NxStage System One: Saying Goodbye to Headaches

February 17, 2010
NxStage System One: Saying Goodbye to Headaches
By Peter Laird, MD

One of the most difficult symptoms that I dealt with while doing conventional incenter hemodialysis were the frequent headaches. Headaches which were especially worse on Monday night, after my long dialysis weekend. As many as 70% of hemodialysis patients complain of headaches before, during or immediately after completing a dialysis session. This does not have to happen, you can say goodbye to headaches.

The most commonly noted type of headache is related to the dialysis disequilibrium syndrome (DDS) which remains an unproven cause to date. Most investigators believe that DDS is related to cerebral swelling after removing high levels of urea during dialysis and slowly compensated cerebral fluid shifts. For myself, it is likely that the throbbing, Monday night headaches, which were centered in my frontal region, were related to this phenomena, since I seldom experienced them on any other dialysis day. I also noted that the headaches on Monday were always worse if I had coffee during our Sunday outings. Caffeine is an important factor in any headache management attempt, Caffeine Withdrawal Headache Explained: Your Brain On - And Off - Caffeine:

The team demonstrated that stopping daily caffeine consumption produces changes in cerebral blood flow velocity and quantitative EEG that are likely related to the classic caffeine withdrawal symptoms of headache, drowsiness and decreased alertness. More specifically, acute caffeine abstinence increased brain blood flow, an effect that may account for commonly reported withdrawal headaches. Acute caffeine abstinence also produced changes in EEG (increased theta rhythm) that has previously been linked to the common withdrawal symptom of fatigue. Consistent with this, volunteers reported increases in measures of "tired," "fatigue," "sluggish" and "weary." Overall, these findings provide the most rigorous demonstration to date of physiological effects of caffeine withdrawal.

Aside from caffeine withdrawal, several other causative factors are associated with headaches among people who use dialysis, including: hypertension, high sodium intake, intradialytic hypotension and a possible connection with low magnesium. Because rare cases are associated with glaucoma, it is mandated that all recurring headaches be taken seriously and have a thorough investigation as to the precise cause.

For people who use dialysis, controlling hypertension is one of the most important treatment factors to consider. Especially when headache complaints are seen in conjunction with high blood pressure. Volume control through sodium reduction and appropriate blood pressure medications are effective in reducing both headaches and high blood pressure. This was demonstrated by Dr. Bernard Charra of Tassin France (PDF link), in several studies since the 1980’s.

Perhaps the greatest benefit I have personally gleaned from switching to the NxStage System One is an almost complete absence of headaches. At present, dietary indiscretions with too much sodium in foods or too much caffeine trigger the few headaches that I do experience, but I no longer have to take long, hot showers once or twice at night after dialysis. These showers were once part of my conventional dialysis routine - no longer! With more frequent dialysis, I experience less frequent headaches.

In addition, the relation of my headaches to sinus congestion for some reason has diminished since starting on NxStage. I am certain that reducing the fluctuation of dialysis associated toxins by doing dialysis five days a week and avoiding the long dialysis weekend are key elements in reducing my headaches. Occasionally this is confirmed, since I do still experience headaches on the few occasions when I have had to skip dialysis two days in a row. In addition, the ultra-pure dialysate used with the NxStage System One may reduce inflammation, inflammation which can directly exacerbate sinus conditions caused by my allergies.
Having access to the NxStage System One and saying goodbye to my headaches is a welcome benefit of taking charge of my own dialysis treatments at home. It is just one of the many blessings I enjoy since leaving behind conventional incenter dialysis. If you suffer headaches during or after hemodialysis, considering daily dialysis. Once other common causes of headaches are excluded by your medical team, you may find more dialysis to be the best defense against dialysis headaches.

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