Acute and prophylactic treatment of dialysis headache: a systematic review.

INTRODUCTION

Dialysis headache (DH) has a prevalence ranging from 27% to 73% among patients undergoing hemodialysis. Research on its treatment remains limited.

METHODS

This systematic review explores the treatment of DH. It was conducted according to the PRISMA statement and registered in PROSPERO (CRD42023493031). The following databases were used: PubMed/Medline, LILACS/Scielo, Cochrane, Scopus, Web of Science, Embase and Google Scholar.

RESULTS

Eight trials were included. One controlled clinical trial showed that watching comedy films during hemodialysis was associated with less headache. Another showed no benefit from drinking coffee. Open-label trials compared different dialysis techniques. There was less headache in profiled hemodialysis (combining sodium and ultrafiltration) than in standard hemodialysis, in hemodialysis using an automatic adjustment in ultrafiltration rate and hemofiltration than in standard hemodialysis. There was no difference between the step and linear sodium profiling programs. An open clinical trial reported a reduction in the intensity and frequency of DH after the use of nortriptyline. A retrospective cohort study reported less DH in patients undergoing online hemodiafiltration (combining diffusion and convection mechanisms) compared to those receiving conventional hemodialysis.

CONCLUSION

Environmental changes and changes in dialysis techniques may contribute to a lower incidence of DH. Nortriptyline possibly improves DH.