Dialysis headache: a systematic review and meta-analysis

Abstract

Introduction
Dialysis headache (DH) is a known but underexplored complication of hemodialysis, affecting some patients during treatment. While, it is recognized, the reported frequency, diagnostic criteria, and associated risk factors vary.
Objective
This systematic review and meta-analysis aim to determine the percentage and characteristics of dialysis headache, identify associated factors, and summarize available evidence from existing literature.
Methods
A comprehensive literature search was conducted across Scopus, Medline, PubMed, and Google Scholar for studies published from 2000 to the present. A total of 15 studies were included, encompassing various study designs and geographic locations. Data on patients demographics, headache characteristics, diagnostic criteria, and hemodialysis parameters were extracted and analyzed. A proportional meta-analysis was performed using R-4.3.2.
Results
The included studies reported DH prevalence ranging from 7% to 53%. The overall pooled estimate was 28% (95% CI: 19-36%). After refining the dataset by excluding studies with confounding factors and improving study selection criteria, the updated prevalence estimate was 16% (95% CI: 9-24%). DH onset typically occurred during hemodialysis sessions, predominantly in the second or third hour, and most cases resolved within four hours post-dialysis. Headaches were generally of moderate intensity and managed with simple analgesics.
Conclusions
Dialysis headache remains a prevalent but inconsistently reported complication of hemodialysis. Standardized diagnostic criteria and further research are needed to better understand its pathophysiology and improve management strategies.