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Sakit Kepala
Headache/ Nyeri Kepala
, kunjungan ke RSDS , kunjungan ke RSCM kunjungan praktek sore Sp.S merupakan
primary headache
NYERI
Pengalaman sensorik amp emosional yg tidak menyenangkan terkait kerusakan jaringan,
baik aktual maupun potensial atau yang digambarkan dalam bentuk kerusakan tsb.
PATOFISOLOGI NYERI
larynx amp neck are not include.HEADACHE/ Nyeri Kepala DEFINITION Pain on head area
Pain in face. pharynx. Osteo arthritis cervicalis is include Epidemiology TTH CTTH Migrain
female. . men Cluster .
Derajat Nyeri Kepala Praktis Ringan pekerjaan/aktifitas sehari normal. Sedang aktifitas berat
terganggu Berat aktifitas seharihari terganggu .
mukosa c. Nervous V. skin. artery dura mater c. VII. skin head. X. C C C . Sub. duramater II.
IX. STRUCTURE ekstra kranial a.STRUCTURE PAIN SENSITIVE I. b. STRUCTURE Intra
Kranial a. sinus. muscle head/neck. jar. artery basis cranium d.kutan. fasia. vein besar amp
aferennya b. ear amp nose III. Structure from eye. arteryartery d.
Piamater. membrana arachnoidea amp duramater . Ependyma. Parenkim brain . pleksus
choroid . Bone skull .STRUCTURE NOT SENSITIVE PAIN .
Iritasi meningen Ex Meningitis Perdarahan Sub Arachnoid SAH . intracranial . Penarikan or
peregangan arteri intracranial Tumor Absces Hematoma intracranial TIK
hidrosefalus.PATOFISIOLOGY Headache General A. BIH TIK post Lumbal Headache .
Vasodilatasi arteri intra kranial Toksic caused infection With drawl caffein Hipoglikemia..
Hipoksia. Hiperkapnea drug vasodilator Post attack Epilepsi Insufiensi sirculation brain .
B.mal occlusion teeth . contraction muscle Tension headache Secondary muscle contraction
headache Ex . inflammation/Penekanan N. inflammation in mucosa nose. IX Neuralgia
trigeminus Neuralgia glossopharingeus .spondylosis cervicalis . inflammation artery
ekstrakranial Giant cell arterytis temporalis . dilatasi cabang A. BERSUMBER ESKTRA
KRANIAL . N. sinus . V. carotis externa Migren Cluster headache .
. Headache Primer Tension headache Migrain Cluster headache . Headache Secunder .
Headache PRIMER Secunder TTH Migrain Cluster Headache infection Tanda infection
Color/Dolor/ Robor Trauma history Trauma Tumor Trias Headache chronic progresif vomit
proyektil Papil edema Vascular acute Defisit Neurologis fokal .
DIAGNOSIS AND TESTING Detailed History and Examination NO YES Secondary
Headache Diagnostic Testing Primary Headache Preliminary Diagnosis Atypical Features .
impaired alertness. abrupt. exertion . severity. or clinical features Triggered headache
valsava. or consciousness Onset sudden. weight loss or secondary risk factors HIV.RED
FLAGS SNOOP T Systemic symptoms fever. systemic cancer Neurologic symptoms or
abnormal signs confusion. especially in middleage gt Previous headache history first
headache or different change in attack frequency. or progressively worsening Older new
onset and progressive headache.
Classification of headaches Primary headaches Secondary headaches OR Idiopathic
headaches OR Symptomatic headaches THE HEADACHE IS ITSELF THE DISEASE NO
ORGANIC LESION IN THE BEACKGROUND TREAT THE HEADACHE THE HEADACHE
IS ON LY A SYMPTOM OF AN OTHER UNDERLYING DISEASE TREAT THE
UNDERLYING DISEASE .
nasal stuffiness. malaise. photophobia Visual prodrome. Ifteral Frontal. photobhobia
Ipsilateral tearing. facial flushing. vomiting. malaise. sharp Unilateral head especially orbit
minutes Psychogenic/ Chronic TTH Trigeminal meuralgia Dull. nausea.Tabel . Important
features of pain in the evaluation of chronic recurrent headaches HEADACHE Common
migraine Classic migraine QUALITY Throbbing LOCATION Unilateral head / Ifteral head
Unilateral head DURATION hours FREQUENCY Sporadic often several times montlly
Sporadic often several times monthly Closely bunched clusters with long remissions
ASSOCIATED SYMPTOMS Nausea. vomiting. anxiaty Pericranial tenderness Identifiable
trigger zone Throbbing hours Cluster Boring. temporal suboccipital Fifth nerve distribution
Oftem unremitting Brief second May be constant Almost daily Many times daily Lancinating .
Hornerss syndrome Depression. pressure Diffuse.
PHYSICAL FINDING Optic atropy. hydrocephalus. cervical arthritis Retinal hemorrhages
Cranial bruit Thickened. malignant hypertensionon arteryovenous malformation Temporal
arterytis Trigeminal neuralgia Cerebral aneurysm TTH/Muscle Contraction Headache .
papiledema POSSIBLE ETIOLOGY Mass lesion. meningitis. tender temporal arteryes
Trigger point for pain Lid ptosis. benign intracranial hypertensionon Focal neurologic
abnormality hemiparese aphasia Stiff neck Mass lesion Subarachnoid hemorrhage. dilated
pupil Spasm and tenderness of Pericranial muscle Ruptured aneurysm. third nerve palsy.
TTH Headache Type Spasm/ Tension Type Headache TTH OVERVIEW The most common
headache Responsive to over the counter med visits When disabling conjunction with
migraine Spectrum of migraine Beware of medication overuse headache MOH .
Tension Type headache attacks lasting min days of the following Bilateral Not pulsating Mild
or moderate intensity Not aggravated by routine physical activity No nausea or vomiting One
or neither photophobia or phonophobia Not attributable to another disorder .
TTH Classification Episodic lt day/month Peripheral pain mechanism Tx NSAID. Parasetamol
Chronic day/month. months Central pain mechanism Tx Amitriptilin .
Tension Type Headache TTH .
Treatment of TTH Evidence A multipel RCT B RCT C Consensus Clinical effect few people
improved Some people improved Most people improved .
Drug evidence Clinical effect Role Route Analgesic amp NSAID Asetaminofen Aspirin
Mefenamic acid Ibuprofen Naproxen A A A A A Acute PO Ibuprofencaffein A Antidepresan
Amitriptilin Maprotilin Mianserin A B B preventive PO Sulpride Fluvoxamine C B Muscle
relaxants Tizanidine Eperisone B B Acuteamppreventive PO Others Alprazolam Etizolam
prochloperazine chlorpromazine B C C C Acute IV Acuteamppreventive PO .
Ibuprofen mgKetoprofen mg .Ibuprofen mg Ketoprofen mg Naproxen mg .Aspirin mg
Paracetamol mg .Ibuprofen mg Caffein mg ..Aspirin/Paracetamol mg Caffein mg .
Migraine The most common disabling headache The most common headache visits
Unknown causes .
Migraine Criteria attacks lasting h of the following Unilateral Pulsating Moderate or severe
intensity Aggravation by routine physical activity Nausea and/or vomiting Photophobia and
phonophobia of the following Not attributable to another disorder .
.
one from column B evere ni ateral hrobbing Ctivity worsens ausea Lite and sound ensitivity
.SULTANS two from column A.
Lipton et al . Rasmussen . Lavados and Tenhamm . Sakai and Igarashi Prevalence
measured over a few years .World prevalence of migraine Denmark France Switzerland USA
Italy Japan Chile year prevalence rates Populationbased studies IHS criteria or modified
Rasmussen and Olesen .
Prevalence of migraine by sex and age Migraine prevalence Age years Females Males The
American Migraine Study n migraine sufferers Lipton and Stewart .
.
Migraine A. The Aura B. The Attack .
.
. . Hindari pencetus Terapi abortif Non spesifik Spesifik Terapi preventif .Penatalaksanan
migrain .
aspartam pemanis buatan Cahaya terang . nitrit pengawet .Pencetus Migraine Kurang atau
kebanyakan tidur Kelelahan Stres dan kecemasan Terlambat makan Perubahan hormonal
Makanan MSG.
supp mg oral A A A A A . oral mg oral mg oral.Terapi abortif non spesifik Obat ASA Dosis.
mg mg oral Evidence A ASA ibuprofen Naproxen Parasetamol Diklofenac mg IV mg.
Terapi abortif spesifik Ergot Angka rekurensi rendah Menginduksi drug overuse headache dg
cepat Maksimal diberikan hari/bulan Efek samping parestesi. kehamilan dan laktasi .
hipertensi. gagal ginjal. serebrovaskular. muntah Kontra indikasi Penyakit kardio.
parestesi. hipertensi. gagal ginjal. serebrovaskular. fatik Kontra indikasi Penyakit
kardio.TRIPTAN Efikasi lebih baik dibanding ergot Sediaan obat di Indonesia sulit di dapat
hanya ada sumatriptan Efek samping nyeri dada. kehamilan dan laktasi .
atau cenderung overuse . . . . Permintaan pasien . aura memanjang . Serangan gt kali/bln
Berlangsung gt jam Pengobatan akut tdk efektif Ada kontra indikasi terapi abortif.
hemiplegi.Terapi prevensi migrain . Gejala luar biasa migrain basiler. efek samping.
Terapi prevensi migrain Konsensus Nasional III Nyeri Kepala PERDOSSI Obat Dosis
mg/hari evidence betablocker metoprolol propanolol A A Calcium channel blocker Flunarizine
Frego A Anti epileptic Valproic acid A Topiramat A .
Sefalgia sekunder .
stroke Wanita th di bawa ke IRD RS krn mendadak sakit kepala. hemiparese kiri .
Pupil sebelah kanan midriasis . Ia mengeluh sakit kepala namun keadaannya saat itu baik
saat dibawa ke IRD. Empat jam kemudian saat diobservasi ia mengeluhkan sakit kepalanya
bertambah hebat dan kejang.Trauma Anak th terkena pemukul baseball di pelipis. Sesaat
setelah terkena pukulan ia tidak sadar sebentar mnt lalu bangun lagi.
disertai demam sumersumer. . sering diare dan sariawan . Dibawa ke IRD oleh keluarganya
krn bicara meracau.Ia mengkonsumsi narkoba berhenti sjk th silam. pengusaha mengeluh
sakit kepala bln.Infeksi Pria th .
sakit kepala bln bertambah hebat terutama saat bangun dan bersin. memakai kontrasepsi
suntik bulan .Tumor Wanita th.
Sekarang sulit tidur dan sering terlihat seperti berbicara sendiri .Sering lupa th dan tidak
mampu berbelanja lagi krn kesulitan melakukan perhitungan ringan.Degenerasi Wanita th
datang ke poli dengan keluhan sakit kepala hilang timbul th.
ATAS PERHATIANNYA .