Dialysis headache: a systematic review and meta-analysis

Introduction: Dialysis headache (DH) is a known but underexplored complication of hemodialysis, affecting some patients during treatment. While, it is recognized, the reported frequency, diagnostic criteria, and associated risk factors vary. Objective: This systematic review and meta-analysis aim to determine the percentage and characteristics of dialysis headache, identify associated factors, and summarize available evidence from existing literature. Methods: A comprehensive literature search was conducted across Scopus, Medline, PubMed, and Google Scholar for studies published from 2000 to the present. A total of 15 studies were included, encompassing various study designs and geographic locations. Data on patients demographics, headache characteristics, diagnostic criteria, and hemodialysis parameters were extracted and analyzed. A proportional meta-analysis was performed using R-4.3.2. Results: The included studies reported DH prevalence ranging from 7% to 53%. The overall pooled estimate was 28% (95% CI: 19-36%). After refining the dataset by excluding studies with confounding factors and improving study selection criteria, the updated prevalence estimate was 16% (95% CI: 9-24%). DH onset typically occurred during hemodialysis sessions, predominantly in the second or third hour, and most cases resolved within four hours post-dialysis. Headaches were generally of moderate intensity and managed with simple analgesics. Conclusions: Dialysis headache remains a prevalent but inconsistently reported complication of hemodialysis. Standardized diagnostic criteria and further research are needed to better understand its pathophysiology and improve management strategies. (AU)