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Nyeri Kepala

Dyah Yuniati
FK UNUSA – RSI Jemursari
Surabaya
Lokasi
 Unilateral
 Migrain
 Cluster
 Hemicrania
 Bilateral
 TTH
 Wajah (Area V1 dan V2)
 TN
 Other facial pain
Durasi
 Jam, intermittent
 Migrain
 Cluster

 Detik-menit
 Trigeminal neuralgia
 Hari
 TTH
Duration
Pola dan Waktu Serangan
 Periodik yang jelas, terutama malam hari
 Cluster
 Waktu bervariasi
 Migrain
Kualitas Nyeri dan Derajat Nyeri
 Severe
 Migraine (pulsating)
 Cluster (deep, boring)
 TN (sharp)
 Mild-Moderate
 TTH (tight)
Gejala penyerta
 Migraine
 Fotofobia
 Nausea, vomiting

 Cluster
 Hiperemia konjungtiva
 Air mata
 Keringat separuh wajah
 pilek
Trigger factor
 Migraine
 Menstrual
 Sleep deprivation
 Light
 Cluster
 Cigarette , alcohol consumption
 TN
 Touch of mouth mucosa
Perilaku pasien
 Migrain
 Tidur, mencari tempat gelap
 TTH
 Mencari kesibukan untuk melupakan sakit
kepalanya
 TN
 Sering memegang bagian wajah yang sakit
Warning Signs—“Headache
Alarms”
 Nyeri mendadak dan sangat hebat (thunderclap headache) → SAH
 Dengan defisit neurologi
 Dengan kejang
 Dengan kaku kuduk dan demam
 Dengan riwayat penyakit lain misalnya HIV dan kanker
 Kronik Progresif
 TD > 180/110
 Nyeri kepala hebat pertama kali usia > 50
 Nyeri kepala disusul penurunan kesadaran
Migrain
 The headache is on only one side.
 There is a pulsating quality.
 The pain is moderate or severe and interferes with normal daily
activities.
 The pain is aggravated by walking stairs or similar physical activity.
 During the headache, at least one of the following is present:
 1. Nausea and/or vomiting.
 2. Photophobia (light sensitivity) and phonophobia
(sound sensitivity).
 The headache is not caused by any other disorder
Female vs male in Migraine
4 stage of Migraine
 Prodrome
 Depressed
 Other behaviour that not usual
 Increase appetite
 Aura
 Scintilating, aphasia, weakness
 Sensory aura
 Headache
 Pulsating w/ nausea and vomiting
 Postdrome
Scintilating and sensory Aura
Migraine Triggers
 Food & drinks
 Caffein withdrawal
 MSG
 Citrus
 aspartat
 Relaxed after stress
 Position
 cough
Treatment
 Abortive  Prophylaxis
 Specific  Betablockers
 Ergot  Antideprresant
 Ergotamine caffeine
 Ca antagonist
 Triptans
 Sumatriptans  Antiepileptics
 Non specific  VPA
 NSAID  Topiramate
 PCT + ASA + caffeine  Gabapentine
 Opioids  5HT antagonist
 Corticosteroids  methysergide
Factors take account on treatment
 Whether the migraineur has severe nausea or
vomiting
 The drug’s risk of rebound
 The headache’s speed of onset
 The headache’s ultimate severity
 The headache’s duration
 How the person responded to past treatments
 Risk factors for complications from a particular
medicine
Indication for prophylaxis
 Frequent > = 2 x/mo w/ disability > 3 days
 Serious SE w/ acute medication
 Acute medication over use
 Hemiplegic migraine or other serious
neurological involvement
 Very frequent headache > 2 x/weeks
Tension Type Headache
• Bilateral
• Tight
• Mild to moderate in severity level
• with spasm of neck and scalp muscle
• minutes to days
• not agravated by activity
TTH clasification
• TTH epidodik infrequent
• TTH episodik frequent
• Chronic TTH
• Probable TTH
TTH Tx
Acute
• simple NSAID
• NSAID + Caffeine
• NSAID + Muscle relaxan
• Transquilizer
• relaxation
• trigger point injection
• Botox injection
Chronic TTH
• usually casue by medication overuse
• Tx;
• Drugs cessation
• antidepresant
• Acupuncture
Cluster headache (Horton neuralgia)
• unilateral
• periodically
• Moderate to severe
• Man > woman
• nasal congestion, red eye and
tear, sweat unilaterally
• 15-180 minutes 3-8x/days
• Agravated by smoke or alcohol
use
Kriteria Diagnostik
• Paling sedikit 5 serangan yang memenuhi kriteria B-D.
• Nyeri hebat atau sangat hebat di orbita, supra orbital
dan/atau temporal yang unilateral, berlangsung 15-180
menit bila tak diobati.
• Nyeri kepala disertai setidak-tidaknya satu dari sbb.
• Injeksi konjungtiva dan atau lakrimasi ipsilateral.
• Kongesti nasal dan atau rhinorrhoea ipsilateral.
• Edema palpebra ipsilateral.
Cluster headache
• Dahi dan wajah berkeringat ipsilateral.
• Miosis dan atau ptosis ipsilateral.
• Perasaan kegelisahan atau agitasi.
• Serangan-serangan mempunyai frekwensi: dari 1
kali setiap 2 hari sampai 8 kali per hari.
Tx Abortif
• Inhalasi O2100% 7 liter/menit dengan masker wajah
 15 menit  perbaikan.
• Ergotamine tartrat 1 mg tab sublingual  tiap 5
menit sampai 3 mg perbaikan.
• Kombinasi inhalasi O2 & ergotamine.
• Ergotamine 1-2 mg oral saat gejala pertama
serangan  lalu inhalasi O2100% dengan
masker resusitasi 7 l/menit  sampai nyerinya reda.
Tx Abortif
 Tetes hidung idocaine
 Inhalasi lidocaine 4% 1ml intranasal  dengan
posisi badan supine dan kepala ekstensi di atas
kepala tempat tidur  sisi nyeri kepala klaster
dinaikkan memperpendek durasi nyeri
Tx preventif
• Lifestyle modification
• Ca antagonis: nifedipin 60-120 mg/hari atau
• Klonidin
• Valproic acid
• kortikosteroid
• TERIMA KASIH

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