TABLE 1

DIFFERENTIAL DIAGNOSIS OF HEADACHE

PRIMARY HEADACHE DISORDERS

1. Migraine Headache
2. Tension Type Headache
1. Episodic tension type
2. Chronic tension type (Chronic Daily Headache (CDH), Chronic Migraine (CM), Rebound Headache)
3. Cluster Headache
4. Miscellaneous Headaches Not Associated With Structural Lesions
1. Cold Stimulus headache
2. Headache associated with sexual activity
3. Benign cough headache
4. Benign exertional headache

SECONDARY HEADACHE DISORDERS

1. Brain tumor, abscess

2. Subarachnoid hemorrhage, aneurysm, arteriovenous malformation
3. Intracerebral hemorrhage
4. Head trauma, subdural or epidural hematoma
5. Meningitis / encephalitis
6. Cerebrovascular disease
7. Inflammation (temporal or giant cell arteritis)
8. Cranial neuralgias: trigeminal neuralgia, occipital neuralgia
9. Sinusitis
10. Increased intracranial pressure (pseudotumor cerebri, aquaductal stenosis)
11. Low pressure headaches (post lumbar puncture, spontaneous, trauma induced)

QUESTIONS TO AID IN HEADACHE DIAGNOSIS

1. How long have you been suffering with headaches?

2. What age were you when the headaches began?
3. Do you know when a headache is coming on do you have an aura flashing lights, numbness of one side of
the body?
4. How often do you get a headache?
5. Are there any aggravating or precipitation factors?
6. Family history of headaches?
7. How long do the headaches last?
8. Where is the pain located?
9. Describe the pain.
10. On a scale of 1 5 how strong is the pain?
11. Are there any other symptoms?
12. Previous medications tried, both prescription and over-the- counter.
13. Previous diagnostic studies.
14. Impact of the headaches How does it disrupt your life? Are the headaches disabling? Do you miss work,
school, play, social activities? Does it keep you from doing things you would normally do?
15. Current treatment, if any.

COMFORT FEATURES FOR DIAGNOSING MIGRAINE HEADACHES

1. Family history of migraine (present in the majority of patients)

2. Headache pain which changes locations
3. Menstrual association
4. Stable headache pattern
5. Otherwise healthy individual
6. Prodromes and/or auras
7. Fulfills IHS criteria
8. Resolution with sleep
 HEADACHE WARNING SIGNS SUGGESTING FURTHER EVALUATION

ONSET OF HEADACHE AFTER AGE 50

ONSET OF A NEW OR DIFFERENT TYPE OF HEADACHE
CHANGE IN A HEADACHE PATTERN
THE WORST HEADACHE EVER EXPERIENCED, SUDDEN APOPLECTIC EVENT
THE FIRST HEADACHE EVER EXPERIENCED
THE ONSET OF A SUBACUTE HEADACHE THAT PROGRESSIVELY WORSENS OVER TIME
THE ABRUPT ONSET OF HEADACHE WITH EXERTION, SEXUAL ACTIVITY, COUGHING, OR SNEEZING
A HEADACHE NOT FITTING A DEFINED PATTERN AND NOT RESPONDING TO AGGRESSIVE
TREATMENT
AN ABNORMAL NEUROLOGICAL EXAMINATION
ABNORMAL NEUROLOGICAL EXAMINATION

HEADACHE ASSOCIATED WITH ANY OF THE FOLLOWING NEUROLOGICAL FINDINGS SUGGEST

CONTINUED INVESTIGATION.
DROWSINESS, CONFUSION, MEMORY IMPAIRMENT
WEAKNESS, ATAXIA, LOSS OF COORDINATION
NUMBNESS AND/OR TINGLING IN EXTREMITIES
PARALYSIS
SENSORY LOSS ASSOCIATED WITH HEADACHE
ASYMMETRY OF PUPILLARY RESPONSE, DEEP TENDON REFLEXES, OR BABINSKI RESPONSE
SIGNS OF MENINGEAL IRRITATION (NECK PAIN, BACK PAIN)
PROGRESSIVE VISUAL OR NEUROLOGICAL CHANGES
OTHER EVIDENCE TO SUGGEST AN UNDERLYING NEUROLOGICAL DISORDER, SUCH AS PERSISTENT
TINNITUS, LOSS OF SMELL, LOSS OF SENSATION OVER THE FACE, DYSPHAGIA, ETC.
PAPILLEDEMA
ABNORMAL MEDICAL EVALUATION

FEVER
STIFF NECK
WEIGHT LOSS
TENDER, POORLY PULSATILE TEMPORAL ARTERIES
CHRONIC COUGH, LYMPHADENOPATHY, RECURRENT NASAL DRAINAGE/DISCHARGE, OR OTHER
EVIDENCE TO SUGGEST A SYSTEMIC ILLNESS
GUIDELINES FOR USE OF CAT OR MRI IN HEADACHES

THE USE OF NEUROIMAGING PROCEDURES MAY BE INDICATED WHEN ANY OF THE FOLLOWING IS
PRESENT.
AN ABNORMAL NEUROLOGICAL EXAMINATION, SUCH AS DECREASED ALERTNESS, FOCAL
NEUROLOGICAL SIGNS OR NUCHAL RIGIDITY
NEW ONSET OF HEADACHES AFTER AGE 50
THE FIRST HEADACHE OR THE WORST HEADACHE EVER EXPERIENCED
AN INCREASING FREQUENCY AND/OR SEVERITY OF THE HEADACHES
A CHANGE IN THE HEADACHE PATTERN
AN ABRUPT ONSET OF THE HEADACHE WITH EXERTION, COITUS, COUGHING OR SNEEZING
A HEADACHE NOT FITTING A DEFINED PATTERN AND NOT RESPONDING TO AGGRESSIVE
TREATMENT

TABEL 1

DIAGNOSIS DIFERENSIAL HEADACHE

GANGGUAN HEADACHE UTAMA

Sakit kepala sebelah

Ketegangan Tipe Sakit kepala

Jenis ketegangan episodik

Tipe ketegangan kronis (Chronic Daily Headache (CDH), Migraine Kronis (CM), Sakit Kepala Rebound)

Cluster Headache

Sakit Kepala Miscellaneous Tidak Berhubungan Dengan Lesi Struktural

Sakit kepala Stimulus Dingin

Sakit kepala berhubungan dengan aktivitas seksual

Sakit kepala jinak

Sakit kepala jenuh

GANGGUAN HEADACHE SEKUNDER

Tumor otak, abses

Perdarahan subarachnoid, aneurisma, malformasi arteriovenosa

Perdarahan intracerebral

Trauma kepala, hematoma subdural atau epidural

Meningitis / ensefalitis

Penyakit serebrovaskular

Peradangan (temporal atau giant cell arteritis)

Neuralgia kranial: neuralgia trigeminal, neuralgia oksipital

Radang dlm selaput lendir

Tekanan intrakranial meningkat (pseudotumor cerebri, stenosis aquaductal)

Sakit kepala tekanan rendah (pasca lumbal tusukan, spontan, trauma yang diinduksi)

PERTANYAAN UNTUK MEMILIKI DIAGNOSA HEADACHE

Sudah berapa lama Anda menderita sakit kepala?

Berapa usiamu saat sakit kepala dimulai?

Tahukah Anda saat sakit kepala sedang terjadi - apakah Anda memiliki lampu aura - berkedip, mati
rasa di satu sisi tubuh?

Seberapa sering Anda sakit kepala?

Apakah ada faktor yang memberatkan atau curah hujan?

Riwayat keluarga sakit kepala?

Berapa lama sakit kepala?

Dimana letak sakitnya?

Jelaskan rasa sakitnya.

Pada skala 1 - 5 seberapa kuat rasa sakitnya?

Apakah ada gejala lain?

Obat sebelumnya dicoba, baik resep maupun over-the-counter.

Studi diagnostik sebelumnya.

Dampak sakit kepala - Bagaimana cara mengganggu hidup Anda? Apakah sakit kepala
melumpuhkan? Apakah Anda merindukan pekerjaan, sekolah, bermain, kegiatan sosial? Apakah hal
itu membuat Anda tidak melakukan hal-hal yang biasanya Anda lakukan?

Perawatan saat ini, jika ada.

FITUR KENYAMANAN UNTUK MENYADARI MIGRAINE HEADACHES

Riwayat keluarga migrain (hadir di sebagian besar pasien)

Sakit kepala yang mengubah lokasi

Asosiasi menstruasi

Pola sakit kepala stabil

Jika tidak sehat individu

Prodromes dan / atau aura

Memenuhi kriteria IHS

Resolusi dengan tidur

TANDA PERINGATAN HEADACHE MENUJU EVALUASI LEBIH LANJUT

ONSET OF HEADACHE SETELAH USIA 50

ONSET JENIS BARU ATAU BERBEDA DARI HEADACHE

PERUBAHAN DALAM POLA HEADACHE

"TERBURUK" HEADACHE EVER EVER EVERIENCED, SUDDEN "APOPLECTIC" EVENT

HEADACHE PERTAMA PERNAH BERPENGALAMAN

THE ONSET OF A SUBACUTE HEADACHE YANG PROGRESSIVELY WORSENS OVER TIME

ONSET ABRUPT OF HEADACHE DENGAN EXERTION, ACTIVITY SEXUAL, COUGHING, ATAU SNEEZING

A HEADACHE TIDAK MENYEDIAKAN POLA DEFINISI DAN TIDAK BERTANGGUNG JAWAB ATAS
PERAWATAN AGRESIF
PEMERIKSAAN NEUROLOGI ABNORMAL

PEMERIKSAAN NEUROLOGI ABNORMAL

HEADACHE BERKAITAN DENGAN TEMUAN-TEMUAN NEUROLOGI BERIKUT TERUS MENERUSKAN

INVESTIGASI TERUS MENERUS.

KERUGIAN, KONFUSSI, MEMORY IMPAIRMENT

KESEMPATAN, ATAXIA, KERUGIAN KOORDINASI

NUMBNESS AND / ATAU TINGLING IN EXTREMITIES

KELUMPUHAN

KERUGIAN SENSOR YANG TERKAIT DENGAN KEPALA

ASYMMETRI RESPON PUPILLARY, DEEP TENDON REFLEXES, ATAU BABINSKI RESPONSE

TANDA-TANDA IRRITASI MENINGEAL (NECK PAIN, BACK PAIN)

PERKEMBANGAN VISUAL ATAU NEUROLOGI PROGRESIF

BUKTI LAINNYA UNTUK MENYAMBUT KESEHATAN NEUROLOGI YANG TIDAK SESUATU, SEPERTI
TINNITUS PERSISTEN, KEHILANGAN Bau, KEHILANGAN SENSASI TERHADAP WAJAH, DYSPHAGIA, DLL.

PAPILLEDEMA

EVALUASI MEDIS ABNORMAL

DEMAM

LEHER KAKU

KERUGIAN BERAT

TENDER, SEMENTARA SEMENTARA PULSATIL TEMPORAL

KEKERASAN KRONIS, LYMPHADENOPATHY, DRAINASE NASIONAL TERBARU / DISCHARGE, ATAU

BUKTI LAIN UNTUK MENYENANGKAN KESULITAN SISTEMIK

PEDOMAN PENGGUNAAN CAT ATAU MRI DI HEADACHES

PENGGUNAAN PROSEDUR NEUROIMAGING DAPAT DIANJURKAN SAAT SETIAP BERIKUT INI ADALAH
PRESENT.

PEMERIKSAAN NEUROLOGI ABNORMAL, SEPERTI PENURUNAN TERSURAT, TANDA-TANDA

NEUROLOGI FOKUS ATAU KAPAL NUCHAL

ONSET BARU KEPALA SETELAH USIA 50

HEADACHE PERTAMA ATAU HEADACHE "TERBURUK" YANG PERNAH BERPENGALAMAN

MENINGKATKAN FREKUENSI DAN / ATAU SEJATI KEPALA

PERUBAHAN DALAM POLA HEADACHE

ONSET ABRUPT OF HEADACHE DENGAN EXERTION, COITUS, COUGHING ATAU SNEEZING

A HEADACHE TIDAK MENYEDIAKAN POLA DEFINISI DAN TIDAK BERTANGGUNG JAWAB ATAS
PERAWATAN AGRESIF