Dr. M.

Aufa N
 Nyeri kepala

primer sekunder

Tension type Cluster

migrain
headache headache
 Pulsatile
 Unilateral
 4 – 72 hours
 Can’t do ADL (not relieving by rest)
 Can followed by : Photophobia &
Phonophobia (classical / aura)
 Stress
 Foods : MSG, tyramine, nitrite
 Coffein withdrawal
 Too little or too much sleep
 Non pharmacology :
◦ Relaxation technique
◦ Biofeedback
◦ Dark, quite room
◦ Avoid trigger
◦ Adequate sleep, Avoid excessive sleep
◦ Regular exercise
 Pharmacologic :
◦ Abortive
 Ergotamine
 Sumatriptan
◦ Preventive
 Beta blocker
 Tricyclic antidepressant
 Asam valproate
 Calcium channel blocker
 All round
 Tight like headache
 Pericranial muscle tenderness
 Relieving by rest
 Stress factor
 Strictly unilateral
 Ipsilateral autonomic symptoms –at least one of:
conjunctival injection, nasal blockage, facial
sweating, miosis,ptosis
 Bouts-typically 1/year lasting 6-12 weeks
with discrete headaches 1-8times /day each
lasting 30-60 mins
 Age 20-40 M>F=7:1
 Headache severe/excrutiating- restless
“banging head against wall”
 Subcutaneous sumatriptan 6mg

 High dose/high flowrate oxygen

 Intranasal triptans- not so effective

 Verapamil 240-960mg/day ( ECG)-
bradycardia,hypotension,arrythmias,constipation,fatigue,oedema

 Lithium 400-2000mg/day hypothyroidism,Diabetes insipidus,

tremor,nausea, wt gain ataxia drowsiness, confusion seizure

 Methylsergide 3-12mg/day vascular constrictive

phenomena, fibrotic reactions ,muscle cramps, abdominal discomfort weight gain, mood
change

Transitional treatments:
High dose corticosteroids- 1mg/kg ( up to 60mg
daily for 5 days tapering over 2-3 weeks
rapid onset of action. Attack recurs once dose reduced. Initial
add-on until other preventatives are effective
 vertigo

Perifer Sentral
berputar dizzines

Neuritis vestibularis
BPPV Meniere - Cerebellum
& Labirinitis
Perub posisi + detik tinitus - Brain stem
Riw infeksi + lama

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