Dialysis headache: characteristics, impact and cerebrovascular evaluation

Abstract

Background: Headache is one of the most frequent symptoms that occur during hemodialysis sessions. Despite the high prevalence of dialysis headache, it has been little studied. Objective: To evaluate the characteristics, impact and factors associated with dialysis headache. The behavior of the cerebral vasculature was also compared between patients with and without dialysis headache. Methods: This was a cross-sectional study. Consecutive patients who underwent hemodialysis were assessed through a semi-structured questionnaire, the Headache Impact Test (HIT-6), the Hospital Anxiety and Depression Scale and the Short Form-36 Health Survey (SF-36). Transcranial Doppler ultrasonography was performed in the first and fourth hours of hemodialysis. Results: A total of 100 patients were included; 49 of them had dialysis headache. Women (OR=5.04; 95%CI 1.95-13.04), younger individuals (OR=1.05; 95%CI 1.01-1.08), individuals with higher schooling levels (OR=3.86; 95%CI 1.4-10.7) and individuals who had spent longer times on dialysis programs (OR=0.99; 95%CI 0.98-1) had more dialysis headache (logistic regression). Individuals with dialysis headache had worse quality of life in the domains of pain and general state of health (56.9 versus 76.4, p=0.01; 49.7 versus 60.2, p=0.03, respectively). Dialysis headache was associated with significantly greater impact on life (OR=24.4; 95%CI 2.6-226.6; logistic regression). The pulsatility index (transcranial Doppler ultrasonography) was lower among patients with dialysis headache than among those without them. Conclusions: Dialysis headaches occur frequently and are associated with worse quality of life and patterns of cerebral vasodilatation.

Dialysis headache: A literature review in the last 30 years

“…This multifactorial nature of headache makes it difficult to assess. 9,11 Studies have shown that women have more risk factors for dialysis headache 9,11 , although no statistical relationship was found between dialysis headache and sex. 1,7,8,12 In our review, we found a predominance of dialysis headache in men (56.5% versus 43.5%), possibly because men more frequently undergo hemodialysis.…”

“…11 There is a significant decrease in plasma concentrations of CGRP after dialysis, thus, high values of this peptide may contribute to the onset of headache. 13 In turn, factors related to dialysis headache were associated with longer time in the hemodialysis program 9,12 and the frequency of sessions per week. 9 One study described that online haemodiafiltration (OL-HDF) had good results as a preventive method of dialysis headache.…”

“…13 In turn, factors related to dialysis headache were associated with longer time in the hemodialysis program 9,12 and the frequency of sessions per week. 9 One study described that online haemodiafiltration (OL-HDF) had good results as a preventive method of dialysis headache. There is a consensus regarding the characteristics related to the type of pain, location, intensity, onset and duration of symptoms.…”

“…8 However, despite this high prevalence, it is one of the poorly researched clinical conditions, requiring studies to elucidate its clinical characteristics, epidemiology, pathophysiology, management and prevention. 9 Some narrative reviews on dialysis headache have already been carried out 8,10 , but they did not specify the methodology or expose the results found in a quantitative way. In thisreview, we aim to describe the prevalence, clinical features, associated symptoms and risk factors of dialysis headache.…”

Dialysis headache

“…Although a common and debilitating experience in patients undergoing the procedure, little is known about its mechanisms. In this edition, Melo et al 2 is shedding some light in the understanding of this condition by studying 100 consecutive dialytic patients with structured questionnaires and transcranial doppler ultrasonography.…”