headaches kuliah

7/23/2019 Headaches Kuliah

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HEADACHESProf. dr. Basjiruddin ahmad, Sp.S (K)Fakultas Kdoktran !ni"rsitas Andalas#S. Dr. $. DjamilPadan%

3


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Hada&h In medical terminology : cephalgia Headache is defined as pain in the head that is

located above the eyes or the ears, behind thehead (occipital), or in the back of the upperneck, and has many causes

Majority of headaches are benign and selflimiting,secondary headache can life-threating conditionssuch as encephalitis,meningitis, tumor, cerebralhemorrhage, etc

!early universal e"perience #revalance :- $ year periode of %& '

- a life time of %%' iagnosis : areful history, e"amination and

diagnostic testing


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*imilar headaches can have different cause dependon the pain-sensitive structures, include:+Intracranial structures

ura near vessels

ranial nerves , II, I, ircle of .illisy Meningeal arteries /arge veins

01"ternal to the skull *calp and neck muscles ervical nervus and roots utaneous nerves and skin Mucosa of the paranasal sinuscs 2eeth

1"ternal carotid arteries

Pain'snsiti" stru&turs


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PAIN SENSITIVE CRANIAL STRUCTURES

*kin, subcutan, muscle 1"tracranial arteries *kull periosteum 1ye, ear, nasal cavities,

sinuses

Intracranial venous sinuses,large veins, pericavernousstructures

0asis duramater, meningealarteries, pro"imal anteriormiddle cerebral arteries,

carotis interna arteries *uperficial temporal arteries ranial nerves: ! II, ! III,

! , ! I, ! ,$-3


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!erves *upply*plancno cranium supply by cranial nerve , II,I and

!euro cranium, structures e"ternal to the skull(including scalp and neck muscle), are suppliedby nnspinalis $, 4, 3


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Location luster headaches al.ays unilateral 5&' migraines: are unilateral, some could be

spread become bilateral

2rigeminal neuralgia: uccurs unilaterally in thesecond and third trigeminal distribution 0rain tumor: bilateral or unilateral 2ension headache bilateral

Duration Migraine 6-74 hours in adults luster headache $8-$9& minutes 2ension type headche 3& minutes-days 2rigeminal neuralgia a fe. seconds 4minutes

Headache


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2.o types of headache: Primary headache,are not associated .ith

other diseases, for e"ample tension headache,migraine, cluster headache

Secondary headache, are caused byassociated diseases; may be minor or seriousand life threatening

2ension headache is the most common type of

primary headache, and more common among .omenthan men


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Classi&ation of primar hada&h(intrnational hada&h so&it *+ modid)

1. Migraine

a Migraine .ithout aura

bMigraine hemiplegic migraine

c 0asiler migraine

d


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3 luster headache and chronic paro"ismal

hemicraniaa luster headacheb hroic paro"ismal hemicrania

6 Headache associated .ith head trauma

8 Headache associated .ith vascular disease:infarction, hematoma, subarachnoid hemorrhage acutearterial hypertension

5 Headache associated .ith metabolicabnormality, dypo"ia, dialysis

7 Headache associated .ith intracranialdisordera Infection= abscessb 2umorc >ranulamotor disease

Classi&ation...


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9 Headache associated .ith us order of neck,eye, sinus, teeth

a ranial neuralgiab 2rigeminal neuralgiac >lossopharyngeal neuralgia

%


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$i%rain

Migraine is a chronic condition of recurrent attacks,due to changes in the brain and surrounding bloodvessels

#ain located in the forehead, around eye, or back ofhead, unilateral

?sually aggravated by daily activities, like .alkingupstairs etc

!ausea, vomiting, cold hands, facial pallor 2ypically last from 6-74 hours and vary in fre@uency

from daily to fe.er than $ per year +ffects about $8' or the population (.omen : men

A 3 : $) B 9&' migraineurs have other members in the

family


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Smptoms

Vary from person to personFive phases often to be identified: Prodrome: feeling ChighD, irritable, depressed,

funny taste of smell

ura: visual disturbance preceedes headachaphase, blind spots (scotoma), flashing, colorful orlose vision on one side (hemianopia)

!eadache: on one side of the head, 3&' spreadon both sides

2hrobbing pain, E9&' nauseated, and some vomit 7&' photophobia and phonophobia !eadache termination: pain usually goes a.ay

.ith sleep Postdrome: inability to eat, fatigue, problem .ith

concentration may linger after pain disappeared


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Phase of Acute Migrain


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"auses 1"act cause is not clearly understood

1"perts believe :+ combination of the e"pansion of blood vesselsand the release of certain chemicals, .hichcauses inflamation and pain2he chemicals dopamine and serotonine can

cause blood vessels to act abnormally if theypresent in abnormal amounts, or if the bloodvessels are unusually sensitive to them

Triggers ertain foods : chocolate, cheese, nuts, alcohol,

and M*> (monosodium glutamate) *tress and tension or physical stress 0irht control pills (estrogen) *moking Missing a meal may bring on a headache


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ssociated symptoms

#efore headache5&' migrainous have prodrome in hour before:Irritability, depression, eupharia small

hypertensiveDuring headacheMigraine: by nausea in %&', vomiting E 8&'

Foto=fobo sensitivity in 9&'

!asal congestion

luster : ipsilateral ptosis, miosis in 3&'ysability

fter headache2ired, drained, depression, decreased mental

acuity


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Migraine $ithout aura %common migraine& 0enign periodic headache lasting several hours,

.ithout preceding focal neurologic symptoms

?nilateral pain, nausea or vomitting, positive familyhistory, respon to ergotamin, scalp tenderness in9&'

Migraine $ith aura %c'assic migraine& Headache associate .ith characteristic premonitory

sensory, motor, or visual symptoms isual G scotomas or hallucinations (usually in centralvisual field) paracentral scotoma e"pands 4& to 48minutes


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#asi'ar migraine

0rainstem signs, including vertigo, dysarthria, diplopia;occur as sole neurologic symptoms of migraine in 48'

!emip'egic migraine Hemiparesis migraine may occur during prodrome; lasts

4& to 3& minutes

More severe: hemiplegia for days to .eeks headachesubsides

Familial from autosomal dominant

(ptha'mop'egic migraine +ttasck of periorbital pain and vomiting for $ to 6 days omplete third nerve palsy follo.s, often including

pupillary dilation, loss of lihgt response May persist days to 4 months


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iagnosis criteria). Migraine $ithout aura

a +t least 8 attacks fulfilling b cb +ttacks lasting 6-74 hc uring headache

!ausea and=or vomiting photophobi, phonofobi Headache .ith 4 of tha follo.ing

?nilateral, pulsating @uality Moderate severe intensity +ggravation by .alking stairs or similar activity

)). Migraine $ith aura$ +t least 4 attacks fulfilling b4 3 of the follo.ing


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$ana%mnt

cute treatment

Immediate administration of full dose ofagent at attack onset

Mild headache : aspirin, acetaminophen0utalbital and caffeine added if necessaryIbuprofen, napro"en often useful

Isometheptene compounds effective formild-to-moderate Dstress headacheD


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Moderate*to*severe headache:ergotamine (oral or suppository); sumatritan(oral intranasal, subcutaneous dose),iJatriptan, Jolmitriptan, naratriptan,2riptans indicated for attack fre@uency E 4 to3 per month

"ontra indications: Hypertension *troke oronary artery disease


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Severe headache: dihydroergotamine(parenteral, nasal spray) IntravenousprochlorperaJine, metoclopramide,

dihydroergotamine"hronic dai'y headache: amitriptyline,nortriptyline, anti depresants, valproat,

topiramate


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Prophy'a+is

aily administration re@uired 1ffect lags 4.eeks

Medications include:propanolol, amitriptiline,verapamil, valproat

+dditional drug include topiramate, Jonisamide

Probabi'ity of success5&' to 78'drug maybe tappered after 8 month


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-nsion Hada&h

+ tension headache is the most commonheadache and yet itKs not clear understood

>enerally produces mild to moderate pain, in theback of neck at the base of the skull feeling a

tight band around head *ymptoms can last from 3& minutes to an entire

.eek, or nearly all the time (never free fromheadache)

#atients e"perience: 2enderness on scalp, neck and shoulder muscles ifficulty sleeping (insomnia), fatigue, instability /ost of appetite, difficulty concentrating

*omeimes may be severe


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The causes sti'' continue to debate e+actcause are unno$n

-esearches no$ be'ieve

hanges among certain brain chemicals Gserotonine, endorphine and numerous otherchemicals G that help nerves communicate

2he process activate pain path.ays to the brainand to interfere .ith the brainKs ability to

supress the pain 2ight muscles in the neck=scalp contribute to a

headache, on the other hand, the tight musclesmay be a result of these chemical changes

auses


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Muscle tension that may cause Tension

Type Headache


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Potntial -ri%%rs

*tress epression, an"iety /ack of sleep or changes in sleep routine

#oor posture; lack of physical activity Lorking in a.k.ard positions Hormonal changes; menstruation,

pregnancy


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Classi&ation of -nsion Hada&h

1. /pisodic tension*type headache %/TT!&is defined as recurrent episodes of headache(older term: tension hedache, muscle contraction headache)


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I #ressing, tighthening nonpulsating @uality Mild or moderate intensity

0ilateral location

II !o nausea or vomiting !o aggravation by .alking stairs or

same =e"ercise

!o or one of phono-photophobia

Chara&tristi& -nsion tp hada&h


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Dia%nosti& &ritria E--H

haracteristic I and II .ith :+ +t least $& previous headache episodes

number of days .ith such headche $9&=y($8=mo)

0 Headche lasting from 9& min-7 days

Dia%nosti& &ritria of C--H Include characteristic + and 0 .ith :

+varage headache fre@uent $8 days=month($9& days=year) for 5 months


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T$o ris of "TT!

- +nalgesic rebound

- ormobidity

?se of combination analgesics should belimited to days or 46 tablets

**I (*erotinin *elective euptake

Inhibitor) drugs may administered as aprevention (fluo"etin)


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-ratmnt

2he goal is to relieve symptoms andprevent future headaches

#revention is the best treatment If possible, remove or control headache

triggers Medications :


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Pr"ntion *tress management strategies ela"ation e"cercises >ood posture .hen .orking, reading,

activities 1nough sleep and rest

Massage of sore muscles /ifestyle changes


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Clustr hada&h

/pisodic: most common type


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linical features #eriorbital, temporal, ma"illary pain begins

.ithout .arning, peaks .ithin 8 minutes


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2reatment2o abort attack : o"ygen inhalation($&m/=min via nonrebreathing mask),

intranasal topical lidocaine, sumatriptan 2oprevent further attacks during bout:prednisone, methysergide, ergotamine,verapamil


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Post&on&ussion hada&h

Follo. severe or trivial head injury(including head trauma .ithout loss of

consciousness)


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Brain Tumor Headache

hief complaint in 3&' of patints .ith braintumor: deep, dull aching @uality, moderateintensity, intermitten, .orsened by e"ertion

or change in position, associated .ithnausea and vomiting Headache disturbssleep in about $&' omiting precedesheadache by .eeks in posterior fossa brain

tumor


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#frn&s

+dams #rinciples of neurology 5th ed Mc>ra. Hill $%%7

Harsono, 0uku +jar !eurologi, 0ab II Harsono, apita selekta neurologi, 0ab II MaJJoni#MerrittsNs !eurology Handbook 4nd ed

resden /ippincott Lilliam Lilkins 4&&7 1vans L Hanbook of headache #hiladelphia

/ipincott Lilliam Lilkins, $%%% Headache .ikipedia Mayo clinic com


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Thank You

headaches kuliah

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