(CEFALGIA / HEADACHE)
NYERI
N. NOSISEPTIF N. PSIKOGENIK
N. Somatik N. NEUROPATIK
N. Viseral
Referred Pain Perifer
Sentral
DEFINISI
NYERI NOSISEPTIF:
Nyeri yang timbul bila reseptor nyeri (nosiseptor)
teraktivasi.
NYERI NEUROPATIK:
Nyeri yang timbul akibat lesi atau disfungsi pada susunan
saraf
NYERI PSIKOGENIK:
Nyeri dengan faktor psikogen tanpa sebab organik.
The Pain Pathway
Pain Perception
Brain
Spinal Cord
Nociceptor Gottschalk A et al. Am Fam Physician. 2001;63:1979-84.
Fields HL et al. Harrisons Principles of Internal Medicine. 1998:53-8.
Definisi Nyeri Kepala
Rasa nyeri atau rasa tidak
mengenakkan pada daerah atas
kepala memanjang dari orbita sampai
kedaerah belakang kepala (area
oksipital dan sebagian daerah
tengkuk)
Patofisiologi :
a. Rangsang nyeri bisa disebabkan oleh
adanya tekanan, traksi displacement
maupun proses kimiawi & inflamasi thd
nosiseptor2 pd struktur yg pain sensitive di
kepala. Jk struktur2 pain sensitive yg
terletak pd ataupun diatas tentorium
serebelli dirangsang mk rasa nyeri akan
timbul terasa menjalar pd daerah didpn
batas garis vertikal yg ditarik dari kedua
telinga kiri dan kanan melewati puncak
kepala (daerah frontotemporal dan parietal
anterior). Rasa nyeri ini ditransmisi oleh N.
V (Trigeminus)
b. Sedangkan rangsangan thd struktur yg
peka thd nyeri dibwh tentorium (yi yg
terletak pada fosa kranii posterior) radix
servikalis bag atas dg cab2 saraf
perifernya akan menimbulkan nyeri pd
daerah diblk garis tsb diatas, yaitu pd
daerah oksipital, sub oksipital area dan
servikal bag atas. Rasa nyeri ini
ditransmisi oleh saraf kranial IX, X dan
saraf spinal C-1, C-2 dan C3.
c. Ada 3 pembagian besar dr struktur yg pain
sensitive di kepala :
1. Struktur Intra Kranial :
- Sinus kranialis dan vena aferen (sinus
venosus, dan vena2 yg mensuplay sinus2 tsb)
- Arteri dr duramater (a. meningea media)
- Arteri di basis kranii yg membentuk sirkulus
Willisi dan cab2 besarnya.
- Sebagian dr duramater yg berdekatan dg
pembuluh darah besar terutama yg terletak
dibasis fossa kranii anterior dan posterior
dan
meningens
2. Struktur Ekstra kranial
- Kulit, Scalp, otot, tendon & fascia daerah
kepala dan leher
- Mukosa sinus paranasalis & cavum nasi.
- Gigi geligi,
- Telinga luar dan tengah,
- Tlg tengkorak tu. daerah supra orbita,
temporal dan oksipital bwh, rongga orbita
beserta isinya.
- Arteri ekstra kranial.
3. Saraf
- N. Trigeminus, N. Fasialis, N.
Glossofaringeus, N. Vagus.
- Saraf spinal servikalis 1,2,3.
d. Sedangkan struktur parenkim otak ,
sebagian duramater tengkorak adalah
relatif tidak sensitif thd nyeri.
INTERNATIONAL CLASSIFICATION
of
HEADACHE DISORDERS (ICHD-II)
2nd edition
(ICHD-II)
Part 1:
Primary headache disorders
Part 2:
Secondary headache disorders
Part 3:
Cranial neuralgias, central and primary
facial pain and other headaches
Primary:
Secondary
(ie, caused by another disorder):
new headache occurring in close temporal
relation to another disorder that is a known
cause of headache
coded as attributed to that disorder
(in place of previously used term associated
with)
Status migrainosus
A debilitating migraine attack lasting for more
than 72 hours.
Migraine
Diagnostic criteria:
A. At least 5 attacks1 fulfilling criteria B-D
B. Headache attacks lasting 4-72 hours (untreated or
unsuccessfully treated)
C. Headache has at least two of the following
characteristics:
1. unilateral location
2. pulsating quality
3. moderate or severe pain intensity
4. aggravation by or causing avoidance of routine
physical activity (eg, walking or climbing stairs)
D. During headache at least one of the following:
1. nausea and/or vomiting
2. photophobia and phonophobia
E. Not attributed to another disorder
Patofisiologi
The neurovascular (trigeminovascular) theory,
one of the oldest, states that intracranial
vasoconstriction is responsible for migraine
aura, and the subsequent rebound
vasodilatation and activation of perivascular
nociceptive nerves results in headache. Wolff et
al
In 1944, Leao proposed the theory of Cortikal
Spreading Depression (CSD) to explain the
mechanism of migraine with aura.
Patofisiologi 2
Hypertension Beta-blockers
Angina Beta-blockers
Stress Beta-blockers
Depression Tricyclic antidepressants, SSRIs
Underweight Tricyclic antidepressants
Epilepsy Valproic acid, Topiramate
Mania Valproic acid
Pathophysiology
Usually no structural lesion is present, although
many investigators agree that vascular
compression, typically venous or arterial loops
at the trigeminal nerve entry into the pons, is
critical to the pathogenesis of the idiopathic
variety. This compression results in focal
trigeminal nerve demyelination.
Since the exact pathophysiology remains
controversial, TN may have either a central
and/or peripheral etiology
Pengobatan Neuralgia
Trigeminus
Karbamazepin
Suntikan lokal
Operasi
Sakit kepala yang SERIUS
Sakit kepala yang hebat
Sakit kepala yang progresif
Sakit kepala yang disertai
kesadaran menurun
kebingungan
demam tinggi
gangguan pengelihatan
gangguan keseimbangan
kelemahan
TERIMAKASIH