Dialysis Headache: An Updated Literature Review

The objective of this review is to describe recent updates in the understanding of dialysis headache. These recent findings will be placed in a historical context that reviews the clinical features, classification, epidemiology, pathophysiology, and treatment of dialysis headache.

There is something intrinsic to the dialysis procedure itself that leads to headaches in susceptible individuals. Proposed mechanisms include fluid and electrolyte shifts, blood pressure parameters, the release of neuroinflammatory particles, and the mechanics of the dialysis procedure. Recent findings quantify the potential roles of CGRP and substance P in dialysis headache pathophysiology. Advances in dialysis techniques, like online hemodiafiltration, have also been found to vastly reduce headache incidence. Caffeine, which has anecdotally been considered potentially therapeutic for dialysis headache, may not actually provide benefit. Dialysis headache significantly impairs quality of life in many individuals on hemodialysis, a procedure which is itself already burdensome. A clearer understanding of the pathophysiology of dialysis headache has the potential to drive therapeutic advances.