Sakit kepala

William Lukman dan Karin Felicity

 DD
• Migrain
Pasien datang • Vertigo
dengan keluhan Anamnesis • HT
sakit kepala • TTH
• SAH
• Infeksi
 Unilateral ,
berdenyut,
4 – 72 jam.
Worst Seperti
headache tertekan di
in my life ( kepala dan
PJK, HT) leher
Sakit
kepala
Demam/
Seperti
riwayat
berputar
infeksi

TD >
140/90
 Unilateral ,
berdenyut, 4 – 72
jam, fotofobia,
diperberat aktivitas,
mual

Tata Laksana akut:

Aspirin, NSAID
Profilaksis: beta
blocker, antagonis
Migraine Dengan aura dan
tanpa aura
serotonin, CCB,dll

Pencetus:Hormon,
makanan, stress,
rangsangan sensorik,
faktor fisik, perubahan
lingkungan, alkohol,
merokok
 • MIGREN
• Nyeri Kepala berulang dengan serangan nyeri
berlangsung 4 – 72 jam.
• Sifat: Unilateral, berdenyut, intensitas nyerinya sedang
sampai berat, diperhebat oleh aktivitas +
mual/muntah, foto&fonofobia
• Klasifikasi: umum (tanpa aura), klasik (aura)
• Pencetus:Hormon, makanan, stress, rangsangan
sensorik, faktor fisik, perubahan lingkungan, alkohol,
merokok
• Tata Laksana akut: Aspirin, NSAID
• Profilaksis: beta blocker, antagonis serotonin, CCB,dll
 Migraine without aura
• Diagnostic criteria:
A. At least 5 attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hours (untreated or unsuccessfully
treated)
C. Headache has at least two of the following characteristics:
A. unilateral location
B. pulsating quality
C. moderate or severe pain intensity
D. aggravation by or causing avoidance of routine physical activity (eg,
walking or climbing stairs)
D. During headache at least one of the following:
A. nausea and/or vomiting
B. photophobia and phonophobia
E. Not attributed to another disorder
 Migraine with aura
• Diagnostic criteria:
A. At least 2 attacks fulfilling criterion B
B. Migraine aura fulfilling criteria one of the
• Aura consisting of at least one of the following, but no motor weakness:
– fully reversible visual symptoms including positive features (eg, flickering
lights, spots or lines) and/or negative features (ie, loss of vision)
– fully reversible sensory symptoms including positive features (ie, pins and
needles) and/or negative features (ie, numbness)
– fully reversible dysphasic speech disturbance
• At least two of the following:
– homonymous visual symptoms and/or unilateral sensory symptoms
– at least one aura symptom develops gradually over ≥5 minutes and/or
different aura symptoms occur in succession over ≥5 minutes
– each symptom lasts ≥5 and ≤60 minutes
C. Not attributed to another disorder
 Treatment nonpharmacologic
• identification and avoidance of specific
headache triggers
• regulated lifestyle is helpful, including a
healthy diet, regular exercise, regular sleep
patterns, avoidance of excess caffeine and
alcohol, and avoidance of acute changes in
stress levels
 Migren umum Migren Klasik TTH
Awitan Anak-d.muda Anak-d.muda U.Pertengahan
Kelamin Wanita> Wanita> -
Riwayat Ada Ada Tidak
Ev&Wkt Relatif&Ep. Relatif&Ep Ep/konstan
Kualitas Denyut Denyut Tidak/stabil
Lokasi Var/unilateral Var/uni Var/bi
Gejala Prodormal Prodormal tidak
 nyeri/ rasa tidak
nyaman di kepala,
kulit kepala atau
leher 
ketegangan otot

Tata Laksana akut:

TTH
Analgesik, NSAID
Episodic (30m-7w)
Profilaksis: & Chronic (>15d)
Kompres&mandi panas,
tidur/istirahat

Depresi/Ansietas
 • TENSION TYPE HEADACHE
nyeri/ rasa tidak nyaman di kepala, kulit kepala atau
leher  ketegangan otot
• Sifat: ringan/sedang, tidak hubungan aktivitas,
bilateral, tidak (mual-muntah,fono/foto-fobia)
• Klasifikasi: Episodic (30m-7w) & Chronic (>15d)
• Manifestasi: Nyeri relative, tumpul dan tidak
berdenyut, difus, spontan, stress/lelahm
insomnia, iritabilitas.
• Tata Laksana akut: Analgesik, NSAID
• Profilaksis: Kompres&mandi panas,
tidur/istirahat
 Thunderclap
headache/ nyeri
kepala yang
sangat parah,
kaku kuduk,mual

Tatalaksana : pecahnya pemburu

Farmako
(nimodipine) dan
Bedah
SAH darah didalam ruang
sub-arachnoid secara
spontan/tanpa trauma

CT-SCAN / MRI
 • CVD Sub-Arakhnoid
Nyeri kepala yang disebabkan pecahnya pemburu
darah didalam ruang sub-arachnoid secara
spontan/tanpa trauma
• S&S: sakit kepala menyeluruh dan hebat,
penurunan kesadaran hingga pingsan, kaku
kuduk, mual dan muntah
• PF & FR: Nyeri + meningeal + perdarahan retina,
papiledema, HT, PJK
• Komplikasi: Hemoragic berulang, Penyebaran
pendarahan, Vasospasme Arteri, Hidrosefalus,
Kejang, dll
• Tatalaksana : Farmako (nimodipine) dan Bedah
• Prognosis : malam
 Headache attributed to subarachnoid
haemorrhage (SAH)
• Diagnostic criteria:
A. Severe headache of sudden onset fulfilling
criteria C and D
B. Neuroimaging (CT or MRI T2 or flair) or CSF
evidence of non-traumatic subarachnoid
haemorrhage with or without other clinical signs
C. Headache develops simultaneously with
haemorrhage
D. Headache resolves within 1 month
 Gerakan berputar

CCB (Flunarisin,Sinarisin),
AH (Prometasin,
Dimenhidrat), AK
(Skopolamin, Atropin), MA
Vertigo Sentral dan perifer

(Amfeamine,Efedrin

Nistagmus, neurologis (Posturografi

(tes Romberg yang dipertajam, post-
pointing test, Manuver Nylen Barany
atau Dix Hallpike), tes kalorik saraf
kranial, motoric, sensorik)
 Vertigo : Sensasi abnormal berupa gerakan berputar
Vertigo tipe sentral adalah gerakan Vertigo tipe perifer dikenal dengan Benign Positional Paroxysmal
berputar yang umumnya disebabkan Vertigo (BPPV), umumnya membaik dengan maneuver posisional.
oleh masalah vaskuler BPPV umumnya idiopatik dan psikologis di telinga

Predisposisi: Kurangnya pergerakan aktif, alkoholisme akut, pascaoperasi mayor

PF: Nistagmus, neurologis (Posturografi (tes Romberg yang dipertajam)

Anamnesa dan Pemeriksaan Fisik Sentral Perifer

Rasa mual berlebihan + +++
Muntah + +
Diperburuk o/ pergerakan kepala tidak spesifik ++
Pencetus o/ pergerakan kepala spesifik (Dix-Hallpike) + -
Nistagmus paroksismal ke atas & rotatoar (MDH) - +++
Nistagmus paroksismal ke bawah dengan MDH ++ +++
Nistagmus d/ perubahan posisi horizontal paroksismal (geotropic/ageiotrpik) yang + ++
dibangkitkan oleh perputaran posisi horizontal kepala
Nistagmus persisten ke bawah pada semua posisi +++ -
Hilangnya nistagmus dengan pengulangan posisi - +++
Membaik setelah perawatan dengan manuver posisional - +++
 INFEKSI
Etiologi: Meningitis & ensefalitis
• MK: TB, Herpes, Sifilis, dll
• Def: Sakit kepala yang disebabkan oleh adanya
proses peradangan di kepala dikarenakan proses
dari mikrobiologi.
• S&S : Bilateral, nyeri tajam, makin nyeri ketika
digerakan atau melakukan maneuver,
peningkatan TIK, foto fobia dan kaku kuduk
positif.
• Tatalaksana : AB, AV (kdg), OAT
 Headache attributed to bacterial
meningitis
• Diagnostic criteria:
A. Headache with at least one of the following characteristics
and fulfilling criteria C and D:
A. diffuse pain
B. intensity increasing to severe
C. associated with nausea, photophobia and/or phonophobia
B. Evidence of bacterial meningitis from examination of CSF
C. Headache develops during the meningitis
D. One or other of the following:
A. headache resolves within 3 months after relief from
meningitis
B. headache persists but 3 months have not yet passed since
relief from meningitis
 Headache attributed to lymphocytic
meningitis
• Diagnostic criteria:
A. Headache with at least one of the following characteristics
and fulfilling criteria C and D:
A. acute onset
B. severe intensity
C. associated with nuchal rigidity, fever, nausea, photophobia
and/or phonophobia
B. Examination of CSF shows lymphocytic pleocytosis, mildly
elevated protein and normal glucose
C. Headache develops in close temporal association to
meningitis
D. Headache resolves within 3 months after successful
treatment or spontaneous remission of infection
 Hipertensi

Tiga bacaan tekanan darah  140/90 mmHg saat

istirahat

American Heart Association

Recommended Blood
Pressure Levels
 Headache attributed to hypertensive
crisis without hypertensive
encephalopathy
• Diagnostic criteria:
A. Headache with at least one of the following characteristics and
fulfilling criteria C and D:
A. bilateral
B. pulsating quality
C. precipitated by physical activity
B. Hypertensive crisis defined as a paroxysmal rise in systolic (to
>160 mm Hg) and/or diastolic (to >120 mm Hg) blood pressure
but no clinical features of hypertensive encephalopathy
C. Headache develops during hypertensive crisis
D. Headache resolves within 1 hour after normalisation of blood
pressure
E. Appropriate investigations have ruled out vasopressor toxins or
medications as causative factors
 Headache attributed to hypertensive
encephalopathy
• Diagnostic criteria:
A. Headache with at least one of the following characteristics and fulfilling criteria C
and D:
A. diffuse pain
B. pulsating quality
C. aggravated by physical activity
B. Persistent blood pressure elevation to >160/100 mm Hg with at least two of the
following:
A. confusion
B. reduced level of consciousness
C. visual disturbances (other than those of typical migraine aura) including blindness
D. seizures
C. Headache develops in close temporal relation to blood pressure elevation
D. Headache resolves within 3 months after effective treatment and control of
hypertension
E. Other causes of the neurological symptoms have been excluded
 Treatment
• It is suggested that physicians induce a
prompt but partial BP decrease, aiming at a <
25% BP reduction during the first hours,
• Labetalol, sodium nitroprusside, nicardipine,
nitrates and furosemid

ESC journal
Algoritma pengobatan hipertensi
 10 Cara untuk Mengontrol Tekanan
Darah
1. Ketahui tekanan darah anda
Apakah diperiksa secara teratur ?
2. Ketahui berat badan anda
Apakah proporsional?
3. Jangan gunakan garam yang berlebih pada
makanan
Hindari makanan asin
4. Makan makanan yang diet rendah lemak
5. Jangan merokok
6. Minum obat seperti yang sudah diresepkan
7. Sering berkonsultasi dengan dokter
8. Rutin berolahraga
9. Ajak anggota keluarga anda untuk mengontrol
tekanan darah secara teratur
10. Hiduplah secara normal dan bahagia.