To determine headache prevalence and its association with HIV characteristics among persons living with HIV (PLWH) on ART in Lusaka, Zambia.

Headaches are one of the most common conditions worldwide and contribute substantially to decreased quality of life. Headache burden is not well studied in Sub-Saharan Africa, and the impact of HIV on headaches is unknown.

The HARDSHIP survey, a headache epidemiology questionnaire previously validated in Zambia, was distributed to all adult PLWH attending routine clinic appointments at the Adult Infectious Disease Center (AIDC) at the University Teaching Hospital in Lusaka, Zambia in September 2019. HIV disease characteristics were then abstracted from the chart. Results were compared to prior Zambia national headache prevalence data.

568 patients responded to the survey. Mean age was 43.4 + 10.6 years, 63% (n=354) were female, 100% were on ART, and median CD4 count was 424 (IQR 252, 609).  Overall, 59.5% reported having a headache within the last year unrelated to another illness, significantly lower than the 75.7% reported amongst urban dwellers in the prior national survey (p=0.005). Among those with headache, 121 met criteria for migraine (21.4%), 146 for tension-type headache (TTH) (25.9%), 9 for medication-overuse headache (1.6%), and 62 for undetermined headache (10.9%). There was no difference in prevalence between migraine and TTH in this cohort and the prior national survey. There were no associations between overall headache prevalence or headache subtype prevalence with HIV disease characteristics including CD4 count, viral load, antiretroviral regimen, and time since HIV diagnosis.

Among PLWH in Zambia, headaches are not associated with HIV disease characteristics and are less common than previously reported in the general population in Zambia. However, they remain highly prevalent, affecting 59.5% of PLWH in this study. Optimizing headache treatment may improve quality of life for PLWH in Zambia.