Dialysis headache: prevalence and clinical presentation in hemodialysis and kidney transplant patients


  • Bruno Teixeira Gomes Renal Transplant Research Laboratory, Division of Nephrology, School of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil. https://orcid.org/0000-0002-1547-8125
  • Alberto Luis Gomes da Costa Division of Neurology, Clinics Hospital, University of Campins, Sao Paulo, Brazil.
  • Marilda Mazzali University of Campinas https://orcid.org/0000-0001-6297-4909




Anxiety, Dialysis headache, Sleepiness, Dialysis, Transplantation



Headache is a common symptom among hemodialysis patients, with a prevalence around 70%. Dialysis headache is defined according to International Classification of Headache Disorders (ICHD-3) as a headache without specific characteristics, occurring during and caused by hemodialysis that spontaneously disappears within 72 hours after the dialysis session. There is no consensus on trigger factors or physiopathology.


To evaluate prevalence, clinical characteristics, and associated factors with dialysis headache.


Observational study with quantitative analysis. Study patients were divided into two groups: (HD) 25 hemodialysis patients and (Tx) 25 early post kidney transplant patients. A structured questionnaire was applied to all patients, including Hospital Anxiety and Depression Scale (HADS) and Epworth Sleepiness Scale. Laboratory data, blood pressure and body weight were analyzed before and after one dialysis session. Results: In group HD, eight patients (32%) had diagnosis of dialysis headache, with pulsating headache (n=6, 75%), photophobia (n=6, 75%), phonophobia (n=4, 50%), and nauseas or vomiting (n=6, 75%), with a mean pain score of 7.75 ± 1.58. Headache group had higher scores of anxieties (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), lower levels of serum calcium (p=0.01), and higher systolic (p=0.02) and diastolic (p=0.02) blood pressure pre dialysis. In group Tx, five patients (20%) reported dialysis headache, with pulsating headache (n=4, 80%), nauseas or vomiting (n=4, 80%), with a mean pain score of 8.0 ± 1.41. Headache group had a higher score of sleepiness (9.20 ± 4.32 vs. 4.80 ± 4.51, p=0.029) and were younger (38.93 ± 14.43 vs. 54.02 ± 8.31, p=0.03).


Headache is frequent among hemodialysis patients and had similar symptoms of migraine. In this series dialysis headache was associated with higher scores of anxieties and sleepiness, higher blood pressure and lower calcium pre dialysis.


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Sav M, Sav T, Senocak E, Sav N. Hemodialysis-related headache. Hemodial Int 2014;18(4): 725-9. doi:10.1111/hdi.12171 DOI: https://doi.org/10.1111/hdi.12171

Melo E, Aguiar F, Rocha-Filho P. Dialysis Headache: A Narrative Review. Headache. 2017;57(1): 161-164. doi:10.1111/head.12875 DOI: https://doi.org/10.1111/head.12875

Stojimirovic B, Milinkovic M, Zidverc-Trajkovic J, et al. Dialysis headache in patients undergoing peritoneal dialysis and hemodialysis. Ren Fail. 2015 ;37(2): 241-4. doi:10.3109/0886022X.2014.982486 DOI: https://doi.org/10.3109/0886022X.2014.982486

Bana D, Yap A, Graham J. Headache during hemodialysis. Headache. 1972; 12(1): 1-14. doi:10.1111/j.1526-4610.1972.hed1201001.x DOI: https://doi.org/10.1111/j.1526-4610.1972.hed1201001.x

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013 ;33(9): 629-808. doi:10.1177/0333102413485658 DOI: https://doi.org/10.1177/0333102413485658

Botega NJ, Bio MR, Zomignani MA, Garcia Jr C, Pereira WAB. Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD. Ver Saúde Pública. 1995; 29(5):359-363. doi:10.1590/S0034-89101995000500004 DOI: https://doi.org/10.1590/S0034-89101995000500004

Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna Barreto SS, Johns MW. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol. 2009;35 (9):877-883. doi:10.1590/S1806-37132009000900009 DOI: https://doi.org/10.1590/S1806-37132009000900009

Gozubatik-Celik G, Uluduz D, Goksan B, et al. Hemodialysis-related headache and how to prevent it. Eur J Neurol 2019; 26(1): 100-105. doi:10.1111/ene.13777 DOI: https://doi.org/10.1111/ene.13777

Chhaya K, Mankad S, Shah M, Patel M, Desai D, Desai S. Headache Associated with Hemodialysis in Patients with End-Stage Renal Disease in India: A Common Yet Overlooked Comorbidity. Ann Indian Acad Neurol 2022;25(1): 82-87. doi:10.4103/aian.aian_404_21 DOI: https://doi.org/10.4103/aian.aian_404_21

Sousa Melo E, Pedrosa R, Carrilho Aguiar F, Valente L, Sampaio Rocha-Filho P. Dialysis headache: characteristics, impact and cerebrovascular evaluation. Arq Neuropsiquiatr 2022; 80(2): 129-136.doi:10.1590/0004-282X-ANP-2021-0133 DOI: https://doi.org/10.1590/0004-282x-anp-2021-0133

Göksan B, Karaali-Savrun F, Ertan S, Savrun M. Haemodialysis-related headache. Cephalalgia 2004; 24(4): 284-7. doi:10.1111/j.1468-2982.2004. 00668.x DOI: https://doi.org/10.1111/j.1468-2982.2004.00668.x

Cho S, Song T, Chu M. Sleep and Tension-Type Headache. Curr Neurol Neurosci Rep 2019;19(7):44. doi:10.1007/s11910-019-0953-8 DOI: https://doi.org/10.1007/s11910-019-0953-8

Ferini-Strambi L, Galbiati A, Combi R. Sleep disorder-related headaches. Neurol Sci 2019; 40(Suppl 1):107-113. doi:10.1007/s10072-019-03837-z DOI: https://doi.org/10.1007/s10072-019-03837-z

Baskin S, Lipchik G, Smitherman T. Mood and anxiety disorders in chronic headache. Headache. 2006 ;46 (Suppl 3): S76-87. doi:10.1111/j.1526-4610.2006.00559.x DOI: https://doi.org/10.1111/j.1526-4610.2006.00559.x

Huang C, Wee P, Low L, et al. Prevalence and risk factors for elevated anxiety symptoms and anxiety disorders in chronic kidney disease: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69: 27-40. doi:10.1016/j.genhosppsych.2020.12.003 DOI: https://doi.org/10.1016/j.genhosppsych.2020.12.003

Cohen S, Cukor D, Kimmel P. Anxiety in Patients Treated with Hemodialysis. Clin J Am Soc Nephrol 2016;11(12): 2250-2255.doi:10.2215/CJN.02590316 DOI: https://doi.org/10.2215/CJN.02590316

Mei Y, Barrett J, Hu H. Calcium release-activated calcium channels and pain. Cell Calcium. 2018;74: 180-185. doi:10.1016/j.ceca.2018.07.009 DOI: https://doi.org/10.1016/j.ceca.2018.07.009

Kowalska M, Prendecki M, Piekut T, Kozubski W, Dorszewska J. Migraine: Calcium Channels and Glia. Int J Mol Sci 2021;22(5): 2688. doi:10.3390/ijms22052688 DOI: https://doi.org/10.3390/ijms22052688

Golan E, Haggiag I, Os P, Bernheim J. Calcium, parathyroid hormone, and vitamin D: major determinants of chronic pain in hemodialysis patients. Clin J Am Soc Nephrol 2009;4(8): 1374-80. doi:10.2215/CJN.00680109 DOI: https://doi.org/10.2215/CJN.00680109




How to Cite

Gomes BT, Costa ALG da, Mazzali M. Dialysis headache: prevalence and clinical presentation in hemodialysis and kidney transplant patients. Headache Med [Internet]. 2023 Feb. 2 [cited 2024 Mar. 2];13(4):265-70. Available from: https://headachemedicine.com.br/index.php/hm/article/view/735