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MIGRAIN

DISUSUN OLEH: SUPERVISOR PEMBIMBING:


CARIMA GHALIE DZAKI DR. RAHMAWATI AKIB, SP.S, M.KES
111 2016 2054
DEFINISI

Nyeri kepala unilateral dengan


karakteristik serangan berdenyut yang
berlangsung 4-72 jam, dengan intensitas
nyeri sedang, bertambah berat dengan
aktivitas fisik, dan dapat disertai mual,
muntah, fotofobia dan fonofobia

Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
International Headache Society (IHS). 2013. The International Classification of Headache Disorders, 3rd edition. Journal Cephalgia. Vol.33(9). Hal.629-808.
Epidemiologi

Prevalensi mencapai 10%di seluruh dunia


Wanita > Pria
Usia terbanyak 25-55 tahun
90% merupakan migrain yang disertai
aura

Harsono. 2005. Buku Ajar Neurologi Klinis. Yogyakarta: Gadjah Mada University Press. Hal 289-300
Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
Talley, Britt MD. 2010. Migraine. USA: AuthorHouse Publisher.
Faktor Pencetus
Puasa
Emosi
Perilaku / Kebiasaan Gangguan tidur
Stress
Aktivitas
Stimulus cahaya/visual
Bau
Pengaruh lingkungan
Pergantian musim
Asap rokok
Infeksi ISPA
Minuman berkafein
Minuman beralkohol
Diet
Coklat
Es krim
Monosodium glutamat
Tyramin
Kimiawi
Nitrat
Aspartat
Hormonal Menstruasi
Harsono. 2005. Buku Ajar Neurologi Klinis. Yogyakarta: Gadjah Mada University Press. Hal 289-300
Talley, Britt MD. 2010. Migraine. USA: AuthorHouse Publisher.
Patofisiologi

Teori Cortical Spreading


Depression

Teori
Teori Vascular Trigeminovascular

Migrain

Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
Harsono. 2007. Kapita Selekta Neurologi Edisi Kedua. Yogyakarta: Gadjah Mada University. Hal. 253-262.
Diamond, Seymour. 2015. Headache and Migraine Biology and Management. USA: Elsevier.
Patofisiologi

Teori Cortical Spreading


Depression
Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
Harsono. 2007. Kapita Selekta Neurologi Edisi Kedua. Yogyakarta: Gadjah Mada University. Hal. 253-262.
Diamond, Seymour. 2015. Headache and Migraine Biology and Management. USA: Elsevier.
Patofisiologi

Teori
Trigeminovascular
Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
Harsono. 2007. Kapita Selekta Neurologi Edisi Kedua. Yogyakarta: Gadjah Mada University. Hal. 253-262.
Diamond, Seymour. 2015. Headache and Migraine Biology and Management. USA: Elsevier.
Patofisiologi

Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
Harsono. 2007. Kapita Selekta Neurologi Edisi Kedua. Yogyakarta: Gadjah Mada University. Hal. 253-262.
Diamond, Seymour. 2015. Headache and Migraine Biology and Management. USA: Elsevier.
Manifestasi Klinis

Fase Prodromal

Fase Aura

Fase nyeri kepala

Fase Postdromal

Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
Harsono. 2005. Buku Ajar Neurologi Klinis. Yogyakarta: Gadjah Mada University Press. Hal 289-300
Klasifikasi Migrain
1. Migrain tanpa aura
2. Migrain dengan aura
a. Migrain dengan aura yang khas
b. Migrain dengan aura batang otak / Basilar migraine
c. Migrain hemiplegik
- Familial hemiplegic migrain
- Sporadic hemiplegic migrain
d. Migrain retinal
3. Migrain kronik
4. Probable Migrain
a. Probable migrain tanpa aura
b. Probable migrain dengan aura

International Headache Society (IHS). 2013. The International Classification of Headache Disorders, 3rd edition. Journal Cephalgia. Vol.33(9). Hal.629-808.
Diamond, Seymour. 2015. Headache and Migraine Biology and Management. USA: Elsevier.
Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
Diagnosis

International Headache Society (IHS). 2013. The International Classification of Headache Disorders, 3rd edition. Journal Cephalgia. Vol.33(9). Hal.629-808.
Diamond, Seymour. 2015. Headache and Migraine Biology and Management. USA: Elsevier.
Diagnosis

International Headache Society (IHS). 2013. The International Classification of Headache Disorders, 3rd edition. Journal Cephalgia. Vol.33(9). Hal.629-808.
Diamond, Seymour. 2015. Headache and Migraine Biology and Management. USA: Elsevier.
Diagnosis

International Headache Society (IHS). 2013. The International Classification of Headache Disorders, 3rd edition. Journal Cephalgia. Vol.33(9). Hal.629-808.
Diamond, Seymour. 2015. Headache and Migraine Biology and Management. USA: Elsevier.
Diagnosis

International Headache Society (IHS). 2013. The International Classification of Headache Disorders, 3rd edition. Journal Cephalgia. Vol.33(9). Hal.629-808.
Diamond, Seymour. 2015. Headache and Migraine Biology and Management. USA: Elsevier.
Diagnosis

International Headache Society (IHS). 2013. The International Classification of Headache Disorders, 3rd edition. Journal Cephalgia. Vol.33(9). Hal.629-808.
Diamond, Seymour. 2015. Headache and Migraine Biology and Management. USA: Elsevier.
Diagnosis Banding
Karakteristik Migrain Tipe Tegang Kluster

Pervalensi usia Remaja-Dewasa Semua umur Dewasa-Lansia

Laki-laki >
Jenis kelamin Perempuan > Laki-laki Perempuan > Laki-laki
Perempuan

Durasi serangan 4 72 jam 30 menit 7 hari 15 menit 3 jam

Frekuensi serangan Bervariasi Kadang-kadang Setiap hari

Kualitas nyeri Berdenyut Tumpul, seperti diikat Hebat, seperti ditusuk

Retroorbital, temporal, Bilateral, temporal


Lokasi Unilateral, retroorbital
hemikranial dan/atau oksipital

Tanda dan gejala


Mual, muntah,
Gejala penyerta Jarang ada otonom pada
fotofobia, fonofobia,
ipsilateral

Fowler, JT. 2011. Clinical Neurology, 4th Edition. London: Hodder & Stoughton Ltd. Hal. 217-233
Jose, Biller. 2012. Practical Neurology 4th Edition. Philadelpia: Lippincott Williams & Wilkins. Hal. 207-208
Terapi

Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
Harsono. 2007. Kapita Selekta Neurologi Edisi Kedua. Yogyakarta: Gadjah Mada University. Hal. 253-262.
Jose, Biller. 2012. Practical Neurology 4th Edition. Philadelpia: Lippincott Williams & Wilkins. Hal. 207-208
Terapi
Terapi Komplemen

Magnesium disitrat 600 mg/hari

magnesium oksida 400 mg/hari

CoQ10 300 mg/hari

400 mg/hari
Vit B2

Asam Alfalipoat 600 mg/hari

Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
Harsono. 2007. Kapita Selekta Neurologi Edisi Kedua. Yogyakarta: Gadjah Mada University. Hal. 253-262.
Jose, Biller. 2012. Practical Neurology 4th Edition. Philadelpia: Lippincott Williams & Wilkins. Hal. 207-208
Profilaksis
indikasi profilaksis:
nyeri kepala terkait disabilitas terjadi 3 hari per bulan
durasi migrain > 48 jam
medikasi migrain akut tidak efektif, dikontraindikasikan,
atau overused
serangan menghasilkan disabilitas berat, aura yang
memanjang, atau nyata terjadi migrainous infarction,
serangan lebih dari dua sampai empat kali per bulan
meski dengan perawatan memadai
pasien lebih memilih terapi preventif.

Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
Dito Anurogo. 2012. Penatalaksanaan Migren. Jurnal Cermin Dunia Kedokteran-198. Vol.39 No.10. 2012. RS PKU Muhammadiyah Palangkaraya, Kalimantan Tengah, Indonesia.
Jose, Biller. 2012. Practical Neurology 4th Edition. Philadelpia: Lippincott Williams & Wilkins. Hal. 207-208
Profilaksis
Terapi Preventif Terapi Preventif

Beta bloker Antidepressan


Propanolol 40-120 mg/hari Amitriptylin 25-75 mg
Metoprolol 25-100 mg 2x1 notriptylin 75-150 mg/hari

Anti konvulsan CoQ10 300 mg/hari


Topiramate 50-200 mg/hari
Gabapentin 900-3600mg/hari
Vit B2 400 mg/hari

Flunarizine 5-15 mg/hari


Valproate 400-600mg 2x1

Dodick, David. 2016. Migraine, Third Edition. New York: Oxford University Press.
Dito Anurogo. 2012. Penatalaksanaan Migren. Jurnal Cermin Dunia Kedokteran-198. Vol.39 No.10. 2012. RS PKU Muhammadiyah Palangkaraya, Kalimantan Tengah, Indonesia.
Jose, Biller. 2012. Practical Neurology 4th Edition. Philadelpia: Lippincott Williams & Wilkins. Hal. 207-208
Prognosis
3%
3%
Remisi
Migrain
parsial 10%
kronis
Remisi
sempurna

84%
Migrain
persisten

Bigal, ME. 2008. The Prognosis Of Migraine. Journal Curr Opin Neurol. Vol.21(3). Hal. 301-308