Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 27 views

    Primary Headache Kuliah Stikes Upload

    Uploaded by

    Doni Marthen
    HeADACHE / Nyeri Kepala DEFINITION Pain on head area Pain in face, pharynx, larynx and neck are not include. Osteoarthritis cervicalis is include Epidemiology STRUCTURE Pain SENSITIVE.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd

    Primary Headache Kuliah Stikes Upload

    Uploaded by

    Doni Marthen
    27 views48 pages
    HeADACHE / Nyeri Kepala DEFINITION Pain on head area Pain in face, pharynx, larynx and neck are not include. Osteoarthritis cervicalis is include Epidemiology STRUCTURE Pain SENSITIVE.

    Original Title

    primary headache kuliah stikes upload.pptx

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    HeADACHE / Nyeri Kepala DEFINITION Pain on head area Pain in face, pharynx, larynx and neck are not include. Osteoarthritis cervicalis is include Epidemiology STRUCTURE Pain SENSITIVE.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    27 views48 pages

    Primary Headache Kuliah Stikes Upload

    Uploaded by

    Doni Marthen
    HeADACHE / Nyeri Kepala DEFINITION Pain on head area Pain in face, pharynx, larynx and neck are not include. Osteoarthritis cervicalis is include Epidemiology STRUCTURE Pain SENSITIVE.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 48

    Sakit Kepala

    Headache/ Nyeri Kepala


    18,9% kunjungan ke RSDS 17,4% kunjungan ke RSCM 42% kunjungan praktek sore Sp.S 90% merupakan primary headache

    NYERI

    Pengalaman sensorik & emosional yg tidak menyenangkan terkait kerusakan jaringan, baik aktual maupun potensial atau yang digambarkan dalam bentuk kerusakan tsb.

    PATOFISOLOGI NYERI

    HEADACHE/ Nyeri Kepala


    DEFINITION Pain on head area Pain in face, pharynx, larynx & neck are not include. Osteo arthritis cervicalis is include Epidemiology

    TTH 35-78% (CTTH 3%) Migrain 18% female, 6% men


    Cluster 0.015%
    5

    Derajat Nyeri Kepala (Praktis)


    Ringan : pekerjaan/aktifitas sehari2 normal. Sedang : aktifitas berat terganggu Berat : aktifitas sehari-hari terganggu

    STRUCTURE PAIN SENSITIVE


    I. STRUCTURE Intra Kranial a. sinus, vein besar & aferennya b. artery dura mater c. artery basis cranium d. duramater II. STRUCTURE ekstra kranial a. skin, skin head, jar. Sub.kutan, fasia, muscle head/neck. b. mukosa c. artery-artery d. Structure from eye, ear & nose III. Nervous: V, VII, IX, X, C1 C2 C3

    STRUCTURE NOT SENSITIVE PAIN

    1. Parenkim brain 2. Ependyma, pleksus choroid 3. Piamater, membrana arachnoidea & duramater 4. Bone skull

    PATOFISIOLOGY Headache General : A. intracranial: 1. Iritasi meningen Ex: Meningitis Perdarahan Sub Arachnoid (SAH) 2. Penarikan or peregangan arteri intracranial: Tumor Absces Hematoma intracranial TIK : hidrosefalus, BIH TIK : post Lumbal Headache

    3. Vasodilatasi arteri intra kranial Toksic caused infection With drawl caffein Hipoglikemia, Hipoksia, Hiperkapnea drug vasodilator Post attack Epilepsi Insufiensi sirculation brain

    10

    B. BERSUMBER ESKTRA KRANIAL


    1. dilatasi cabang A. carotis externa Migren Cluster headache 2. inflammation artery ekstrakranial Giant cell arterytis temporalis 3. contraction muscle Tension headache Secondary muscle contraction headache Ex: - mal occlusion teeth - spondylosis cervicalis 4. inflammation/Penekanan N. V, N. IX Neuralgia trigeminus Neuralgia glossopharingeus 5. inflammation in mucosa nose, sinus
    11

    1. Headache Primer Tension headache Migrain Cluster headache 2. Headache Secunder

    12

    Headache

    PRIMER

    Secunder

    TTH

    Migrain

    Cluster Headache

    infection Tanda2 infection (Color/Dolor/ Robor)

    Trauma history Trauma

    Tumor -Trias -Headache chronic progresif -vomit proyektil -Papil edema

    Vascular -acute -Defisit Neurologis fokal

    13

    DIAGNOSIS AND TESTING


    Detailed History and Examination NO YES Secondary Headache Diagnostic Testing
    14

    Primary Headache?
    Preliminary Diagnosis

    Atypical Features

    RED FLAGS SNOOP T


    Systemic symptoms (fever, weight loss) or
    secondary risk factors (HIV, systemic cancer)

    Neurologic symptoms or abnormal signs (confusion, impaired


    alertness, or consciousness)

    Onset: sudden, abrupt, or progressively worsening Older: new onset and progressive headache, especially in
    middle-age >50

    Previous headache history: first headache or different


    (change in attack frequency, severity, or clinical features)

    Triggered headache (valsava, exertion)


    15

    Classification of headaches
    Primary headaches Secondary headaches OR Idiopathic headaches OR Symptomatic headaches
    THE HEADACHE IS ITSELF THE DISEASE NO ORGANIC LESION IN THE BEACKGROUND TREAT THE HEADACHE! THE HEADACHE IS ON LY A SYMPTOM OF AN OTHER UNDERLYING DISEASE TREAT THE UNDERLYING DISEASE!

    16

    Tabel 1 . Important features of pain in the evaluation of chronic recurrent headaches


    HEADACHE Common migraine Classic migraine QUALITY Throbbing LOCATION Unilateral head / Ifteral head Unilateral head DURATION 6 48 hours FREQUENCY Sporadic (often several times montlly) Sporadic (often several times monthly) Closely bunched clusters with long remissions ASSOCIATED SYMPTOMS Nausea, vomiting, malaise, photophobia Visual prodrome, vomiting, nausea, malaise, photobhobia Ipsilateral tearing, facial flushing, nasal stuffiness, Hornerss syndrome Depression, anxiaty Pericranial tenderness Identifiable trigger zone

    Throbbing

    3 12 hours

    Cluster

    Boring, sharp

    Unilateral head (especially orbit)

    12 120 minutes

    Psychogenic/ Chronic TTH Trigeminal meuralgia

    Dull, pressure

    Diffuse, Ifteral Frontal, temporal suboccipital Fifth nerve distribution

    Oftem unremitting Brief (15-60 second)

    May be constant Almost daily Many times daily

    Lancinating

    17

    PHYSICAL FINDING Optic atropy, papiledema

    POSSIBLE ETIOLOGY Mass lesion, hydrocephalus, benign intracranial hypertensionon

    Focal neurologic abnormality (hemiparese aphasia)


    Stiff neck

    Mass lesion
    Subarachnoid hemorrhage, meningitis, cervical arthritis

    Retinal hemorrhages
    Cranial bruit Thickened, tender temporal arteryes Trigger point for pain Lid ptosis, third nerve palsy, dilated pupil Spasm and tenderness of Pericranial muscle

    Ruptured aneurysm, malignant hypertensionon


    arteryovenous malformation Temporal arterytis Trigeminal neuralgia Cerebral aneurysm TTH/Muscle Contraction Headache

    18

    TTH (Headache Type Spasm/ Tension Type Headache TTH)


    OVERVIEW:
    The most common (90%) headache Responsive to over the counter med 5% visits When disabling conjunction with migraine Spectrum of migraine Beware of medication overuse headache (MOH)

    19

    Tension Type headache


    10 attacks lasting 30 min7 days 2 of the following 4
    Bilateral Not pulsating Mild or moderate intensity Not aggravated by routine physical activity

    No nausea or vomiting One or neither photophobia or phonophobia Not attributable to another disorder
    20

    TTH Classification
    Episodic <15 day/month Peripheral pain mechanism Tx NSAID, Parasetamol Chronic 15 day/month, 3 months Central pain mechanism Tx Amitriptilin
    21

    Tension Type Headache

    TTH

    22

    Treatment of TTH
    Evidence A : multipel RCT B : 1 RCT C : Consensus Clinical effect : + few people improved ++ Some people improved +++ Most people improved
    23

    Drug

    evidence

    Clinical effect

    Role

    Route

    Analgesic & NSAID


    Asetaminofen Aspirin Mefenamic acid Ibuprofen Naproxen A A A A A ++ ++ ++ ++ ++ Acute PO

    Ibuprofen+caffein

    ++

    Antidepresan
    Amitriptilin Maprotilin Mianserin A B B +++ + ++ preventive PO

    Sulpride
    Fluvoxamine

    C
    B

    +
    ++

    Muscle relaxants
    Tizanidine Eperisone B B ++ ++ Acute&preventive PO

    Others
    Alprazolam Etizolam prochloperazine chlorpromazine B C C C ++ ++ ? ? 24 Acute IV Acute&preventive PO

    -------- Ibuprofen (400 mg) + Caffein (200 mg) -------- Ibuprofen (400 mg)=Ketoprofen (50 mg)
    -------- Ibuprofen (200 mg) = Ketoprofen (25 mg) = Naproxen (275 mg) -------- Aspirin/Paracetamol (500-1000 mg) + Caffein (30 mg) -------- Aspirin (500-1000 mg) = Paracetamol (500-1000 mg)

    25

    Migraine
    The most common disabling headache The most common headache visits Unknown causes

    26

    Migraine Criteria

    5 attacks lasting 472 h 2 of the following 4


    Unilateral Pulsating Moderate or severe intensity Aggravation by routine physical activity Nausea and/or vomiting Photophobia and phonophobia

    1 of the following

    Not attributable to another disorder

    27

    28

    SULTANS: two from column A, one from column B


    evere ni ateral hrobbing Ctivity worsens
    ausea Lite and sound ensitivity

    29

    World prevalence of migraine


    Denmark 10% France 8% Switzerland 13%

    USA 12% Italy 16%

    Japan 8%

    Chile 7%

    1-year prevalence rates Population-based studies IHS criteria (or modified)


    Rasmussen and Olesen (1994); Rasmussen (1995); Lipton et al (1994); Lavados and Tenhamm (1997); 30 Sakai and Igarashi (1997)

    Prevalence measured over a few years

    Prevalence of migraine by sex and age


    Migraine prevalence (%) 30 25 20 15 10 5 0 20 30 40 50 60 Age (years) 70 80 100 Females Males

    The American Migraine Study (n=2479 migraine sufferers)


    Lipton and Stewart31 (1993)

    32

    Migraine

    A. The Aura

    B. The Attack

    33

    34

    Penatalaksanan migrain
    1. 2. 3. Hindari pencetus Terapi abortif Non spesifik Spesifik Terapi preventif

    35

    Pencetus Migraine
    Kurang atau kebanyakan tidur Kelelahan Stres dan kecemasan Terlambat makan Perubahan hormonal Makanan (MSG, nitrit (pengawet) ,aspartam (pemanis buatan)) Cahaya terang
    36

    Terapi abortif non spesifik


    Obat ASA Dosis, mg 1000 mg oral Evidence A

    ASA ibuprofen
    Naproxen Parasetamol Diklofenac

    1000 mg IV 200-800mg, oral


    500-1000mg oral 1000 mg oral,supp 50-100 mg oral

    A A
    A A A

    37

    Terapi abortif spesifik


    Ergot
    Angka rekurensi rendah Menginduksi drug overuse headache dg cepat Maksimal diberikan10 hari/bulan Efek samping : parestesi, muntah Kontra indikasi Penyakit kardio, serebrovaskular, hipertensi, gagal ginjal, kehamilan dan laktasi
    38

    TRIPTAN

    Efikasi lebih baik dibanding ergot Sediaan obat di Indonesia sulit di dapat (hanya ada sumatriptan) Efek samping : nyeri dada, parestesi, fatik Kontra indikasi : Penyakit kardio, serebrovaskular, hipertensi, gagal ginjal, kehamilan dan laktasi

    39

    Terapi prevensi migrain


    1. 2. 3. 4. Serangan >2-8 kali/bln Berlangsung >48 jam Pengobatan akut tdk efektif Ada kontra indikasi terapi abortif, efek samping, atau cenderung overuse 5. Gejala luar biasa ( migrain basiler, hemiplegi, aura memanjang) 6. Permintaan pasien
    40

    Terapi prevensi migrain Konsensus Nasional III Nyeri Kepala PERDOSSI 2010
    Obat Dosis mg/hari evidence

    betablocker
    metoprolol propanolol 50-200 40-240 A A

    Calcium channel blocker


    Flunarizine (Frego) 5-10 A

    Anti epileptic
    Valproic acid 500-1800 A

    Topiramat

    25-100

    A
    41

    Sefalgia sekunder

    42

    stroke
    Wanita 75 th di bawa ke IRD RS krn mendadak sakit kepala, hemiparese kiri

    Trauma
    Anak 15 th terkena pemukul baseball di pelipis. Sesaat setelah terkena pukulan ia tidak sadar sebentar 15 mnt lalu bangun lagi. Ia mengeluh sakit kepala namun keadaannya saat itu baik saat dibawa ke IRD. Empat jam kemudian saat diobservasi ia mengeluhkan sakit kepalanya bertambah hebat dan kejang. Pupil sebelah kanan midriasis

    Infeksi
    Pria 40 th , pengusaha mengeluh sakit kepala 2 bln, disertai demam sumer-sumer, sering diare dan sariawan .Ia mengkonsumsi narkoba berhenti sjk 1 th silam. Dibawa ke IRD oleh keluarganya krn bicara meracau.

    Tumor
    Wanita 35 th, sakit kepala 8 bln bertambah hebat terutama saat bangun dan bersin, memakai kontrasepsi suntik 3 bulan

    Degenerasi
    Wanita 79 th datang ke poli dengan keluhan sakit kepala hilang timbul 2 th.Sering lupa 3-4 th dan tidak mampu berbelanja lagi krn kesulitan melakukan perhitungan ringan. Sekarang sulit tidur dan sering terlihat seperti berbicara sendiri

    ATAS PERHATIANNYA

    48

    You might also like