Dialysis Headache in Hemodialysis Patients: Is a History of Recurrent Headaches Prior to Hemodialysis a Risk Factor?

Background: Headache is a frequent but underrecognized complication in patients undergoing hemodialysis. This study aimed to estimate the frequency and describe the clinical characteristics of dialysis headache, and to identify associated risk factors, particularly a pre-dialysis history of recurrent headaches, in patients with end-stage renal disease. Methods: A cross-sectional study was conducted at the hemodialysis unit of King Khalid University Hospital. Data were collected from adult end-stage renal disease patients receiving maintenance hemodialysis using a structured questionnaire administered via direct interviews and phone calls. Results: Seventy-nine patients were included; 40 (50.6%) met criteria for dialysis headache. Females were more common in the dialysis headache group, while males predominated among those without headache. Diabetes mellitus was significantly more prevalent in the non–dialysis headache group. A prior history of headaches was associated with dialysis headache. Most dialysis headaches were of moderate intensity, described as dull or throbbing, or with mixed characteristics, typically located in the temporal or frontotemporal regions and lasting about five hours. Diastolic blood pressure during dialysis was significantly lower in patients with dialysis headache. On multivariate analysis, female sex and prior headache history were independently associated with dialysis headache, whereas diabetes mellitus was associated with a lower likelihood of DH. Conclusion: Dialysis headache was observed in a substantial proportion of patients with end-stage renal disease undergoing hemodialysis. A history of recurrent headaches, female sex, and lower intradialytic diastolic blood pressure were associated with dialysis headache, while diabetes mellitus showed an inverse association. Given the cross-sectional design, single-center setting, and relatively small sample size, the findings should be considered exploratory. Further multicenter studies with larger sample sizes are needed to confirm these findings and better elucidate the underlying mechanisms. Plain Language Summary: Patients with end-stage renal disease who undergo hemodialysis often experience headaches during or after dialysis sessions, a condition known as dialysis headache. Despite being common, this condition is often overlooked in clinical practice. In this study, we found that about half of the patients receiving hemodialysis experienced dialysis headaches. These headaches typically occurred during the second half of the dialysis session, were of moderate intensity, and resolved within 24 hours. We also found that patients who had a history of headaches before starting the dialysis program were more likely to develop dialysis headaches. Additionally, female patients were at higher risk, while patients with diabetes appeared less likely to experience these headaches. These findings highlight the importance of recognizing dialysis headache and identifying patients at higher risk. Improved awareness may help clinicians better manage this condition and improve patients’ quality of life.