Dialysis headache
Headache is one of the most common complaint among chronic kidney disease (CKD) patients who are on hemodialysis (HD). Headache occurs in 27% to 70% of hemodialysis patients. We will discuss about the type of headache, causes and the ways to tackle this common problem among dialysis patients.
Type of headache
Dialysis headache has the following features
- Starts with mild pain and gradually becomes more severe
- Pain is bifrontal (i.e., situated on both sides at the front of head)
- Throbbing type (pulsating)
- May worsen on lying down
- If severe may lead to nausea and vomiting
- Headache resolves within 72 hours of finishing the dialysis (usually resolves in few hours after dialysis session)
- It may start during the dialysis or few hours after the end of dialysis session
- Headache disappears after successful kidney transplantation
Causes of dialysis headache
Exact cause for hemodialysis headache is not clear yet but there are some factors which are associated with headache in these patients.
a)Blood pressure
Those patients with higher blood pressure values before dialysis had higher chance of dialysis head ache. Drop in blood pressure (Hypotension) during a dialysis session can also cause headache
b)Low magnesium levels
Low levels of magnesium in the blood have been associated with dialysis headache and there are reports of treatment of patients with magnesium supplements.
c)Change in urea levels before and after dialysis
Excessive decline in levels of urea before and after dialysis is considered as one of the triggering factors. Excess rapid decrease in urea levels may cause mild brain swelling which causes headache and gradually swelling decreases with resolution of pain.
d)Excessive coffee consumption
Caffeine withdrawal headache occurs within 24 hours of last consumption in people who consume 200mg of caffeine per day for more than 2 weeks. This is also seen in dialysis patients because caffeine is eliminated in dialysis leading to withdrawal.
e)Depression
Patients who have depressive symptoms have increased risk of pain in the body. Headache in turn may worsen depression in these patients.
f)Changes in the components of blood with dialysis
Studies have shown that changes in some protein components of the blood like gene-related peptide (CGRP), substance P with dialysis can trigger headache. Changes in nitric oxide levels are also associated with headache.
g)Raised intraocular pressure (Rare cause)
Rarely high intraocular pressure (high pressure in the eyes- glaucoma) during dialysis sessions can cause headache.
Impact of headache in dialysis patients
Severe and recurrent headache may lead to poor quality of life, depression and incomplete dialysis sessions. Incomplete dialysis sessions will lead to accumulation of water and waste products in the body.
Treatment
As there is no clarity regarding the exact cause of dialysis headache specific treatment option is not available and multiple medications are tried with variable success rates in these patients. Following measures can be tried to prevent and treat the headache.
- Controlling blood pressures to appropriate level and prevention of drop in blood pressure during dialysis session
- Checking levels of electrolytes Sodium, magnesium and correction of those abnormalities if present can help. Magnesium can be supplemented as tablets if there is deficiency
- Advise patients to avoid excess coffee consumption to prevent withdrawal headache. If patient persistently consumes excessive coffee then a cup of coffee during dialysis can help in some patients if cause is attributed to coffee withdrawal
- Treatment of depression can decrease bodily pain along with headache
- Some medications like chlorpromazine before dialysis session, angiotension conveting enzyme inhibitors (fosinopril and lisinopril) and nortryptiline are tried in these patients but there is no strong evidence of clear benefit. They need to be taken only when prescribed and under nephrologist supervision as they can have unwanted adverse effects which may be serious sometimes.
Dr. Kishore Kumar Ariga
Nephrologist and renal transplant physician
PACE hospitals
Hyderabad