Hemodialysis-related headache (HRH) is highly prevalent in patients undergoing hemodialysis and these headaches appear to be associated with serum blood-urea-nitrogen (BUN) and blood pressure prior to and after dialysis, according to study results published in the European Journal of Neurology.

A total of 494 patients with chronic renal failure on a routine dialysis program for ≥6 months were enrolled in the study. Patients reporting HRH were provided a semi-structured questionnaire to assess the presence and clinical characteristics of headaches and the Visual Analog Scale (VAS) was used to determine headache pain intensity. In addition, data on arterial systolic-diastolic blood pressure, BUN, creatinine, and urea reduction ratio were collected prior to and after hemodialysis.

Of the overall cohort, a total of 175 patients (35.4%) were diagnosed with HRH using the ICHD-II criteria. A significantly greater percentage of patients with HRH were male than female (64.0% vs 36.0%, respectively; P <.001). The mean time until the start of post-hemodialysis headache was 2.90±0.86 hours and the mean headache duration across the HRH population was 6.22±7.8 hours. Headache pain intensity was moderate in severity as determined by a VAS score of 5.64±2.05.

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Compared with patients not reporting headache, patients with HRH had significantly greater differences in pre- and post-BUN values (86.8 ± 28.5 vs 94.6 ± 31.1, respectively; P =.006). In addition, the systolic blood pressure differences between pre- and post-dialysis were greater in patients with HRH (22.4 ± 16.5 mmHg) vs the non-headache controls (12.8±19.4 mmHg) (P <.001). Significantly higher differences in pre- and post-dialysis in systolic/diastolic blood pressure values were also found between the HRH group vs the patients reporting no headache (P <.001, P =.001, respectively).

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A limitation of the study was the lack of screening for headache and anxiety in participants, both conditions that may contribute to headache incidence.

The investigators suggest that HRH may “be prevented by screening for high blood pressure and serum BUN levels prior to dialysis.”


Gozubatik-Celik G, Uluduz D, Goksan B, et al. Hemodialysis related headache [published online August 13, 2018]. Eur J Neurol. doi:10.1111/ene.13777