Hemodialysis 101 | Why Do You Get Headaches During Dialysis? How to Prevent Them?

Headache is one of the common complications for patients undergoing maintenance hemodialysis (MHD), often forcing patients to interrupt or prematurely end treatment.

Studies show that 27.6% to 70% of dialysis patients have experienced hemodialysis-related headaches (HRH), significantly impacting their quality of life.

I. How to Diagnose HRH?

HRH typically occurs 3 to 4 hours after the start of hemodialysis, lasting less than 4 hours, with moderate intensity. The most common areas affected are the bilateral frontal and temporal regions, characterized by recurrence, intermittence, and nonspecificity.

The 2013 ICHD-3β further defined the diagnostic criteria for HRH:

1. No headache before dialysis, with headaches occurring entirely in relation to dialysis.

2. Patients with a history of migraines, tension-type headaches, etc., exhibit headache characteristics during dialysis that are distinctly different from their past experiences.

II. Related Pathogenic Factors

Headaches are caused by a combination of complex factors. The mechanism of HRH is not yet clear, with no definitive clinical, laboratory, or imaging manifestations, making it difficult for clinicians to diagnose and treat. Effective treatment methods are lacking both domestically and internationally. Previous studies suggest the following factors are related to the occurrence of HRH:

1. Dialysis Disequilibrium Syndrome:

The rapid removal of urea from plasma and extracellular fluid during dialysis creates an osmotic pressure difference between the blood and cerebrospinal fluid, causing brain edema and imbalances in water, electrolytes, and acid-base levels.

2. Changes in Arterial Blood Pressure:

A sudden rapid increase in blood pressure is one of the factors causing headaches. Hypertension can lead to various cardiovascular diseases, such as coronary artery disease and congestive heart failure, which can cause headaches.

3. Cerebral Blood Flow Velocity:

Transcranial Doppler tests have shown that cerebral blood flow velocity in HRH patients is significantly higher than in those without headaches. Treatment with vasodilators significantly reduces cerebral blood flow velocity, suggesting a connection between increased cerebral blood flow velocity and headaches.

4. Long-term Coffee Consumption:

For patients who regularly drink coffee, dialysis can quickly remove caffeine from the body, leading to caffeine withdrawal headaches.

5. Central Venous Stenosis:

The incidence of central venous stenosis is about 30% in hemodialysis, with high-pressure turbulence stimulating intimal hyperplasia, causing vascular stenosis. Increased blood flow during dialysis can lead to excessive venous filling, causing facial and eye conjunctiva, increased intracranial pressure, headaches, and vomiting.

Other factors include glaucoma, hemolysis, dialyzer reactions, emotional tension, and lack of sleep, all of which can cause headaches during dialysis.

III. How to Diagnose HRH

HRH typically occurs 3 to 4 hours after the start of hemodialysis, lasting less than 4 hours, with moderate intensity. The most common areas affected are the bilateral frontal and temporal regions, characterized by recurrence, intermittence, and nonspecificity.

1. Shorten Initial Dialysis Time: The dialysis time should not be too long (2-4 hours is appropriate).

2. Adjust Dialysis Protocol: Use low-temperature dialysis, reduce dialysis fluid flow rate, and extend dialysis time.

3. Prevent Cerebral Edema: Inject 50% glucose before the end of dialysis; infuse mannitol or albumin during dialysis.

4. Reduce Disequilibrium Syndrome Incidence: Use glucose-containing or high-sodium dialysis fluids.

5. Control Blood Pressure: Hypertensive patients should actively manage blood pressure through a reasonable diet and control of dry weight. During dialysis, patients can take or inject antihypertensive medications.

6. Treat Glaucoma: Glaucoma patients should use eye drops to reduce eye pressure.

7. Change Dialyzers: Using more biocompatible dialyzers can significantly improve headaches caused by poor biocompatibility.

Headaches reduce the quality of life for MHD patients and can lead to anxiety, depression, and other mental disorders. Understanding the causes of headaches can help patients better prevent or reduce their occurrence.

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References:

1. Gan Quan et al. Platelet Parameters and Hemodialysis-Related Headaches. Stroke and Neurological Diseases, 2024, 31(01), 58-62.

2. Yan Danxia et al. Effects of Different Dialysis Methods on the Incidence of Headaches During Hemodialysis. Nursing Practice and Research, 2019, 16(14), 27-29.

3. Xue Chengfang, Han Xinrong. Analysis of Factors Related to Headaches During Dialysis in Hemodialysis Patients and Nursing Strategies. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine, 2014, 24(08), 177-178.

4. Zhang Tong et al. Research Progress on Dialysis-Related Headaches. Chinese Journal of Gerontology, 2015, 35(20), 5983-5985.

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