Dialysis Headache Associated with Caffeine-Withdrawal Headache in Patients Undergoing Hemodialysis

Abstract

Headaches are particularly relevant as a complication of hemodialysis, given that this condition increases the discomfort felt by patients undergoing this therapy. The objective of the present study was to evaluate the prevalence of headache in patients undergoing hemodialysis sessions, particularly considering dialysis headaches due to caffeine-withdrawal. This was a crosssectional, observational, quantitative and qualitative study with questionnaires and interviews. The questionnaire addressed biopsychosocial aspects, clinical aspects and criteria for the classification of headaches according to the International Headache Society. A hundred and sixty patients with stage-V chronic kidney disease responded to the questionnaire during hemodialysis sessions. Headache prevalence was 90% and over the period studied 53.1% of patients presented the symptom. Among these patients with headaches, over half (55.3%) presented criteria for concomitant caffeine-withdrawal headaches and dialysis headaches. The beginning of headaches varied between one month and more than five years, with most occurring for more than five years. Frequency varied from sporadic crises to more than one crisis a day, though more than one crisis a day predominated. The interval between crises was of a few days, with mean duration of less than one hour, which ceased with the use of self-medicated analgesics, with no worsening factor. This condition is a challenge for neurologists and headache experts. More studies are needed to decrease this prevalence, to decrease the abusive use of analgesics and improve the quality of life of these patients.