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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