What causes pounding headaches during dialysis?

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Posted on Thu, 14 Jan 2016 in Kidney Conditions
Question: My dad has been on dialysis for 2 years and has only recently been getting pounding headaches 1 hour into dialysis. He says they are pretty painful and it only occurs in his forehead and just to the right of the forehead. It does not make him sensitive to light, sound or any vision changes. He was in the hospital a month ago for a left leg amputation and while in the rehab unit, he had a seizure that we witnessed and it took him 2 days to wake up from it. The MRI showed Posterior Reversible Encepholopothy, caused by very high blood pressure. Luckily, he is almost 100% neurologically and memory regained. I bring that up because only after the seizure and PERS MRI result is when the headaches started on dialysis. He never had headaches before on dialysis prior to the seizure/headache. The doctors did not put him on any new medications after this and tylenol helps the headache greatly but it still bothers him, and I do not like him taking tylenol almost every day. He is on Metoprolol 50MG Extended Release 1x per day usually in the morning and his blood pressure is fairly controlled(usually in the 130's/70's) however sometimes it gets high during dialysis . I have an appointment with a neurologist in January, as that was the first available.
Any answers?

Thank You!
doctor
Answered by Dr. Rakesh Madhyastha 36 minutes later
Brief Answer:
Dialysis headache

Detailed Answer:
Hello

Thanks for the query

Dialysis headache is common and it can be because of various reasons. I need a few more details from you in order to help you

1. What is the blood pressure during the start, 1st hour, 2nd hour and end of dialysis?
2. How often does he get dialysed in a week?
3. Since how long he's diabetic? Was blood sugars checked when he gets headaches?
4. What is the usual weight gain between dialysis?
5. If possible, please ask your dialysis technician what Ultrafiltrate profiling has been kept for your father

Please get back to me, I am awaiting your reply

Regards
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Rakesh Madhyastha 1 hour later
1. Usually blood pressure before dialysis is 140-150/70, 1st hour gets a little lower, 2nd hour around 140-150/70 and the end of dialysis gets high if the do a rinse back, if not it stays at the 140-150/70 range.
2. He goes 3x times a week for 3.5 hours each time.
3. He has been a diabetic for 20 years. His blood sugar has never been checked at the dialysis clinic, but I will have them do that next time. When I check it at night(sometimes when he has a headache), its almost always under 200.
4. He usually gains 1.2-1.5kilos between dialysis, although he has been urinating a little more then he used too.
5. I will ask them or have him ask them the next time he sees them.
doctor
Answered by Dr. Rakesh Madhyastha 23 hours later
Brief Answer:
Ultrafiltrate control

Detailed Answer:
Hello

Thanks for getting back

Going through what you have said it looks like his dry weight needs adjusting, sudden surge in blood pressure at the end of dialysis indicates too much fluid removal which can cause headache.
The other solution is to remove more during the first 2 hours and lesser during the last hour, this is known as UF profiling, please speak to your doctor regarding this.

I hope I was of help, if you need any further assistance please get back to me

Regards
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Rakesh Madhyastha 19 minutes later
Thank you doctor, I will talk to them about UF profiling. He spoke with the Neophrologist at the facility, and he prescribed him a new blood pressure medication because his blood pressure was getting high both before, during and after dialysis. He said the Metoprolol has a high chance of getting wiped out during dialysis, so he prescribed a drug that has less of a chance of that.
doctor
Answered by Dr. Rakesh Madhyastha 21 hours later
Brief Answer:
Can be taken after dialysis

Detailed Answer:
Hello

Thanks for getting back. It is true that Metoprolol is dialysable but it is a good anti hypertensive and has additional properties of preventing mycoardial infaction , hypertrophy of the heart etc.

I usually ask my patients to take the metoprolol after dialysis.

Which drug has the nephrologist prescribed?

Regards
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Rakesh Madhyastha 42 minutes later
He has said to continue taking Metoprolol and also prescribed Nifedical 60mg before dialysis
doctor
Answered by Dr. Rakesh Madhyastha 5 hours later
Brief Answer:
Regards

Detailed Answer:
Hello

Its a good drug and has a prolonged action, please take the medicine as advised . I wish you and your family merry Christmas and a happy new year.

Regards
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
Answered by
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Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4360 Questions

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