Professional Documents
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Dr.Amsar AT, SpS
Bagian Saraf FK UNRI
What is a headache
pain in the head that is located above the eyes or the ears, behind the head, or in the back of the upper neck.
Causes of headaches
1. Primary headaches
- not associated with other diseases. - Examples ; - migraine headaches, - tension headaches, - cluster headaches
2. Secondary headaches
- caused by associated disease. - may be : - minor or - serious and life threatening.
Primary headache
Tension headaches ; most common type ; as many as 90% of adults, women > men. Migraine headaches : second most common type. about 12% of the population in US affect children as well as adults. before puberty, boys = girls after puberty, women > men. 6% of men and up to 18% of women Cluster headaches : a rare type, affecting 0.1% of the population. 85% are men average age is 28-30 years, may begin in childhood.
Secondary headaches
serious and life threatening,
- brain tumors,
- strokes, meningitis, and - subarachnoid hemorrhages
Some elderly migraine sufferers may experience only the visual aura without the headache. A less common aura consists of pins-and-needles sensations in the hand and the arm on one side or around the mouth and the nose on the same side. auditory (hearing) hallucinations and abnormal tastes and smells.
Tension headache
does not have a clear cause. to excess stress or a hectic day. may have a cause that is similar to the cause of migraine headaches.
Cluster headache
does not have a clear cause, alcohol and cigarettes can precipitate attacks.
Subdural hematomas
which are collections of blood underneath the dura due to bleeding from ruptured veins. typically occur in elderly individuals after a fall or other trauma to the head. Sometimes the fall can precede the visit to the doctor by weeks, and the elderly patients may not even recall the fall. Symptoms include chronic headaches, change in personality, and weakness of the extremities
Epidural hematomas
which are rapid collections of blood due to the rupture of arteries that run on the inner surface of the skull. usually are the result of skull fractures. The typical story is a head injury that causes a concussion with loss of consciousness and a skull fracture. The return of consciousness is followed by the sudden development of coma caused by an expanding hematoma.
Infections
such as meningitis caused by bacteria tuberculosis, Lyme disease, or cryptococcus Infections of the sinuses (sinusitis), ear (otitis), and teeth
Strokes
due either to blood clots within the arteries of the brain or rupture of the blood vessels in the brain
Subarachnoid hemorrhages
bleeding into the space between the brain and its outer arachnoid lining. most common source of subarachnoid hemorrhage is an aneurysm,
Temporal arteritis
a vasculitis of the temporal artery which runs beneath the skin of the temple. occurs primarily in older people and may be associated with fatigue, body aches, and anemia. Without proper treatment, may lead to blindness and strokes.
Acute angle glaucoma - sudden elevation of pressures inside the eyes Infections of the sinuses, ear, and teeth Hypothyroidism, Repeated carbon monoxide poisoning Parkinson's disease
Medications
such as indomethacin, estrogen, progestins, calcium channel blockers selective serotonin reuptake inhibitors
Overuse
of over-the-counter or prescription pain relievers. of pain relievers causes the pain relievers to become less effective. as the effect of the pain reliever wears off, headaches recur (rebound headache).
Cardiac ischemia
as a cause of either heart attacks or angina, it also may cause a headache. occur with or without the accompanying chest pain of a heart attack or angina. As with angina, may occur with exertion and subside with rest.
5. Associated mental deterioration, seizures, or weakness of the extremities or face, which can be symptoms of brain tumors.
Pemeriksaan penunjang
Blood tests An elevated leucocyt infection. An elevated LED temporal arteritis. Abnormal thyroid tests thyroid disorders. CT scan of the head - detecting accumulation of blood such as subdural hematomas and SAB. - detecting brain tumors and strokes infarct
MRI scan of the head detect subdural and epidural hematomas, herpes simplex infection of the brain, strokes, tumors, and arterial aneurysms.
Lumbar puncture
- can reveal infection (meningitis due to bacteria or tuberculosis) or blood from hemorrhage. - patients with subarachnoid hemorrhage, CT scans are normal, and lumbar punctures are necessary to demonstrate blood
Acetaminophen
reduces pain and fever by acting on pain centers in the brain. well tolerated and generally is considered easier on the stomach than NSAIDs. cause severe liver damage in high (toxic) doses damage the kidneys when taken in large doses. not be taken more frequently or in larger doses than recommended
NSAIDs
relieve pain by reducing the inflammation that causes the pain
Triptan
attach to serotonin receptors on the blood vessels and nerves and thereby reduce inflammation and constrict the blood vessels. prescribed for moderate or severe migraines after OTC analgesics and other simple measures failed. can be used as the first treatment for patients with migraines that are causing disability. used early after the migraine begins, before the onset of pain or when the pain is mild. can be expected to abort more than 80% of migraine headaches within 2 hours.
Ergots
are medications that abort migraine headaches. cause constriction of blood vessels, but ergots tend to cause more constriction of vessels in the heart and other parts of the body than the triptans, and their effects on the heart are more prolonged than the triptans. not as safe as the triptans. more prone to cause nausea and vomiting than the triptans. cause prolonged contraction of the uterus and miscarriages in pregnant women
migraine triggers
Stress and fatigue Changes in weather, season, altitude level or time zone Changes in sleep patterns, including too much or too little sleep Bright lights Unusual odors Certain medications, including cimetidine, fenfluramine, nifedipine and theopylline Low blood sugar, changes in mealtimes, skipped meals or fasting Intense physical exertion, including sexual activity Tobacco, including secondhand smoke
Migraine prophylaxis
The goals of preventive therapy (1) to reduce attack frequency, severity, and/or duration; (2) to improve responsiveness to acute attacks, and (3) to reduce disability.
Migraine prophylaxis
Indications :
1. more than 2 migraine attacks per month. 2. single attacks that last longer than 24 hours. 3. major disruptions in the patient's lifestyle. 4. Abortive therapy fails or is overused. 5. complicated migraine.
Prophylactic drugs
antiepileptics, antidepressants, antihypertensives
Antiepileptics
topiramate are indicated for migraine prophylaxis and are well tolerated. The main adverse effects are weight loss and dysesthesia. Valproic acid is also indicated as a migraine prophylactic and useful as a first-line agent. other antiepileptics, such as gabapentin, lamotrigine, and oxcarbazepine, are limited in migraine.
Tricyclic antidepressants
are good second-line alternatives because of their adverse-effect profile and efficacy. amitriptyline and nortriptyline are most effective,
Antihypertensives
beta-blockers are approved by FDA for migraine prophylaxis, Calcium channel blockers are another possible choice of treatment. Angiotensin-converting enzyme (ACE) inhibitors (eg, lisinopril) and angiotensin-receptor blockers (ARBs, eg, candesartan) have recently shown to be effective for migraine prevention.
Headache Description
(Any 2)
Associated Symptoms
(Any 1)
Pressing or tightening Mild to moderate intensity Bilateral location No worsening with exertion
Associated Symptoms
(Any 1)
Unilateral Pulsatile quality Moderate to severe pain intensity Aggravation by or causing avoidance of routine physical activity
Autonomic Symptoms
(Any 2)
Severe headache Unilateral Duration of 15180 min Orbital, periorbital, or temporal locatio
Rhinorrhea Lacrimation Facial sweating Miosis Eyelid edema Conjunctival injection Ptosis
Tension-Type*
Bilateral Mild/moderate 30 min to 7 days Pressing/tightening No Female > male
Cluster
Strictly unilateral Severe 15 to 90 min Severe Yes -- autonomic Male > female
Intensity
Duration Quality Associated symptoms Gender