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What Causes Severe Headaches During Dialysis Procedure?
Question: I asked about my father getting headaches during dialysis and I wanted to clarify some points.
History: He is a diabetic type 2, End Stage Renal Disease, Hypertension, high cholesterol and had his left leg above the knee amputated. On the last day of his hospital stay he had a seizure, which he never had before. The MRI revealed PERS due to high blood pressure and my father has had 100% memory and cognitive function regained since that. No repeat MRI or CT has been done.
Problem: My father gets very bad headaches in his forehead right above his eyes 1 hour into dialysis and it gets really bad where he has to come off early sometimes. His blood pressure is actually controlled in the 130-140 over 60-80 range. His headache usually goes away a couple hours after coming off dialysis, although he has some minor headaches on non-dialysis days.
I followed the advice of a doctor on here who recommended controlling the blood pressure and lowering the dialysis pump speed which we did, however it has not helped. Prior to the seizure/PERS, he rarely had a headache with dialysis. Could he be allergic to some fluids or the filter they use?
History: He is a diabetic type 2, End Stage Renal Disease, Hypertension, high cholesterol and had his left leg above the knee amputated. On the last day of his hospital stay he had a seizure, which he never had before. The MRI revealed PERS due to high blood pressure and my father has had 100% memory and cognitive function regained since that. No repeat MRI or CT has been done.
Problem: My father gets very bad headaches in his forehead right above his eyes 1 hour into dialysis and it gets really bad where he has to come off early sometimes. His blood pressure is actually controlled in the 130-140 over 60-80 range. His headache usually goes away a couple hours after coming off dialysis, although he has some minor headaches on non-dialysis days.
I followed the advice of a doctor on here who recommended controlling the blood pressure and lowering the dialysis pump speed which we did, however it has not helped. Prior to the seizure/PERS, he rarely had a headache with dialysis. Could he be allergic to some fluids or the filter they use?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Thank you for your question on HCM!
Your fathers symptoms seem to be compatible with dialysis headache.
This is a common type of headache occurring during the dialysis and lasts some hours up to 72 hours after the dialysis.
It can be explained by different factors :
-the psychological stress associated with dialysis
-the increase in nitric oxide that peaks between the third and fourth hour of dialysis
-low levels of magnesium (before and after dialysis)are a risk factor
The intake of Nifedical during dyalisis seems to exacerbate this headache (increasing even more nitric oxide). I would recommend discussing with his doctor on the possibility of lowering the dose of nifedical or switching to another antihypertensive drug, to avoid this effect.
I agree with your doctor's advise on controlling the blood pressure and lowering the dialysis pump speed. This can be helpful. A low blood pressure is essential in controlling headaches.
You should know that PRESS occurs when blood brain barrier is disrupted because the autoregulatory mechanisms of the blood vessels have failed (by high blood pressure in this case). This may have lead to a hypersensibility of blood vessels in the brain to nitric oxide, leading to high frequency of headaches.
I would also recommend measuring his magnesium plasma levels. If it results low, magnesium supplements would help relieve headache.
ACEI or amytriptiline would help too, as a preventive therapy, but I am afraid that they can not be used in this case, because of their adverse effects and the complex medical situation of your father.
These types of headache is known to be relieved by successful renal transplant, but I don't know if this is possible in your father's case
Hope to have been of helfpul!
Best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Thank you for your question on HCM!
Your fathers symptoms seem to be compatible with dialysis headache.
This is a common type of headache occurring during the dialysis and lasts some hours up to 72 hours after the dialysis.
It can be explained by different factors :
-the psychological stress associated with dialysis
-the increase in nitric oxide that peaks between the third and fourth hour of dialysis
-low levels of magnesium (before and after dialysis)are a risk factor
The intake of Nifedical during dyalisis seems to exacerbate this headache (increasing even more nitric oxide). I would recommend discussing with his doctor on the possibility of lowering the dose of nifedical or switching to another antihypertensive drug, to avoid this effect.
I agree with your doctor's advise on controlling the blood pressure and lowering the dialysis pump speed. This can be helpful. A low blood pressure is essential in controlling headaches.
You should know that PRESS occurs when blood brain barrier is disrupted because the autoregulatory mechanisms of the blood vessels have failed (by high blood pressure in this case). This may have lead to a hypersensibility of blood vessels in the brain to nitric oxide, leading to high frequency of headaches.
I would also recommend measuring his magnesium plasma levels. If it results low, magnesium supplements would help relieve headache.
ACEI or amytriptiline would help too, as a preventive therapy, but I am afraid that they can not be used in this case, because of their adverse effects and the complex medical situation of your father.
These types of headache is known to be relieved by successful renal transplant, but I don't know if this is possible in your father's case
Hope to have been of helfpul!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Wow, that was a very detailed answer and I thank you for that. I will discuss this with his Nephrologist and Neurologist. If he does have a hypersensibilitt to NO,or the Nitric,Oxide is causing the headaches, what can be done to help with that?
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello again!
As I explained, this is one of the physiopathological mechanisms of this type of headache.
There is not too much we can do in his clinical situation.
I would recommend reducing the dose of nifedical if possible, or switch to another drug. Nifedical is a contributor of nitric oxide.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello again!
As I explained, this is one of the physiopathological mechanisms of this type of headache.
There is not too much we can do in his clinical situation.
I would recommend reducing the dose of nifedical if possible, or switch to another drug. Nifedical is a contributor of nitric oxide.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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