalence and its functional impact among HIV-infected adults in rural Rakai District, Uganda. J Neurovirol 2019; 25:248-253. [PMID: 30607892 DOI: 10.1007/s13365-018-0710-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/08/2018] [Accepted: 12/03/2018] [Indexed: 02/07/2023]
Abstract
Headache is common, but its prevalence and impact in sub-Saharan Africa and especially in HIV+ individuals is relatively unknown. We sought to determine the prevalence and functional impact of headache among HIV-infected (HIV+) adults in a cross-sectional observational cohort study in rural Rakai District, Uganda. Participants completed a sociodemographic survey, depression screen, functional status assessments, and answered the headache screening question, "Do you have headaches?" Participants responding affirmatively were assessed with the ID Migraine tool for diagnosis of migraine and Headache Impact Test-6 to determine functional impact of headache. Characteristics of participants with and without headaches and with and without functional impairment were compared using t tests for continuous variables, chi-square tests for categorical variables, and multivariate logistic regression. Of 333 participants, 51% were males, mean age was 37 (SD 9) years, 94% were on antiretroviral therapy (ART) and mean CD4 count was 403 (SD 198) cells/μL. Headache prevalence was 28%. Among those reporting headache, 19% met criteria for migraine, 55% reported functional impairment, and 37% reported substantial or severe impact of headache. In multivariate analyses, female sex (odds ratio (OR) 2.58) and depression (OR 2.49) were associated with increased odds and ART (OR 0.33) with decreased odds of headache. Participants with substantial/severe functional impact were more likely to meet criteria for depression (32% vs 9%). In conclusion, headache prevalence in HIV+ rural Ugandans was lower than global averages but still affected more than one quarter of participants and was associated with significant functional impairment.
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Affiliation(s)
| | | | - Aggrey Anok
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - James Batte
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | | | | | - Kevin R Robertson
- Department of Neurology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ned Sacktor
- Department of Neurology, Johns Hopkins University School of Medicine, Meyer 6-113, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Meyer 6-113, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.
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