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Culture Documents
female male
Epidemiology
in
Indonesia
(hospital
base)
Prevalence
life
>me
TTH
78%
Episodic
TTH
63%
male
56%
,female
71%
TTH
chronic
3%
male
2
%
,female
5%
ETTH(Indonesia
31%,
Medan
9.8%)
CTTH
(Indonesia
24%,
Medan
44%)
Migraine
=10%
(Indonesia)
Without
aura(
Medan
6.3%)
with
aura
(Medan
1.8%)
Prevalence
in
Indonesia
(2004)
outpa>ent
clinic
1. Sefalgia
42
%
1. Migraine
wthout
aura
6-10%
2. Osteo
arthri>s
9.5%
2. Migraine
with
aura
1.8%
3. Stroke
7.7%
3. ETTH
31%
4. LBP
+
OA
7.3%
4. CTTH
24%
5. Insomnia
4.0%
5. Cluster
Headache
0.5%
6. Epilepsy
3.8%
6. Mixed
Hx
14%
7. Post
trauma
cap
syndr
14%
7. Ver>go
3.6%
8. Secondary
Headache
3%
8. Bells
palsy
3.2%
9. Chronic
Daily
Headache
9%
9. LBP+HNP
2.5%
10.Chronic
Paroksismal
10. Neuropathy
2.3%
Hemikrania
1%
Headache
verbal
Scale
0
=
no
headache
1
:
mild
headache,
ADL
normal
2
:
moderate
headache,
ADL
a
mild
disturbed
(no
need
take
a
rest)
3
:
severe
headache
:
ADL
very
disturbed
(need
take
a
rest/
admiTed
to
hospital).
Pathophysiology
theory
of
headache
1. Sensi>za>on
2. theory
vasodilata>on
3. ac>vation
trigeminovascular
4. Steril
inamma>on
neuron
5.cor&cal
spreading
depression,
6. ac>va>on
rostral
brainstem
7. ac>vity
imbalance
brain
stem
nuclei
regula&ng
an&nocep&on
with
vascular
control
8. etc
HEADACHE
CLASSIFICATION
1.
PRIMARY
HEADACHE
1. Migraine
2. Tension
Type
Headache
3. trigeminal
autonomic
chephalalgias
4. Other
primary
headache
2.
SECONDARY
HEADACHE
3.
Painful cranial neuropathies, other
facial pains and other headaches
Part two: 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
12. Headache attributed to psychiatric disorder
Part three: Painful cranial neuropathies, other
facial pains and other headaches
13. Painful cranial neuropathies and other facial pains
Trigeminal neuralgia
Glossopharyngeal neuralgia Nervus intermedius (facial
nerve) neuralgia
Occipital neuralgia
Optic neuritis
Headache attributed to ischaemic ocular motor nerve
palsy
Tolosa-Hunt syndrome
Paratrigeminal oculosympathetic (Raeders) syndrome
Recurrent painful ophthalmoplegic neuropathy
Burning mouth syndrome (BMS)
Persistent idiopathic facial pain (PIFP)
Central neuropathic pain
1. Migraine
A. At
least
5
aTacks
B. Hx
aTacks
lasDng
4-72
hrs
C. Hx
has
2
following
characterisDcs:
A. Unilateral
B. PulsaDng
C. Moderate
or
severe
pain
D.AgravaDon
by
physical
acDvity
D. During
Hx
1
of
the
following
A. Nausea
and/or
vomiDng
B. Phonophobia
and
photophobia
E. Not
aTributed
to
another
disorder
hasan
sjahrir
1.2 Migraine with aura
Stress
(79.7%),
light(s)(38.1%),
hormones in women alcohol
(37.8%),
(65.1%), smoke
(35.7%),
not eating (57.3%), sleeping
late
weather (53.2%), (32.0%),
sleep disturbance heat
(30.3%),
(49.8%), food(26.9%),
perfume or odour exercise
(22.1%)
(43.7%),
sexual
ac>vity
neck
pain
(38.4%),
(5.2%).
Kelman
L.
Cephalalgia
2007;
27:394402.
Food
as
Trigger
factor
of
migraine
MAYOR
MINOR
MSG
nuts
wine
/vodka/bier
Fried
foods
Cheese
Popcorn
Chocolate
Chile
peppers
Yogurt/yeast
Seafoods
citrus
fruits
Pork
/
livers
Bufermilk,
milk
Salty
food/sweety
Therapy
acute
migraine
Paroxysmal SUNCT
Therapy Cluster Headache
Hemicrania Syndrome
100% oxygen, 15 l/min (A)
Sumatriptan 6 mg, subcutaneous
(A)
Acute Sumatriptan 20 mg nasal (A) None None
Zolmitriptan 5 mg nasal (A/B)
Zolmitriptan 10 mg nasal (A/B)
Verapamil (A)
Preventiv Indomethacin (A)
Steroids (A)
e
52
Pure menstrual migraine without aura
Diagnostic criteria:
A. Attacks, in a menstruating woman,1 fulfilling cri-
teria for 1.1 Migraine without aura and criterion B
below
B. Documented and prospectively recorded
evidence over at least three consecutive cycles
has confirmed that attacks occur exclusively on
day 1 2 (i.e. days -2 to +3) of menstruation in at
least two out of three menstrual cycles and at no
other times of the cycle.
Menstrually related migraine without aura
Diagnostic criteria:
A. Attacks, in a menstruating woman,1 fulfilling
criteria for 1.1 Migraine without aura and criterion B
below
B. Documented and prospectively recorded
evidence over at least three consecutive cycles has
confirmed that attacks occur on day 1 2 (i.e. days
-2 to +3) of menstruation1 in at least two out of
three menstrual cycles, and additionally at other
times of the cycle.
Non-menstrual migraine without aura
Diagnostic criteria:
A. Attacks, in a menstruating woman, fulfilling cri-
teria for 1.1 Migraine without aura and criterion B
below
B. Attacks do not fulfil criterion B for A1.1.1 Pure
menstrual migraine without aura or A1.1.2
Menstrually related migraine without aura.
THE END