Intractable dialysis-associated headache: a management dilemma in pediatric hemodialysis.

Dialysis-associated headache (DAH) is a common and recognized complication of chronic hemodialysis. We report a diagnostically challenging case of severe intradialytic headache in an adolescent with chronic kidney disease stage 5 and a history of ventriculoperitoneal shunt. A comprehensive evaluation excluded dialysis disequilibrium syndrome, biochemical and hemodynamic contributors, primary headache disorders, infection, vascular pathology, ophthalmologic causes, and shunt malfunction. Subsequent progression of focal neurological findings revealed a diffuse intramedullary spinal cord glioma. This case highlights the limitations of solely attributing refractory DAH to dialysis-related etiologies and underscores the importance of repeated neurological reassessment and multidisciplinary management in pediatric dialysis patients.