Headache in pediatric and adolescent patients with chronic kidney disease, with and without hemodialysis: A comparative cohort study

Background: Several studies have reported dialysis-related headache in adults. We investigated headache and its characteristics in pediatric and adolescent patients with chronic kidney disease and patients treated with dialysis, and compared characteristics of patients with and without headache in the entire cohort and separately among dialysis and among chronic kidney disease patients. Methods: Patients and their parents who attended a nephrology clinic and hemodialysis unit were interviewed regarding the existence of headache and its characteristics. We reviewed hospital files for medical history, blood test results, and pharmacologic treatment. Headache was defined according to International Headache Society criteria. Results: The cohort comprised 60 patients: 39 with chronic kidney disease without hemodialysis and 21 treated with hemodialysis; 39 were males, mean age 11.9 ± 5.3 years. Twenty-six (43.3%) reported experiencing headaches. The hemodialysis group had a higher rate of headache than the chronic kidney disease patients, at 76.2% vs. 25.5%, p < 0.001. In the hemodialysis group, 15 out of 16 reported dialysis-related headache; 14 (87.5%) of these had migraine characteristics. For the entire cohort, headache was associated with hemodialysis, chronic kidney disease grade, lower glomerular filtration rate anemia and a higher parathyroid hormone level. In logistic regression analysis, glomerular filtration rate was significantly associated with headache, odds ratio 2.74 (95% CI 1.56–4.82, p < 0.001). Conclusions: A high rate of headache, mostly migraine type, was reported by hemodialysis patients. Hemodialysis, anemia, higher parathyroid hormone levels, phosphate, and lower glomerular filtration rate are strongly associated with headache among chronic kidney disease pediatric and adolescent patients.