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HEADACHE
Definition:
Headache: Pain above the head
from orbita occiput.
Facial pain: Pain bellow
orbitomeatal line, above the neck
and the front of the ear.
Headache should be
defferentiated with vertigo.
MECHANISMS OF
HEADACHE
Headache occur doe to stimulation of pain sensitive
craniale structur.
Pain sensitive craniale structur.
Extracraniale structurs :
Skin, periosteum, muscle( m. frontalis
superfecial, m.occipitalis.
Extracranial arteries.
Structur of the eye, ear, nasal cavities
and sinus
Intracraniale structures :
Intracraniale venous sinuses
Part of the dura at the base of brain.
Arteries with in the dura and piaaraachnoid, and particulary the proximal
parts of the anterior and midle cerebral
arteries. And the intracranila segment of the
internal carotid ertery.
CLASSIFICATION OF
HEADACHE
A. Primary headache.
1. Migraine.
2. Tension type headache.
3. Cluster headache
4. Other primary headache.
- Primary cough headache.
-. Primary exertional headache.
-. Primary headache associated
with sexual activity.
CLASSIFICATION OF
HEADACHE (cont).
Hypnic headache.
Primary thunderclap headache.
Hemicranial continua.
New daily persistent headache
(NDPH)
B. Secondary headache (Organic cause
headache).
-
RED FLAG
Red flag in history.
1. Abrupt onset of new type of severe headache.
2. Worst headache the patient ever had.
3. Progressive worsening of headache over period of
days or weeks.
4. Headache precipitated by exertion (exercise, coughing,
sneezing, bending over, or sexual exciment).
5. Headache accompanied by generalized illness or
fever, nausea,vomiting, or stiff neck.
6. Headache accompanied by neurological symptoms
( aphasia, poor coordination, focal weakness or
numbness,drowsiness, decrease in hiher intelectual
function in personality).
HEADACHE
RED FLAG
NO
YES
PRIMARY
HEADACHE
SECONDARY HEADACHE
PRIMARY HEADACHE
(ATYPICAL SIGN)
NO
PRIMARY
HEADACHE
YES
ETHIOLOGY
1.
2.
3.
4.
5.
6.
7.
Oromanibular disfunction
Psychology stress
Anxiety
Depresi
Muscle stress
Drug abuse
Delution phenomena
CLINICAL SYMPTON.
1. Episodic pain, last a few minutes day.
2. Bilateral location, pressing/tightening
must be not throbbing.
3. Mild to moderate intensity.
4. Not aggravated by routine physical
activity.
5. No nausea or vomiting.
6. No photophobia and phonophobia, but
one of the two can be present.
TENSION TYPE
HEADACHE
TREATMENT.
1. Simple analgetic
- Aspirin, acetaminophen
2. NSAIDs (ibuprophen, sod. naproxen,
sod, diclofenac).
3. Combination analgetic, sedative, minor
transquilizer.
TREATMENT.
4. Muscle relaxant: tizaniden, eperison hcl,
baclophen and diazepam.
5. Injection botox.
6. Non farmacology treatment.
- Cognitive behavior theraphy
- Relaxation.
- Physiotheraphy.
CLUSTER HEADACHE
= Migrainus neuralgia, Horton
headache, histamine headache.
Clinical sign.
1. Severa headache, unilateral , orbital, supra orbital or
temporal.
2. Frequency: 1-8 time/day.
3. Follow by:
- conjuctival injection
- lacrimation
- nasal congestion.
- rhinorrhea.
- Forhead and facial sweating.
- Miosis and ptosis,
4. Not attributed to another this order.
CLUSTER HEADACHE
A. Episodic cluter headache
attacks occurirng I periods lasting 7 days to 1 year
seperated by pain-free periods lasting 1 month or
longer.
B. Chronic cluter headache
attacks occurring for more than 1 year without
remission or with remission lasting less than 1
month.
TREATMENT.
1. Oksigen 100%, 7 lt/minutes (10-15 minutes).
Combination 1-2 mg ergotamin and oksigen
100%.
2. Sumatriptan
- subcutan 6 mg (5-15mg).
3. Zolmatriptan 5 mg.
4. Dehydroergotamin (o,5-1,5mg).
5. Ergotamin 1-2 mg sup.
6. Analgetic and narcotic.
PROPHYLACTIC
1. Ergotamine 1-2 mg, verapamil 360480mg)
2. Metisergid 1-2 mg( 3-4 time/day).
3. Kortiokosteroid (prednisolon 60-80
mg).
4. Lithium carbonate.
5. Sodium valproate.
6. Pizotipen
7. Nerve block.
PREVENTION
1. Avoid precipitated factor.
2. Sleep regulation.
3. Avoid stress, smooking, and
excessive working.
MIGRAINE
PATHOPHYSIOLOGY 0
1. Cortical spreading depression (Leo)
PATHOPHYSIOLOGY (CONTINUES)
2.
2. System
System trigeminovascular
trigeminovascular
MIGRAINE.
A. Migraine with out aura = common
migraine.
A. Recurrent headache (5 X).
B. Headache last with in 4 72 hours.
C. Headache has at least two of the following
characteristic:
1. Unilateral.
2. Throbbing or pulsating headache.
3. Moderate or severe pain intensity.
4. Aggravated by routine physical activity such as
bending, climbing stairs.
MANAGEMENT.
A. General principles.
Avoid precipitated factor.
1.
2.
3.
4.
B. Abortive treatment.
Attenttion:
1.
2.
3.
4.
5.
Pengobatan berhasil?
1. Bebas nyeri 2 jam setelah pengobatan.
2. Perbaikan skala nyeri kepala 2 (sedang),
atau 3 (berat) menjadi sekala nyeri 1
(ringan) atau skal 0 , sesudah 2 jam.
3. Efikasi pengobatan konsisten pada 2-3
kali serangan.
4. Tidak ada nyeri kepala berulang dan
tidak ada pemakaian obat lagi
dalam/pada waktu 24 sesudah
pengobatan berhasil
PROPHYLACTIC
1. Recurrent migraine, disturb daily avtivities.
2. More than 2 times attack/week.
3. Failure abortive treatment or exceed abortive
treatment.
4. Side efect with abortive treatment.
5. Patient choise.
6. Uncommon migraine ( hemiphlegic migraine,
basilar migraine, migraine with prolonged
aura, aura infarc migraine).
DRUG FOR
PROPHYLACTIC
1. Beta blocker ( propanolol, metoprolol, timolol
2.
3.
4.
5.
6.
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