Introduction: HIV lipodystrophy is a well known complication of longstanding HIV infection and antiretroviral therapy. We present a case of incapacitating headaches secondary to HIV lipodystrophy treated with botulinum toxin.

Case Summary: A 59 year old male with a history of longstanding HIV and familial dyslipidemia was referred to the plastic surgery service for reduction of his cervicodorsal fat pad. He has a history of multiple cardiac events and rhabdomyolysis secondary to dyslipidemia and receives includes plasma apheresis treatments. His dorsal hump has been enlarging steadily for four years. Over the last year, he developed disabling headaches requiring narcotics and two hospitalizations. After a thorough neurological evaluation showed no other causes, it was postulated that the dorsal hump was putting pressure on the scalp and causing tension headaches. Due to high cardiac risks and the unknown risks of systemic lipid release from liposuction, a less invasive treatment modality was selected initially. The occipitalis and frontalis muscles were injected with a total of 80U botulinum toxin producing a marked decrease in headache severity and frequency.

Summary: Cervical lipodystrophy is a cause of headache, and may be successfully treated with botulinum toxin.