Barber Mark
The David S. and Ruth L. Gottesman Center for Headache Treatment and Translational Research at the Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 7th Floor, New York, NY, 10029, USA.
Curr Pain Headache Rep. 2025 Jan 8;29(1):16. doi: 10.1007/s11916-024-01313-8.
The objective of this review is to describe recent updates in the understanding of dialysis headache. These recent findings will be placed in a historical context that reviews the clinical features, classification, epidemiology, pathophysiology, and treatment of dialysis headache.
There is something intrinsic to the dialysis procedure itself that leads to headaches in susceptible individuals. Proposed mechanisms include fluid and electrolyte shifts, blood pressure parameters, the release of neuroinflammatory particles, and the mechanics of the dialysis procedure. Recent findings quantify the potential roles of CGRP and substance P in dialysis headache pathophysiology. Advances in dialysis techniques, like online hemodiafiltration, have also been found to vastly reduce headache incidence. Caffeine, which has anecdotally been considered potentially therapeutic for dialysis headache, may not actually provide benefit. Dialysis headache significantly impairs quality of life in many individuals on hemodialysis, a procedure which is itself already burdensome. A clearer understanding of the pathophysiology of dialysis headache has the potential to drive therapeutic advances.
本综述的目的是描述对透析性头痛认识的最新进展。这些最新发现将置于一个历史背景中，该背景回顾了透析性头痛的临床特征、分类、流行病学、病理生理学及治疗。
透析过程本身存在某种内在因素，可导致易感个体出现头痛。提出的机制包括液体和电解质变化、血压参数、神经炎性颗粒的释放以及透析过程的力学原理。最新发现量化了降钙素基因相关肽（CGRP）和P物质在透析性头痛病理生理学中的潜在作用。还发现诸如联机血液透析滤过等透析技术的进步可大幅降低头痛发生率。以往一直认为可能对透析性头痛有治疗作用的咖啡因，实际上可能并无益处。透析性头痛严重损害了许多接受血液透析患者的生活质量，而血液透析本身就已负担沉重。对透析性头痛病理生理学更清晰的理解有可能推动治疗进展。
