title: Headache during haemodialysis in a patient with shunt: a cause for concern?
abstract: A 20-year-old woman with a functioning ventriculoperitoneal (VP) shunt consistently reported unbearable vertex headaches and nausea during the last hour of her haemodialysis (HD) sessions. After one particularly severe episode, which was associated with vomiting, restlessness and blurred vision, her team suspected that she was developing dialysis disequilibrium syndrome. She improved fully on cessation of HD, requiring simple analgaesia only, and continued dialysis three times per week. Several more distressing episodes of nausea and headaches compelled us to give intravenous mannitol during HD, resulting in temporary improvement. Subsequently, shorter and more frequent dialysis sessions along with intravenous mannitol resulted in satisfactory clinical response.
authors.affiliation: Department of Neurosurgery, Cork University Hospital, Cork, Ireland.
authors.forename: Padraig
authors.initials: P
authors.lastname: O'Sullivan
authors.affiliation: Department of Neurosurgery, Cork University Hospital, Cork, Ireland.
authors.forename: Jahangir
authors.initials: J
authors.lastname: Sajjad
authors.affiliation: Department of Neurosurgery, Cork University Hospital, Cork, Ireland.
authors.forename: Sahibzada
authors.initials: S
authors.lastname: Abrar
authors.affiliation: Department of Neurosurgery, Cork University Hospital, Cork, Ireland.
authors.forename: Charles
authors.initials: C
authors.lastname: Marks
mesh_terms: D004234:Diuretics, Osmotic / Q000627:therapeutic use; D005260:Female; D006261:Headache / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008353:Mannitol / Q000627:therapeutic use; D009325:Nausea / Q000209:etiology; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D017287:Ventriculoperitoneal Shunt; D014786:Vision Disorders / Q000209:etiology; D014839:Vomiting / Q000209:etiology; D055815:Young Adult
chemical_list: D004234:Diuretics, Osmotic; D008353:Mannitol
references.citation: Cephalalgia. 2004 Apr;24(4):284-7
references.pmid: 15030537
references.citation: Intensive Care Med. 2000 May;26(5):628-30
references.pmid: 10923740
references.citation: Hemodial Int. 2008 Jul;12(3):313-5
references.pmid: 18638084
references.citation: Minerva Anestesiol. 2012 May;78(5):629
references.pmid: 22534734
references.citation: J Child Neurol. 2003 Apr;18(4):292-6
references.pmid: 12760433
references.citation: Hemodial Int. 2008 Jul;12(3):301-6
references.pmid: 18638082
references.citation: J Neurosurg Pediatr. 2008 Aug;2(2):143-5
references.pmid: 18671622
references.citation: Headache. 1976 Sep;16(4):168-72
references.pmid: 965229
references.citation: Pediatr Nephrol. 2012 Dec;27(12):2205-11
references.pmid: 22710692
references.citation: Crit Care. 2012 Dec 31;16(6):472
references.pmid: 23280151
references.citation: Am J Kidney Dis. 1999 Aug;34(2):228-34
references.pmid: 10430967
references.citation: Am J Nurs. 2000 Feb;100(2):53-4
references.pmid: 10683644
references.citation: Cephalalgia. 2013 Jul;33(9):629-808
references.pmid: 23771276
references.citation: Cephalalgia. 2006 Nov;26(11):1287-93
references.pmid: 17059435
references.citation: West J Med. 1989 Jul;151(1):52-5
references.pmid: 2763540
references.citation: Headache. 2006 Jan;46(1):40-5
references.pmid: 16412150
references.citation: Nephrol Nurs J. 2001 Jun;28(3):348-9
references.pmid: 12143458
references.citation: Headache. 2003 Feb;43(2):99-102
references.pmid: 12558762
references.citation: BMC Nephrol. 2013 Nov 18;14:255
references.pmid: 24238645
references.citation: Hemodial Int. 2011 Oct;15 Suppl 1:S64-7
references.pmid: 22093604
references.citation: Semin Ophthalmol. 2007 Jul-Sep;22(3):133-5
references.pmid: 17763231
references.citation: Clin Neurol Neurosurg. 2003 Sep;105(4):249-52
references.pmid: 12954540
references.citation: Cephalalgia. 2005 Jan;25(1):71-4
references.pmid: 15606574
references.citation: BMC Nephrol. 2004 Aug 19;5:9
references.pmid: 15318947
references.citation: Headache. 1972 Apr;12(1):1-14
references.pmid: 4555483