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. Harrison’s Principles of Internal Medicine. 1998:53-8.
KEPEKAAN JARINGAN INTRA DAN EKSTRA
KRANIUM TERHADAP NYERI
Jaringan penutup kranium, semuanya banyak atau sedikit
bersifat peka terhadap nyeri, teristimewa arteri-arteri lebih
peka.
Struktural intrakranial yang bersifat peka terhadap nyeri
adalah sinus venosus besar dan anak-anak venanya dari
permukaan otak, bagian-bagian dari duramater pada
basis arteri-arteri dural, dan arteri-arteri serebral pada
basis otak.
Kranium (termasuk vena diploika dan emissary),
parenchim otak, sebagian besar duramater, sebagian
besar piamater dan arachnoid, batas ependimal dari
ventrikel dan pleksus –pleksus khoroideus adalah tidak
peka terhadap 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)
Description:
Infrequent episodes of headache lasting minutes
to days. The pain is typically bilateral, pressing
or tightening in quality and of mild to moderate
intensity, and it does not worsen with routine
physical activity. There is no nausea but
photophobia or phonophobia may be present.
Infrequent episodic tension-type headache
Diagnostic criteria:
A. At least 10 episodes occurring on <1 day per month on
average (<12 days per year) and fulfilling criteria B-D
B. Headache lasting from 30 minutes to 7 days
C. Headache has at least two of the following characteristics:
1. bilateral location
2. pressing/tightening (non-pulsating) quality
3. mild or moderate intensity
4. not aggravated by routine physical activity such as
walking or climbing stairs
D. Both of the following:
1. no nausea or vomiting (anorexia may occur)
2. no more than one of photophobia or phonophobia
E. Not attributed to another disorder1
Pathofisiologi
Stress may cause contraction of neck and
scalp muscles, although no evidence
confirms that the origin of pain is
sustained muscle contraction.
Stress and/or anxiety
Poor posture
Depression
Psychological or social problems
Pengobatan Sakit Kepala Tipe
Tegang
Analgetika
Anti ansietas
Anti depresan
Relaksan otot
Terapi relaksasi
Nasehat
Olah raga Meditasi
Olah seni Rekreasi / hobi
Membaca
3.1 Cluster headache
Description:
Attacks of severe, strictly unilateral pain which is orbital,
supraorbital, temporal or in any combination of these
sites, lasting 15-180 minutes and occurring from once
every other day to 8 times a day. The attacks are
associated with one or more of the following, all of which
are ipsilateral: conjunctival injection, lacrimation, nasal
congestion, rhinorrhoea, forehead and facial sweating,
miosis, ptosis, eyelid oedema. Most patients are restless
or agitated during an attack.
3.1 Cluster headache
Diagnostic criteria:
A. At least 5 attacks fulfilling criteria B-D
B. Severe or very severe unilateral orbital, supraorbital and/or
temporal pain lasting 15-180 minutes if untreated
C. Headache is accompanied by at least one of the following:
1. ipsilateral conjunctival injection and/or lacrimation
2. ipsilateral nasal congestion and/or rhinorrhoea
3. ipsilateral eyelid oedema
4. ipsilateral forehead and facial sweating
5. ipsilateral miosis and/or ptosis
6. a sense of restlessness or agitation
D. Attacks have a frequency from one every other day to 8 per day
E. Not attributed to another disorder
Pengobatan Migren / Klaster
I. Migren akut
Analgetika
NSAID
Ergotamin
Gol triptan
II. Terapi preventif
Flunarizine
Pizatifen
Cyproheptadin
III. Nasehat : Hindari “5K” es, coklat, keju
Other primary headaches
4.1 Primary stabbing headache
4.2 Primary cough headache
4.3 Primary exertional headache
4.4 Primary headache associated with sexual
activity
4.4.1 Preorgasmic headache
4.4.2 Orgasmic headache
4.5 Hypnic headache
4.6 Primary thunderclap headache
4.7 Hemicrania continua
4.8 New daily-persistent headache (NDPH)
Classification
Part 2: The secondary headaches
5. Headache attributed to head and/or neck
trauma
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
ICHD-II. Cephalalgia 2004; 24 (Suppl 1) ©International Headache Society 2003/4
Classification
Part 2: The secondary headaches
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 structures
12. Headache attributed to psychiatric
disorder
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