DATA PRIBADI
RIWAYAT PENDIDIKAN
RIWAYAT ORGANISASI
Tahun 1977 : DokterdariFakultasKedokteran UNS Tahun 1977-sekarang : IkatanDokter Indonesia (IDI)
Tahun 1987 : DokterspesialisPenyakitSarafdariFakultasKedokteran UNAIR Tahun 1987-sekarang : PERDOSSI
Tahun 1992 : CBR fellowship, Tottori University, Japan Tahun 1990-sekarang : World Federation of Neurology (WFN)
Tahun 2001 : S3 dariIlmuKedokteran UNAIR Tahun 2007-sekarang : American Academy of Neurology (AAN)
Tahun 2003 : KonsultanSerebrovaskulerdari KNI
Tahun 2008-sekarang : World Stroke Organization (WSO)
Tahun 2015 : FAAN dari America Academy of Neurology
Tahun 2015-sekarang : European Academy of Neurology (EAN)
RIWAYAT PEKERJAAN
1977-1981 : Ketua Lab Farmakologi FK UNS
1988-1994 : KetuaJurusanMedik FK UNS
4/18/2014
1994-1998 : Dekan FK UNS
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2005-sekarang : Ketua Lab/ SMF I.PenyakitSaraf FK UNS/ RS Dr. Moewardi
Headache in
Out-Patients Clinic
Suroto
Dept of Neurology, Fac of Medicine
Sebelas Maret University
Defferentiating headache and vertigo
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Of all the painful states, Headache is the most frequent
reason for seeking medical help.
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Pain Sensitive Structure in the Head
Intracranial Intracranial
Large arteries near circle of Parenchyma of brain
Willis Pia mater, arachnoid mater,
Large venous sinuses parts of duramater
Dural arteries and parts of dura Ependyma, choroid plex
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Headache can occur as a result of:
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CLASSIFICATION OF HEADACHE
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Primary, Idiopathic Headache
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Secondary, Symptomatic Headache
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History Taking:
1.Age, sex:
Migraine headache – more frequent in teenagers & young adults,
higher occurrence in female.
Cluster headache – almost exclusively in males.
Cranial arteritis – more frequently in late middle age & in elderly.
2.Quality of pain:
Tension headache – pressing, squeezing, tight or heavy.
Migraine headache – throbbing or pounding.
Headache due to intracranial lesion – relatively mild.
Acute SAH- pain tends to be explosive & intense.
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History Taking: Cont’d
3. Location of headache:
As a general rule localized headache is of greater significance than diffuse
headache.
Tension headache – typically generalized, band like or bioccipital.
Migraine with aura – often unilateral & frequently more prominent
interiorly.
Migraine without aura – frequently bilateral.
Cluster headache – invariably limited to the same side of the head in any
given attacks & usually periorbital.
Sinusitis – fontal/ethmoidal, head position
Cranial arteritis – manifested by localized temporal headache.
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History Taking: Cont’d
4. Associated symptoms:
Tension headache – often associated with other psycho-physiologic
disturbances.
Cluster headache – typically associated with ipsilateral lacrimation,
conjuctival injection, rhinorrhoea, & facial flushing.
Intracranial mass lesion – associated symptoms are more prominent
than headache. Some intra-cerebral lesion may exhibit seizure or
vomiting.
Cranial arteritis – systemic symptoms as fever, anorexia & rheumatic
symptoms.
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History Taking: Cont’d
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History Taking: Cont’d
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Migraine vs Stroke
A migraine: severe headache that can induce nausea, vomiting, and
sensitivity to light, sounds, and smells
Migraine aura:
- In up to 30 percent
- Aura/warning: visual disturbances, numbness, speech difficulties
These warning signs are very similar to the symptoms of a stroke.
Stroke symptoms:
• Numbness or weakness on one side of the body
• Vision loss
• Trouble understanding speech
• Slurred speech
• Headache
• Dizziness
• Disorientation
Several factors can help determine: onset, visual disturbances, pre-
history 18
Sudden vs. gradual.
Strokes occur suddenly.
Migraine aura: occur more gradually, evolving over several mints
Migraine aura: accompanying headache intensifies to a peak.
Positive vs. negative visual disturbances.
Migraine aura: experience additional stimuli, such as flashing
lights or zigzagging lines
Stroke: detracts from vision.
Stroke: not realize immediately that the vision has been impaired
until begin bumping into things.
History vs. no history of migraines.
Migraine aura: tend to be the same every time.,
First migraine aura: it’s less common – in children
Stroke: for the first time late in life
If pts have never a migraine before or if migraine migraine
deviates from its normal course get to an emergency room as
soon as possible to rule out a stroke or TIA. 19
PHYSICAL EXAMINATION:
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PHYSICAL EXAMINATION:
2. Neurological examination:
No neurological abnormality – tension headache.
Permanent residual damage – Evidence of cerebral ischaemia – small
percentage of migraine
Horner’s syndrome – sometimes during migraine headache (rarely
permanent).
Localizing sign – expanding IC-SOL.
Papilledema - ICP due to IC-SOL.
Bruits over the eyes/cranium – vascular malformation.
Sign of meningeal irritation – lesion affecting the meninges.
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Investigations
Blood Examination.
Skull & Cervical Spine Imaging.
CT Scan of the head.
MRI & MRA of the brain.
Eye & ENT evaluation.
Cardiologic & renal evaluation.
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When to scan a patient with headache
Flag Descriptions/example
Systemic symptoms or secondary Fever,W-loss,or known cancer,HIV,
risk factors immunosupression or thrombotic risks
Neurological symptoms or signs Confusion,impaired alertness/drowsy,
persistent focal signs >1h
Onset First and worst headache,sudden abrupt
from sleep, or progressively worsening
Older New onset at age and progressive
(Giant cell arteritis)
Previous headache history Significant change in features, freq. or
severity
Triggered headache By valsalva, exertion,
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HEADACHE OF SOME SERIOUS ILLNESS:
Meningitis:
• Acute severe headache – rapid evolution, minutes to hours.
• Site - generalized or bi-occipital or bi-frontal.
• Associated with fever, photophobia, nausea and vomiting.
• Neck stiff on forward bending, Kernig and Brudzinski signs.
• LP – diagnostic .
SAH:
• Acute severe headache – rapid evolution, minutes to hours.
• Site – generalized.
• Not associated with fever.
• Neck stiffness – on forward bending.
• LP – diagnostic. 25
Brain tumor:
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Temporal arteritis/giant cell arteritis:
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Moewardi Hospital
Headache Out Patient Clinic
Jan-Jul, 2018
Problem n %
TTH 63 54.3
Migraine 21 18.1
ENT problem 9 7.8
Dental problem 6 5.2
Intracranial SOP 6 5.2
Ischemic stroke 4 3.4
ICH 3 2.6
AVM 2 1.7
Intracranial Infection 2 1.7
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Summary
Headache is usually a benign symptom but occasionally it is the
manifestation of a serious illness.
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