1

NYERI KEPALA
(SEFALGIA)
LUHU A. TAPIHERU
FAKULTAS KEDOKTERAN
UMSU MEDAN
Definition of pain 2

Pain is unpleasent sensory and emotional experience associated

with actual or potential tissue damage, or discribed in term of such
damage ( IASP, 1986 )

Types of pain :
Nociceptive pain
Neuropathic pain
Mixed pain
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Definisi Nyeri Kepala

Nyeri/rasa tidak enak sepanjang orbita sampai

tengkuk
 6
Epidemiologi

Penelitian epidemiologi internasional didapatkan

prevalensi life time dari nyeri kepala adalah 90%
pria, 96% wanita
 7
Skala Verbal Nyeri Kepala

0 = No headache
1 = Mild headache, ADL normal
2 = Moderate headache, ADL terganggu sedikit
(tidak perlu istirahat)
3 = Severe headache, ADL terganggu banyak
(perlu istirahat/opname)
 8
Mekanisme Nyeri Kepala

Organ Intra Kranial

Pain Sensitive
sinus venosus & vena
arteri/sirkulus willisii
duramater anterior & posterior
N. Kranialis V, IX, X
Non Pain Sensitive
Parenkim otak
Duramater, tengkorak
Organ Ekstra Kranial
Pain Sensitive
Scalp, kulit tendon
Gigi, mukosa paranasal & cavum nasal
Orbita, Telinga, Pembuluh darah
 9
Mekanisme Nyeri Kepala (lanjutan)

Venous sinuses
Dura at the base of the brain arteries within dura & pia
arachnoid
Middle meningeal &superficial temporal arteries
N II, N III, N V, N IX, N X
C 1, 2, 3
Sensory nuclei of the thalamus
Brain stem periaqueductal gray matter
NOCICEPTOR : 10

Supratentorial structures
Ant / med fossae n v - n v 1-2

Infratentorial structures c 1, 2, 3
post fossae n ix, n x

Ant, 2/3 of the head nv

Back of the head, neck c 1, 2, 3
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Mekanisme Nyeri Kepala

Peregangan (distensi & dilatasi) arteri/vena

intra & ekstra kranial dan sirkulus Willisii
Spasme pembuluh darah ekstra/intrakranial
Inflamasi struktur pain sensitive
intra/ekstrakranial
Perubahan tekanan intrakranial & intrakavitas
Tekanan langsung terhadap saraf
 13
Teori Yang Menyebabkan
Timbulnya Nyeri Kepala

Sensitisasi
Teori vasodilatasi
Aktivasi trigeminovascular
Steril inflamasi neuron
Cortical spreading depression
Aktivasi rostral brainstem
Aktivitas yang imbalance antara brainstem
nuclei regulating antinoception dengan
vascular control
HISTORY :
Attack onset 14
Quality
Severity
Location
Mode of onset
Time, intensity, curve, duration
Condition which exacerbate / relieve the pain
Associated features
Social history, family history
Past headache history
Headache impact
 15

Faktor pencetus Nyeri Kepala

Stres
Kurang/kebanyakan tidur
Tidak/telat makan
Bau menyengat : parfum,rokok
Lingkungan: cahaya silau/berkedip,gaduh,
ketinggian,panas,lembab, ruang berasap
Makanan/minuman
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Klasifikasi Baru Nyeri Kepala (IHS)
2004

I. Nyeri Kepala Primer

a. Migraine
b. Tension type headache
c. Cluster headache and other trigeminal
autonomic cephalgia
d. Other primary headache
II. Nyeri Kepala Sekunder
III. Cranial Neuralgias, central and primary
facial pain and other headaches
 21
MIGREN

Migraine
Migraine without aura
Migraine with aura
Typical aura with migraine headache
Typical aura with non migraine headache
Typical aura without headche
Familial hemiplegic migraine (FHM)
Sporadic hemiplegic migraine
Basilar type migraine
 22
MIGREN

Childhood periodic syndromes that are

commonly precursors of migraine
Cyclical vomiting
Abdominal migraine
Benign paroxysmal vertigo of childhood
Retinal migraine
Complications of migraine
Chronic migraine
Status migrainosus
Persistent aura without infarction
Migrainous infarction
Migraine-triggered seizures
 23
MIGREN

Probable migraine
Probable migraine without aura
Probable migraine with aura
Probable chronic migraine
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Phases of Migraine
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MIGRAINE PATHOPHYSIOLOGY

Vasocontriction (aura) & vasodilatation (headache)

Cortical spreading depression
Oligaemia propagating across the cortex posterior to frontal
Activation of the trigemino-vascular system
Serotonin (5-ht) : vessels, platelet, neuron
Aminergic brainstem nuclei
- Migraine generator
- Cortical hyperexitability
N. O.
Migraine triggers, i.E. : Hormonal fluctuation, emotion,
fatigue, fasting, meteorologigal changes, dietary factors
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MIGRAINE WITHOUT AURA

MIGRAINE WITHOUT AURA

Paling sedikit ada 5 serangan, 4-72 jam
Unilateral
Berdenyut
Moderate/severe intensity
Nausea/vomiting
Fonophobia/Fotophobia
Tidak ada hubungan dengan penyakit lain

PROBABLE MIGRAINE
MIGRAINE LIKE HEADACHE
 32
MIGRAINE WITH AURA

MIGRAINE WITH AURA

Aura : visual, sensoris, speech, 5 menit-1 jam
Paling sedikit ada 2 serangan, 4-72 jam
Unilateral/homonim
Nyeri kepala sesuai dengan migraine without aura :
Berdenyut
Moderate/severe intensity
Nausea/vomiting
Fonofobia/fotofobia
 33
MIGRAINE WITH AURA

FAMILIAL HEMIPLEGIC MIGRAINE

Genetik, kromosom 1&19
Kriteria sesuai dengan migraine with aura
Aura hemiparese 60 menit-1 jam
Cerebellar ataxia (20%)
Onset bisa tiba-tiba
60% pasien FHM mempunyai gejala basillar
type
 34
MIGRAINE WITH AURA

SPORADIC HEMIPLEGIC MIGRAINE

Kriteria idem FHM
No family history
BASILAR TYPE MIGRAINE
Gambaran gejala gangguan fossa posterior
Disartria
Vertigo
Tinnitus, pendengaran berkurang
Diplopia
Ataxia
Bilateral parestesia
penurunan kesadaran
Nyeri kepala sesuai dengan kriteria migraine with aura
 35
MIGRAINE WITH AURA

CYCLICAL VOMITING
2.5% schoolchildren
Recurrent unexplained nausea & vomiting 4x dalam 1 jam-5
hari
No sign of gastrointestinal disease

ABDOMINAL MIGRAINE
12% of schoolchildren
Abdominal pain, anorexia, nausea, vomiting
1-72 jam
 36
MIGRAINE WITH AURA

BENIGN PAROXYSMAL VERTIGO OF CHILDHOOD

Paling tidak 5 serangan severe vertigo
Menghilang sendiri dalam beberapa menit-jam
No neurological deficit
Normal vestibular function
EEG normal
Multiple
Tiba-tiba dengan episode secara sporadik gejala gangguan
keseimbangan, anxiety, nistagmus, muntah
 37
RETINAL MIGRAINE

Jarang
Paling tidak ada 2x serangan scintillating,
scotoma, blindness
Hanya 1 mata saja
Diikuti serangan nyeri kepala migren
Tidak ada penyakit lain
 38
COMPLICATIONS OF MIGRAINE

CHRONIC MIGRAINE
Migraine without aura
> 15 hari/bulannya
> 3 bulan
Tanpa ada tanda medication over used

STATUS MIGRAINOUS
Severe headache migraine > 72 jam
Tidak ada hubungan dengan penyakit lain
 39
COMPLICATIONS OF MIGRAINE

PERSISTENT AURA WITHOUT INFARCTION

Aura symptom menetap > 1 minggu
Pada pemeriksaan neuroimaging tidak ada infark

MIGRAINOUS INFARCTION
Jarang
Satu atau lebih aura typical yang menetap selama 1 jam
Pada neuroimaging nampak infark
Daerah infark sesuai dengan gejala aura
 40
COMPLICATIONS OF MIGRAINE

MIGRAINE TRIGGERED SEIZURE

Seizure yang timbul sesuai dengan kriteria epilepsi yang muncul
pada saat serangan atau 1 jam sesudah serangan migren
Migralepsy
 41
TENSION TYPE HEADACHE

Infrequent episodic tension-type headache

Infrequent episodic tension-type headache
associated with pericranial tenderness
Infrequent episodic tension-type heache
not associated with pericranial tenderness
Frequent episodic tension-type headache
Frequent episodic tension-type headache
associated with pericranial tenderness
Frequent episodic tension-type headache
not associated with pericranial tenderness
 42
TENSION TYPE HEADACHE

Chronic tension-type headache

Chronic tension type headache associated with
pericranial tenderness
Chronic tension-type headache not associated
with pericranial tenderness
Probable tension-type headache
Probable infrequent episodic tension-type
headache
Probable frequent episodic tension-type
headache
Probable chronic tension-type headache
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INFREQUENT EPISODIC TENSION-
TYPE HEADACHE

Paling tidak terdapat 10 episode serangan

dalam < 1 hari/bulan (atau < 12 hari/tahun)
Nyeri kepala berakhir dalam 30 menit-7 hari
Bilateral, menekan, mengikat, tidak berdenyut,
mild or moderate, tidak ada mual/muntah,
mungkin ada fonofobia/fotofobia
Sama sekali tidak ada hubungannya dengan
penyakit nyeri kepala lain
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INFREQUENT EPISODIC TENSION-
TYPE HEADACHE

INFREQUENT EPISODIC TENSION TYPE HEADACHE ASSOCIATED

WITH PERICRANIAL TENDERNESS
Episoda sesuai dengan 2.1, ditambah dengan gejala nyeri
tekan yang bertambah pada daerah perikranial terhadap
palpasi manual
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INFREQUENT EPISODIC TENSION-
TYPE HEADACHE

INFREQUENT EPISODIC TENSION TYPE HEADACHE NOT ASSOCIATED

WITH PERICRANIAL TENDERNESS
Episoda sesuai dengan 2.1, tanpa ada gejala pertambahan
nyeri tekan pada daerah perikranial terhadap palpasi manual
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FREQUENT EPISODIC TENSION-TYPE
HEADACHE

Paling tidak terdapat 10 episode serangan dalam 1-

15 hari/bulan dalam waktu paling tidak selama 3
bulan (atau 12-180 hari per tahunnya)
Nyeri kepala berakhir dalam 30 menit-7 hari
Bilateral, menekan, mengikat, tidak berdenyut, mild or
moderate
Tidak ada mual/muntah
Mungkin ada fonofobia/fotofobia
Sama sekali tidak ada hubungannya dengan
penyakit nyeri kepala lain
FREQUENT EPISODIC TENSION-TYPE 48

HEADACHE

FREQUENT EPISODIC TENSION-TYPE HEADACHE ASSOCIATED WITH

PERICRANIAL TENDERNESS
Episoda sesuai dengan 2.2 ditambah gejala nyeri tekan yang
bertambah pada daerah perikranial terhadap palpasi
manual
FREQUENT EPISODIC TENSION-TYPE 49

HEADACHE

FREQUENT EPISODIC TENSION TYPE HEADACHE NOT ASSOCIATED

WITH PERICRANIAL TENDERNESS
Episoda sesuai dengan 2.2, tanpa adanya pertambahan
pericranial tenderness
 50
CHRONIC TENSION TYPE
HEADACHE

Nyeri kepala yang berasal dari ETH yang timbul > 15

hari/bulannya dalam waktu > 3 bulan (atau > 180
hari/tahun)
Nyeri kepala berakhir dalam 30 menit-7 hari
Bilateral, menekan, mengikat, tidak berdenyut, mild
or moderate, tidak ada mual/muntah, mungkin ada
fonofobia/fotofobia
Sama sekali tidak ada hubungannya dengan
penyakit nyeri kepala lain
 51
CHRONIC TENSION TYPE
HEADACHE

CHRONIC TENSION-TYPE HEADACHE ASSOCIATED

WITH PERICRANIAL TENDERNESS
Nyeri kepala yang sesuai 2.3 tsb, disertai
penambahan pericranial tenderness pada
palpasi manual
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CHRONIC TENSION TYPE
HEADACHE

CHRONIC TENSION-TYPE HEADACHE NOT

ASSOCIATED WITH PERICRANIAL TENDERNESS
Nyeri kepala yang sesuai 2.3 tsb, tanpa disertai
penambahan pericranial tenderness pada
palpasi manual
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PROBABLE TENSION-TYPE
HEADACHE

Dijumpai memenuhi kriteria TTH akan tetapi

kurang satu kriteria untuk TTH bercampur
dengan salah satu kriteria probable migraine
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PROBABLE TENSION-TYPE
HEADACHE

PROBABLE INFREQUENT EPISODIC TENSION-TYPE HEADACHE

Episode memenuhi kriteria ETTH akan tetapi kurang satu
kriteria saja dari 2.1 dan tidak memenuhi kriteria migraine
without aura, dan tidak ada hubungan dengan penyakit
nyeri kepala lainnya
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PROBABLE TENSION-TYPE
HEADACHE

PROBABLE FREQUENT EPISODIC TENSION TYPE HEADACHE

Episode memenuhi kriteria ETTH akan tetapi kurang satu
kriteria saja dari 2.1 dan tidak memenuhi kriteria migraine
without aura, dan tidak ada hubungan dengan penyakit
nyeri kepala lainnya
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PROBABLE TENSION-TYPE
HEADACHE

PROBABLE CHRONIC TENSION-TYPE HEADACHE

Nyeri kepala berlangsung > 15 hari/bulan selama > 3
bulan (atau > 180 hari/tahun)
Nyeri kepala berlangsung selama sekian jam atau
terusmenerus kontinyu
Bilateral, rasa menekan/mengikat, intensitas mild-
moderate
Tidak ada severe nausea/vomiting
Mungkin ada fotofobia/fonofobia
Tidak ada hubungannya dengan penyakit
kepalalainnya, paling tidak masa 2 bulan terakhir
 58
NYERI TEKAN MIOFASCIAL OTOT
PERIKRANIAL

Otot frontal, temporal, masettter, pterygoid,

sternocleidomastoid, splenius, trapezius,
oksipital dan insersi tendon/fascia
Nyeri tekan/miofascial kontraksi otot
Akumulasi metabolit, aktivitas otot, trauma
kontraksi otot
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Epidemiologi TTH

Prevalence lifetime TTH 78%

Episodik TTH 63% pria 56%, wanita 71%
TTH kronik 3% pria 2%, wanita 5%
CLUSTER HEADACHE AND OTHER 60
TRIGEMINAL AUTONOMIC
CEPHALGIA

Cluster headache
Episodic cluster headache
Chronic cluster headache
Paroxysmal hemicrania
Episodic paroxysmal hemicrania
Chronic paroxysmal hemicrania (cph)
Short-lasting unilateral neuralgiform headache
with conjunctival injection and tearing (sunct)
Probable trigeminal autonomic cephalgia
Probable cluster headache
Probable paroxysmal hemicrania
Probable sunct
 61
NYERI KEPALA KLASTER

Umur 20-45 tahun

1-250 pria
Pria : Wanita = 4 : 1
Intermittent, short lasting 15-180 menit, selalu
pada waktu yang sama/tahun/siklus
Nyeri sangat, sharp, boring, drilling, unilateral,
periorbital
Ipsilateral, rhinorrhea, lakrimasi, conjunctival
hiperemia, kepala berkeringat, Horners
syndrome
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PATHOPHYSIOLOGY OF THE CLUSTER
HEADACHE

Paroxysmal parasympathetic discharge of the greater superficial

petrosal nerve & sphenopalatine ganglion
Swelling of the arterial wall of the internal carotid artery
Histamine release
Hypothalamic mechanism
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CLUSTER HEADACHE

Episodic CH : serangan selama 7 hari-1 tahun

dengan interval free 1 bulan atau lebih
Chronic CH : serangan selama > 1 tahun tanpa
remisi, atau dengan remisi yang berlangsung < 1
bulan
 69
CLUSTER HEADACHE

PAROXYSMAL HEMICRANIA
Serangan > 5x/hari
Setiap serangan berlangsung 2-30 menit
Severe headache, unilateral
Supraorbital or temporal pain
Gejala aktivasi parasimpatik ipsilateral dengan
nyerinya
Mempunyai respon absolut terhadap
indomethasin
Jenis episodik dan kronik
 70
CLUSTER HEADACHE

SHORT LASTING UNILATERAL NEURALGIFORM

HEADACHE ATTACTS WITH CONJUNCTIVAL
INJECTION AND TEARING (SUNCT) SYNDROME
Sangat jarang
High frequency attack (3-200x/hari)
Unilateral, orbital, supraorbital, atau temporal,
berdenyut 5-240 detik
Ipsilateral conjunctival injection, lakrimasi
Severe pain & tearing
 71
OTHER PRIMARY HEADACHE

Primary stabbing headache

Primary cough headache
Primary exertional headache
Primary headache associated with sexual activity
Preorgasmic headache
Orgasmic headache
Hypnic headache
Primary thunderclap headache
Hemicrania continua
New daily persistent headache (ndph)
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OTHER PRIMARY HEADACHE

PRIMARY STABBING HEADACHE

Nyeri seperti ditikam di daerah trigeminal
(orbital, temporal, parietal)
Beberapa detik yang rekuren/harinya

PRIMARY COUGH HEADACHE

Nyeri kepala timbul pada saat batuk,
mengedan
Pada pemeriksaan imaging normal (tanpa
ada penyakit aneurisma serebri atau arnold
chiari malformation)
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OTHER PRIMARY HEADACHE

HYPNIC HEADACHE (ALARM CLOCK HEADACHE)

Nyeri saat tidur (nocturnal)
15 x sebulan
15-30 menit
Umur > 50 tahun
Bilateral
Mild-moderate

PRIMARY THUNDERCLAP HEADACHE

Severe headache tiba-tiba, seperti disambar petir seperti
pecahnya aneurisma serebri
Nyeri 1 jam-10 hari, puncak nyeri 1 menit
Neuroimaging normal
 74
OTHER PRIMARY HEADACHE

Hemicrania continua
Nyeri kepala unilateral terus-terusan
Respons baik terhadap indomethasin
Moderate pain

New daily persistent headache

Nyeri bilateral, menekan/berat
Mild moderate intensity
Tidak ada riwayat ETTH sebelumnya
Berlangsung seharian < 3 hari
Diagnosa confirm jika telah berlangsung > 3 bulan
 75
NYERI KEPALA SEKUNDER

Headache attributed to head and/or neck trauma

Acute Posttraumatic headache
Acute Posttraumatic headache attributed to
moderate or severe head injury
Acute Posttraumatic headache attributed to mild
head injury
Chronic Posttraumatic headache
Chronic posttraumatic headache attributed to
moderate or severe head injury
Chronic posttraumatic headache attributed to mild
head injury
 76
NYERI KEPALA SEKUNDER

Acute Headache attributed to whiplash

injury headache
Chronic Headache attributed to whiplash
injury headache
Headache attributed to traumatic intracranial
hematoma
Headache attributed to epidural
hematoma
Headache attributed to subdral
hematoma
 77
NYERI KEPALA SEKUNDER

Headache attributed to other head and/or

neck trauma
Acute headache attributed to other
head and/or neck trauma
Chronic headache attributed to other
head/or neck trauma
Post-craniotomy headache
Acute Post-craniotomy headache
Chronic Post-craniotomy headache
 78
HEADACHE ATRRIBUTED TO HEAD
AND/OR NECK TRAUMA

ACUTE POSTTRAUMATIC HEADACHE ATTRIBUTED TO

MODERATE OR SEVERE HEAD INJURY
Ada riwayat pingsan/tidak sadar > 30 menit
Glasgow Coma Scale < 13
Post traumatic amnesia > 48 jam
Radiologi terdapat kelainan (SAH, ICH,
Kontusio, Fraktur)
Nyeri kepala timbul dalam 7 hari sesudah
trauma/sadar
Nyeri kepala menghilang dalam 3 bulan
sesudah trauma
 79
HEADACHE ATRRIBUTED TO HEAD
AND/OR NECK TRAUMA

ACUTE POSTTRAUMATIC HEADACHE ATTRIBUTED TO

MILD HEAD INJURY
Nyeri kepala timbul dalam masa 7 hari post
trauma
Nyeri kepala akan hilang dalam 3 bulan post
trauma
Tidak/ada pingsan < 30 menit
GCS > 13
Tanda-tanda komosio serebri (+)
 80
HEADACHE ATRRIBUTED TO HEAD
AND/OR NECK TRAUMA

NYERI KEPALA POST TRAUMATIK KRONIK (POST

TRAUMATIC SYNDROME)
Moderate severe idem
Mild head injury idem
Nyeri kepala berlangsung > 3 bulan
 81
NYERI KEPALA SEKUNDER

Headache attributed to cranial and/or

cervical vascular disorders
Headache attributed to non vascular disorder
Headache attributed to a substance or its
withdrawal
Headache induced by acute substance use
or exposure
Medication Overuse Headache
Ergotamine Overuse Headache
Triptane Overuse Headache
Analgesics Overuse Headache
Opioid Overuse Headache
Combination medication-overuse
headache Other substance overuse
 82
NYERI KEPALA SEKUNDER

Headache attributed to other medication

overuse (code to specify substance)
Probable medication overuse headache
(code to specify substance)
 83
NYERI KEPALA SEKUNDER

MEDICATION OVERUSE
Penggunaan obat : triptan, ergotamine,
opioid, kombinasi analgetikum > 10 hari per
bulannya
Simple analgesic > 15 hari per bulannya
 84
NYERI KEPALA SEKUNDER

Headache attributed to infection

Headache attributed to disorder of
homeostasis
Headache or facial pain attributed to disorder
of cranium, eyes, ears, nose, sinuses, teeth,
mouth or other facial or cranial structures
Headache attributed to psychiatric disorder
Cranial Neuralgias and central cause of fascial
pain
 85
Cranial Neuralgias and central
cause of fascial pain

Trigeminal Neuralgia
Classical Trigeminal Neuralgia
Symptomatic Trigeminal Neuralgia
Glossopharyngeal Neuralgia
N. Intermedius Neuralgia
Superior Laryngeal Neuralgia
Nasocilliary Neuralgia
Supraorbital Neuralgia
Other Trigeminal Neuralgia
Occipital Neuralgia
Neck Tongue Syndrome
 86
Cranial Neuralgias and central
cause of fascial pain
External Compression Syndrome Headache
Cold Stimulus Headache
Constant Pain Caused By Compression, Irritation or Distortion
of Cranial Nerve or Upper Cervical Roots by Structural Lesions
Optic Neuritis
Ocular Diabetic Neuropathy
Head or Facial Pain attributed to Herpes Zooster
Head or facial pain attributed to Acute Herpes Zooster
Post herpetic neuralgia
Tolosa-Hunt Syndrome
Opthalmoplegic Migraine
Central causes of Facial Pain
Other Cranial Neuralgia or Other centrally mediated facial
pain (code to specify aetiology)
 87
CHRONIC DAILY HEADACHE

Without drug overused

With drug overused
Acute antimigraine
drug/opioid/combination analgesics > 10
days/month, or simple analgesics > 15
days/month
 TEMPORAL ARTERITIS 88
( GIANT-CELL ARTERITIS, CRANIAL ARTERITIS )

Inflamatory disease of cranial arteries

Aged >50 years,
Intens throbbing /non throbbing headache / Sharp /
stabbing pain
Unilateral, sometimes bilateral
A superficial temporalis: thicked, tender, without pulsation
nodules on the scalp
89
 TEMPORAL ARTERITIS 90
( GIANT-CELL ARTERITIS, CRANIAL ARTERITIS )
( Contd )

Patients feel generally unwell, lose weight, low grade

fever, anemia, myalgia
thrombosis of the opthalmic, posterior cilliary arteries
blindness !!

Diagnosis : biopsy

Treatment : prednison
 91
POSTHERPETIC NEURALGIA

Associated with a vesicular eruption

Herpes zoster virus
Burning / stabbing pain, hyperesthesia, allodynia
Treatment : - anticonvulsants, antidepressants
Prevention PHN : - acyclovir, TCA antidepressant
92
93
TRIGEMINAL NEURALGIA 94
(TIC DOULOUREX)

Middle age
Paroxisms of intens, stabbing pain n v1-2
A few seconds / minutes
Involuntary winces (tic)
Triggered by:
Stimulation (touch, tickle) movement of the face, lips, gums:
shaving, brushing, talking, chewing
95
 96
ETIOLOGY :

Idiopathic
Symptomatic:
Multiple sclerosis,
Aneurysm of the a. Basilar,
CPA tumor, compression of the N V
Treatment :
Anticonvulsants
Causal
 97
GLOSSO PHARYNGEAL NEURALGIA

Intense and paroxysmal pain in the throat -tonsillar

fossa
May be radiate to the ear
N. Ix , auricular branch of n x
Triggered by swallowing, talking, chewing, etc.
Bradycardia, syncope

Treatment : - anticonvulsants
- Surgical
 98
Penanganan Nyeri Kepala

TERAPI NON FARMAKOLOGIK

Penatalaksanaan Umum :
Cara hidup (listyle) yang baik dan teartur
Hindari faktor pencetus nyeri kepala
Olahraga
Relaksasi
Terapi alternatif
 99
Penanganan Nyeri Kepala

TERAPI FARMAKOLOGIK
Pengobatan pada fase akut migraine
Terapi non spesifik
Analgetika antara lain : parasetamol, asam asetil salisilat
Anti inflamasi non steroiid (AINS)
Anti emetika : domperidon, metoklopramid
Terapi Spesifik
Ergotamin derivat : sudah jarang dipergunakan ; ergotamin
tartrat, dihidroergotamin
5HTI (5-Hidroksi Triptamin) agonis : sumatriptan, naratriptan,
zoimitriptan
 100
Penanganan Nyeri Kepala

Pengobatan Profilaksis Migraine

Penyekat Beta : propanolol, timolol, dll
Antidepressan trisiklik : protriptilin, desipiramin,
amitriptilin
Antagonis serotonin : metisergid, pizotifen
Antihistamin : siproheptadin
Antikonvulsan : asam valproat, topiramat
Antagonis kalsium : flunarizin, dll
MAKANAN SEBAGAI FAKTOR 101

PENCETUS MIGREN

MAYOR MINOR
MSG Kacang-kacangan
Wine, vodka, bir Fried foods
Keju, coklat, yoghurt Popcorn
Citrus fruits Chile peppers
Buttermilk, coklat susu Seafoods
Yeast Pork/liver
Terlampau asin/manis
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Preventif Migren

Kriteria :
Lebih dari 3 serangan moderate/severe
headache/bulan
Kegagalan abortive medication
Adanya penurunan quality of life
Kemauan pasien : makan obat tiap hari
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Penanganan Nyeri Kepala

NYERI KEPALA TIPE TEGANG

Terapi Non Farmakologik : fisioterapi,
psikoterapi
Terapi Farmakologik : analgetik & AINS,
antidepressan

NYERI KEPALA REBOUND

Pengobatannya dengan cara penghentian
obat secara bertahap dalam tenggang waktu
8-12 minggu secara rawat jalan/rawat inap
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NYERI KEPALA KLASTER

Terapi Abortif
Oksigen murni inhalasi dengan memakai masker oksigen 8-
10 L/menit selama 15 menit
Ergotamin tartrat
Kombinasi oksigen dan ergotamine tartrat
Tetes hidung Lidocaine 4%
Sumatriptan
Indomethasin
Klorpromazin
Lithium karbonat
Verapami
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NYERI KEPALA KLASTER

Terapi Preventif :
Metisergid
Kortikosteroid
Ergotamin tartrat
Klorpromazin
Lithium karbonat
Verapamil
Terapi Operatif : Bila dengan obat-obatan gagal
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Penanganan Nyeri Kepala

NYERI KELAPA KLASTER MENAHUN :

Obat pilihan Lithium Karbonat

HEMIKRANIA PAROKSISMAL MENAHUN :

Indomethasin

SINDROMA NYERI KEPALA PASCA TRAUMA

Penanganan Umum :
Istirahat fisik dan mental
Hindari faktor pencetus
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Pemeriksaan

Pemeriksaan Klinis
Anamnesis
Pemeriksaan fisik neurologik
Pemeriksaan Penunjang Laboratorium
Rutin : Kimiawi darah rutin lengkap, EEG
Khusus (bilamana diperlukan)
Foto sinus, tengkorak
Foto servikal, gigi geligi, sendi temporo mandibular
Darah khusus : metabolik, endokrin, serologis
Punksi lumbal
CT san otak/MRI, angiografi, USG karotis
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Substances Associated with
Rebound Headache
Caffeine
Over the counter combination medications : pseudoephedryne
hidrochloride or sulfate, acetaminophen, caffeine
Combination analgesics : aspirin, caffeine, butalbital,
acetaminophen
Combination analgesics containing opioids : hydrocodone
bitartrate, acetaminophen, propoxyphene hydrochloride,
aspirin, caffeine, acetaminophen, butalbital, codeine
phosphate
Antimigraine agents : ergotamine tartrat, caffeine,
isometheptene mucate, dichloralphenazone, acetaminophen,
sumatriptan succinate