Dialysis-related headache: prevalence and clinical features in patients on hemodialysis and after kidney transplantation

Abstract

Introduction
Headache is a common symptom among patients on hemodialysis, occurring in up to 70%. Dialysis headache is defined by the International Classification of Headache Disorders (ICHD-3) as a headache with no specific characteristics, occurring during and caused by hemodialysis, and which resolves spontaneously within 72 hours after the session has ended. There is no consensus on its pathophysiology or triggering factors.

Objective
To evaluate the prevalence, clinical features and factors associated with dialysis headache in patients with chronic kidney disease on renal replacement therapy.

Methods
Cross-sectional observational study with a quantitative approach. Participants were divided into two groups: (1) 25 patients on hemodialysis and (2) 25 patients on early post kidney transplantation. All participants were interviewed with a structured questionnaire, the Hospital Anxiety and Depression Scale, and the Epworth Sleepiness Scale. Blood pressure, weight, urea, glucose and electrolytes were evaluated before and after one hemodialysis session. Control groups were classified within the headache-free patients in each group. Numerical variables were expressed as mean and standard deviation and evaluated using Student's t test (two-tailed) or Mann-Whitney U test. Categorical variables were expressed as percentage and evaluated using Pearson's chi- squared test. The p value was considered statistically significant when lower than 0.05.

Results
In group (1), 8 patients (32%) were diagnosed with dialysis headache, predominantly pulsatile (n=6, 75%), accompanied by photophobia (n=6, 75%), phonophobia (n=4, 50%) and nausea or vomiting (n=6, 75%), with a mean pain score of 7.75 ± 1.58. Individuals with headache had higher scores for anxiety (7.00 ± 3.93 vs. 3.82 ± 3.23, p=0.03) and sleepiness (9.13 ± 3.94 vs. 4.76 ± 3, 85, p=0.01). (To see the complete abstract, please, check out the pdf).