Clinical description of hemodialysis headache in end-stage renal disease patients

BACKGROUND: Hemodialysis (HD)-related headaches are a common complaint of patients undergoing this procedure. OBJECTIVE: To determine the frequency and clinical characteristics of headache in patients undergoing HD and to discuss their diagnostic criteria. METHOD: The present study assessed, in a prospective manner, a series of patients consulting at a HD center in Aracaju, Sergipe, Brazil, from November 2007 to January 2008. Only patients with HD-related headaches without previous history of primary headache were diagnosed as isolated HD headache (HDH). RESULTS: Headache was reported by 76.1 percent of the patients studied. Prior to beginning dialysis, 47.9 percent had migraine without aura, 6.7 percent migraine with aura, 0.6 percent hemiplegic migraine, 5 percent episodic tension-type headache, and 2.5 percent migraine and tension-type headache. HDH was diagnosed in 6.7 percent of the patients, the most prevalent features being diffuse or temporal region location, bilateral headache, throbbing nature, and moderate severity. Seven patients with headaches between the sessions were not classified. CONCLUSION: While the pathophysiology of HDH is unknown, to diagnose patients with HDH or other possible HD-related headaches remains a challenge.