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Nyeri kepala

dr. Ariel Nugroho S

SKDI 2013

Primary headache
Tension type headache
Migraine
Cluster type headache

Secodary headache
Headache attributed to trauma or
injury to the head and/or neck
Headache attributed to cranial or
cervical vascular disorder
Headache attributed to non-vascular
intracranial disorder
Headache attributed to a substance or
its withdrawal
Headache attributed to infection
Headache attributed to disorder of
homoeostasis
Headache or facial pain attributed to
disorder of the cranium, neck,eyes,
ears, nose, sinuses, teeth, mouth or
other facial or cervical structure
Headache attributed to psychiatric
disorder

Tension type headache


Sakit kepala yang paling sering dan sering berulang
Tegang otot dan faktor psikogenik

Episodik
Stress
Cemas
Kelelahan

Kronis
15/bulan dalam 6
bulan
Sering memiliki
keluhan somatic
lainnya
(mual2,myalgia,arthr
algia)

International headache society


criteria
2 dari gejala berikut :
Pressing or tightening (nonpulsatile)
Frontal-occipital location
Bilateral (mild/moderate intensity)
Not aggravated by physical activity

therapy
NSAIDs
Profilaksis :
Tryciclic antidepressant
Muscle relaxant
Botox

Non farmakologi
physical therapy
massage therapy
biofeedback
acupuncture
relaxation exercises

The International Classification of Headache Disorders,


3rd edition (beta version).Cephalalgia. 2013 Jul.
33(9):629-808.
Bendtsen.L, Evers.S, Linde.M, et al. EFNS guidline on the
treatment of tension-type headache Report of an EFNS
task force. European Journal of Neurology. 2010;
17:1318-25

Migraine headache
Tanpa aura
Dengan aura 1 dari 5 orang dengan migraine
headache

Perdossi
Nyeri kepala berulang dengan manifestasi serangan selama 4
72 jam dengan karakteristik :
nyeri kepala unilateral
Berdenyut
intensitas sedang atau berat
bertambah berat dengan aktivitas fisik yg rutin
dan diikuti dengan mual muntah (80%) dan atau fonofobi dan
fotofobi.

Gejala penyerta lain


Cranial/cervical muscle tenderness
Horner syndrome (ie, relative miosis with 1-2 mm of ptosis on
the same side as the headache)
Conjunctival injection
Tachycardia or bradycardia
Hypertension or hypotension
Hemisensory or hemiparetic neurologic deficits (ie,
complicated migraine)
Adie-type pupil (ie, poor light reactivity, with near
dissociation from light)

Therapy
Abortive

Selective serotonin receptor (5-HT1) agonists (triptans)


Ergot alkaloids
Analgesics
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Combination products
Antiemetics

Preventive

Antiepileptic drugs
Beta blockers
Tricyclic antidepressants
Calcium channel blockers
Selective serotonin reuptake inhibitors (SSRIs)
NSAIDs
Serotonin antagonists
Botulinum toxin

Silberstein SD, Freitag FG. Preventative treatment of


migraine. Neurology. 2003. 60(7):S38-44.
Matchar DB. Acute management of migraine: highlights
of the US Headache Consortium.Neurology. 60(7):S213.

Cluster headache
Kriteria diagnosis (international headache classification III )

Serangan berat sangat berat


Unilateral (orbital, supraorbital, atau temporal )
Berlangsung 15 180 menit
Berlangsung 1 8 x perhari
Disertai gejala ipsilateral sbg berikut:
Injeksi konjungtiva - facial sweating
Kongesti nasal - miosis
Lakrimasi - ptosis
Rhinorrhea - edema kelopak mata

Episodik
2 serangan
antara 7 hari 1
tahun
Jarak antara 2
serangan
tersebut 1 bulan
atau lebih

Kronik
> 1 kali/ tahun
Tiap serangan <
1 bulan

etiologi
Tidak di ketahui scr pasti
Hipotesis pertama vasoactive substance inflamasi
pembuluh darah parasellar dan sinus cavernosus area
mengaktifkan trigerminal pain pathway
Hipotesis kedua abnormalitas hypothalamus PET
scan, terjadi peningkatan aktifitas pada thalamus saat
terjadi serangan 47% mengikuti irama sirkadian

Dlm beberapa studi , pencetus CH sbg berikut:


Injeksi histamine subkutan 69%
Stress, allergens, seasonal change
Nitroglycerin
80% pasien CH perokok berat
50% peminum alcohol berat

tatalaksana
Abortive
Oxygen (8L/min) 100% NRM
Triptan (sumatriptan 6mg subcutan)
Dihydroergotamine (IM/IV)

Preventive
Calcium channel blocker non dihidropiridin
(verapamil)
Lithium
Tricyclic antidepressant

The International Classification of Headache Disorders,


3rd edition (beta version).Cephalalgia. 2013 Jul.
33(9):629-808.
Tfelt-Hansen P. Acute pharmacotherapy of migraine,
tension-type headache, and cluster headache.J
Headache Pain. 2007 Apr. 8(2):127-34.
Beck E, Sieber WJ, Trejo R. Management of cluster
headache.Am Fam Physician. 2005 Feb 15. 71(4):71724.[Medline].

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