CEPHALGIA

Defenisi

Sakit Kepala
Setiap jenis memiliki dasar organik, meskipun ada
faktor etiologik yang bersifat psikogenik

Etiologi

Rangsang pada area kepala dan leher (pain sensitive structure)

Otot oksipital, temporal, frontal, kulit kepala, arteri arteri subkutis, dan
periostium
Meningens (dura basalis, meningens pada sinus venosus dan arteri
besar pada basis)
Infeksi
Iritasi kimiawi
Peregangan selaput otak
Vasodilatasi

Intrakranial (toksik, metabolik, obat, lonjakan tekanan darah)

Ekstrakranial (VD, gangguan lain)

Gangguan otot yang berhubungan dengan kepala

Referred pain
Ketegangan otot kepala-leher-bahu

Keadaan patologik lain

Kaku kuduk
Tekanan intraokuler
Disfungsi saraf otak
Funduskopi -> papiledema/ papilitis
Sinusitis
Mastoiditis
Horner syndrome
Tanda Lhermitte yang mengungkapkan jepitan pada saraf kranial
Kelainan mediastinum
Kepribadian dan perangai psikoneurotik

The secondary headaches

5. Headache attributed to trauma or injury to the head
and/or neck
6. Headache attributed to cranial or cervical vascular
disorder
7. Headache attributed to non-vascular intracranial disorder
8. Headache attributed to a substance or its withdrawal
9. Headache attributed to infection
10. Headache attributed to disorder of homoeostasis
11. Headache or facial pain attributed to disorder of the
cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or
other facial or cervical structure

Klasifikasi
The primary headaches
1. Migraine
2. Tension-type headache
3. Trigeminal autonomic
cephalalgias
4. Other primary
headache disorders

Migrain

Nyeri kepala berulang dengan

Serangan nyeri yang berlangsung 4-72 jam

Biasanya unilateral
Sifatnya berdenyut
Intensitas nyeri sedang-berat
Diperhebat oleh aktivitas fisik rutin
Dapat disertai nausea, fotofobia dan fonofobia

Klasifikasi migrain

Migraine without aura

Migraine with aura
Chronic migraine
Complications of migraine
Probable migraine
Episodic syndromes that may be associated with
migraine

Tatalaksana migrain

Tension type headache

Termasuk di dalam sakit kepala psikoneurotik

Sifat sakit bervariasi : pegal-kencangnyeri (bisa
seperti berdenyut atau kencang mengikat kepala)
Satu sisiseluruh kepala
Dapat setelah stress
Neurotik -> non neurotik

Klasifikasi Tension type headache

2.1
2.2
2.3
2.4

Infrequent episodic tension-type headache

Frequent episodic tension-type headache
Chronic tension-type headache
Probable tension-type headache

Trigeminal autonomic cephalalgias

(TACs)

Jenis sakit kepala primer yang terjadi dengan rasa sakit

pada satu sisi kepala di daerah saraf trigeminal (orbital,
supraorbital, temporal) dan gejala pada sistem otonom
di sisi yang sama, seperti peningkatan produksi air
mata dan kemerahan atau ptosis.

Klasifikasi Trigeminal autonomic cephalalgias (TACs)

3.1 Cluster headache
3.2 Paroxysmal hemicrania
3.3 Short-lasting unilateral neuralgiform headache
attacks
3.4 Hemicrania continua
3.5 Probable trigeminal autonomic cephalalgia

Other primary headache disorders

4.1 Primary cough headache
4.2 Primary exercise headache
4.3 Primary headache associated with sexual activity
4.4 Primary thunderclap headache
4.5 Cold-stimulus headache
4.6 External pressure headache
4.7 Primary stabbing headache
4.8 Nummular headache
4.9 Hypnic headache
4.10 New daily persistent headache (NDPH)

The secondary headaches

5. Headache attributed to trauma or injury to the head

and/or neck
6. Headache attributed to cranial or cervical vascular
disorder
7. Headache attributed to non-vascular intracranial
disorder
8. Headache attributed to a substance or its withdrawal
9. Headache attributed to infection
10. Headache attributed to disorder of homoeostasis
11. Headache or facial pain attributed to disorder of
cranium, neck, eyes, ears, nose, sinuses, teeth, mouth
or other facial or cranial structure

General diagnostic criteria for secondary headaches

A.Any headache fulfilling criterion C
B.Another disorder scientifically documented to be able to cause headache
has been diagnosed
C.Evidence of causation demonstrated by 2 of the following:
1.headache has developed in temporal relation to the onset of the presumed
causative disorder
2.one or both of the following:
a. headache has significantly worsened in parallel with worsening of the
presumed causative disorder
b. headache has significantly improved in parallel with improvement of
the presumed causative disorder
3.headache has characteristics typical for the causative disorder
4.other evidence exists of causation