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Sakit kepala

1.Sinonim
Cephalgia Nyeri kepala Pusing Pening

2.Defenisi
Ad pengalaman sensoris dan emosional yg tdl menyenangkan pd bgn atas kepala dari daerah orbita sampai daerah occipital

3. Teori
Teori Ray and Wolf Teori Gerbang nyeri Teory melzack & wall Teori Spreading depression oleh Leao Teori inhibisi & excitasi

4.Etiology
Rasa sakit pd kepala disebabkan oleh : traksi/penarikan perpindahan, peradangan, spasme dari pembuluh darah, atau distensi dari struktur di kepala atau leher yang sensitif terhadap rasa nyeri.

5.Faktor Pencetus Nyeri Kepala


1. 2. 3. 4. 5. Stres, relaksasi setelah stres Kurang/kebanyakan tidur Ubah jadwal Tidak/telat makan Bau menyengat : parfum,rokok
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6. Lingkungan: cahaya silau/berkedip,gaduh i. ketinggian,panas,lembab ii. ruang berasap 7. Makanan/minuman 8. Obat 9. Hormonal 10. Trauma kapitis

6.Struktur peka nyeri


1. SKIN, SUBCUTANEUS TISSUE 2. MUSCLES 3. EXTRACRANIAL ARTERIES 4. PERIOSTEUM 5. EYES, EARS, NASAL CAVITIES, 6. SINUSES, TEETH, OROPHARYNX 7. VENOUS SINUSES 8. DURA AT THE BASE OF THE BRAIN 9. ARTERY DURA & PIA ARACHNOID 10. MIDDLE MENINGEAL & SUPERFICIAL TEMPORAL ARTERIES 11. N II, N III, N V, N IX, N X 12. C 1, 2, 3 13. SENSORY NUCLEI OF THE THALAMUS 14. BRAIN STEM PERIAQUEDUCTAL GRAY 15. MATTER

7.Mekanisme
1. TRACTION ON OR DILATATION OF THE INTRACRANIAL ARTERIES 2. DISTENTION OF EXTRACRANIAL ARTERIES 3. TRACTION ON OR DISPLACEMENT OF THE LARGE INTRACRANIAL VEINS OR DURAL ENVELOPE 4. COMPRESSION, TRACTION OR INFLAMATION OF THE CRANIAL AND SPINAL NERVES 5. SPASM, INFLAMATION & TRAUMA TO CRANIAL & CERVICAL MUSCLE 6. DISEASE OF THE TISSUES OF THE SCALP, FACE, EYE, NOSE, EAR AND NECK 7. MENINGEAL IRRITATION AND RAISED / LOWERED INTRACRANIAL PRESSURE 8. THE ROLE OF NEUROTRANSMITTER : SEROTONIN (5 HT) THE ENDOGENOUS PAIN CONTROL MECHANISM GABA

7. Red flag
Ad tanda bahaya yg melatarbelakangi nyeri kepala yg harus diwaspadai jgn dianggap remeh seperti : Deman Infeksi meningitis Defisit neurology TTIK ; kesadaran & Kejang Kronis progressif Ggn keseimbangan

8.Klasifikasi
The Primary Headaches Migraine Tension-type headache (TTH) Cluster headache Other primary headaches The Secondary Headaches Headache attributed to head and/or neck trauma Headache attributed to cranial or cervical vascular disorders Headache attributed to non-vascular intracranial disorders Headache attributed to a substance or its withdrawal Headache attributed to infection Headache attributed to disorder of homoeostasis Headache or facial pain attributed disorder of cranial, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures Headache attributed to psychiatric disorders Cranial Neuralgias, central & primary facial pain & other headaches Cranial neuralgias & central causes of facial pain Others headache, cranial neuralgias & central or primary facial pain Diagnosa : Nyeri kepa sekunder ec 9.HISTORY 1. AGE AT ONSET 2. ATTACK ONSET 3. QUALITY 4. SEVERITY 5. LOCATION, RADITION OF PAIN 6. MODE OF ONSET :early warning symtom, aura 7. TIME, INTENSITY, CURVE, DURATION 8. CONDITION WHICH EXACERBATE / RELIEVE THE PAIN 9. ASSOCIATED FEATURES 10. PREVIOUS TREATMENT
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11. GENERAL HEALTH 12. SOCIAL HISTORY, FAMILY HISTORY 13. PAST HEADACHE&HEALTH HISTORY 14. HEADACHE IMPACT 15. EMOTIONAL STATE

10.VAS (Visual Analog Scale)

Visual Analog Scales


0
Tidak Nyeri

10
Nyeri Menyiksa

0
Nyeri hilang
Garis harus tepat 10 cm

10
Nyeri tidak mereda

McQuay, 1998.

Skala Nyeri Numerik


0 1 2 3 4
13 46 7 10

10 Nyeri Menyiksa

Tidak Nyeri
Nyeri ringan Nyeri sedang Nyeri berat

HAS/Neuro/2004

Skala Wajah

HAS/Neuro/RSHS-FKUP

Nyeri Kepala

No Tanda Gejala 1 Sifat

Migrain Episodic Recurrent

Tension Type Headache Konsisten Continue

Cluster headache Terjadi pd malam hariterbangun , sensasi terbakar pd daearah lateral hidung mata Spt menikam

Bentuk

Berdenyut

1.Terasa berat 2.Spt Tertekan 3.Spt diperas 4.Spt mau meledak Bilateral belakang kepalabelakang leherbahu

Lokasi

Unilateral

Unilateral Orbital Supra orbital Temporal 1.Ggn emosional, marah, frustasi 2.Aktivitas fisik yg berat

Pemicu

1.Pemanis buatan 2. Lingkungan 3.Suara rebut, brisik 4.Cahaya kelap kelip

1.Pubertas 2.Pindah sekolah 3.Masalah pekerjaan

3.Pengaruh ketinggian 4.Perubahan siklus tidur 5 Durasi 4-72 jam 30 menit 7 hari 1.Bbr menit 2.30 60menit 3.Tiap hari 4.> 1x/hari COINCIDE WITH ANXIETY & DEPRESSION

Penyeba b

Dilatasi vasculer

Psychologic factors Muscle contraction and myofacial tenderness Humoral factors : 5HT Central factors : central pain control system

Mekanis me

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 MIGRAINE TRIGGERS, i.e. : HORMONAL FLUCTUATION, EMOTION, FATIGUE, FASTING, METEOROLOGIGAL CHANGES, DIETARY FACTORS

Stress fisik Hiperventilasi CO2 dln darah Ggn keseimbangan asam basa Alkalosis Kalsium Otot leher kaku Nyeri

SWELLING OF THE ARTERIAL WALL OF THE INTERNAL CAROTID ARTERY HISTAMINE RELEASE HYPOTHALAMIC MECHANISM

Prevalen si VAS Diperber at

80% before 30 years of age Sedang berat Aktivitas fisik

Dominasi wanita

Pria > wanita (5:1)

9 10

Mild to moderate

Sgt berat (severe)

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Penyerta Nausea Muntah Fotofobia Fonofobia

Nasal congesti Rhinorrhea Conjunctional injection Lacrimation Miosis Ptosis Eyeled edema Forehead and facial sweeting

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Phase

1. Fase premonitor (prodromal) Fase ini terjadi berjam-jam atau berhari-hari ( 24-72 jam ) sebelum onset nyeri kepala. 2. Aura Berupa gejala visual, sensorik, motorik, gangguan bahasa maupun gejala disfungsi batang otak) 3. Nyeri kepala 4. Fase postdromal Fase ini mengikuti fase nyeri kepala, penderita mungkin mengalami gangguan konsentrasi atau lelah, dan irritable. Kelemahan otot, nyeri dan anoreksia atau rakus dapat terjadi.

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Klassifik asi

Migrain tanpa Aura Migrain dengan Aura

Episodik TTH Chronic TTH

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Penanga nan

a.ABORTIVE *ACETAMINOFEN, ASA, NSAID * SPECIFIC DRUGS : - ERGOT ALKALOIDS ( ERGOTAMINE, DHE ) - SUMATRIPTAN b. PREVENTIVE : - ADRENOCEPTOR BLOCKER

Farmakology Analgetik AntidepressantMuscle relaxant

ACETAMINOPHEN, ASA, NSAID ANTIDEPRESSANTS PSYCHOTHERAPY

Non Farmakology
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( PROPRANOLOL ) - ANTIDEPRESANT - Ca-CHANNEL BLOCKER - ANTICONVULSANT - ANTAGONIST SEROTONIN

Fisioterapi Istirahat & posisi tubuh yg benar Relaxasi otot Psychoterapi