Gusti Ayu Ketut M.

NIM : 030.11.117
Kepaniteraan Klinik Ilmu Penyakit Saraf
Periode 29 Juni 2015 1 Agustus 2015
Fakultas Kedokteran Universitas Trisakti
Jakarta

A primary cephalgiais caused by problems

with or overactivity of pain-sensitive
structures in your head. A primary headache
isn't a symptom of an underlying disease.
Chemical activity in your brain, the nerves or
blood vessels of your head outside your skull,
or muscles of your head and neck or some
combination of these factors may play a
role in primary cephalgia. Some people may
carry genes that make them more likely to
develop such cephalgia.

The most common primary headaches are:

Cluster headache
Migraine(with and without aura)
Tension headache(medically known as
tension-type headache)
Trigeminal autonomic cephalalgia (TAC),
including cluster headache and
paroxysmal hemicrania

Secondary cephalgia
A secondary cephalgia is a symptom of a
disease that can activate the painsensitive nerves of the head. Any number
of conditions varying greatly in
severity may cause secondary
cephalgia. Some sources of secondary
headaches include arterial tears (carotid
or vertebral dissections), blood clot
(venous thrombosis) within the brain
separate from stroke, brain aneurysm.

DEFINITION

Cluster headaches occur in cyclical patterns or

clusters, which gives the condition its name.
Cluster headache is one of the most painful
types of headache.

Pain in or around one eye on one side of your

head.

May last from weeks to months, usually

followed by remission periods when the
headache attacks stop completely. During
remission, no headaches occur for months and
sometimes even years.

Excruciating pain, generally located in or

around one eye, but may radiate to other
areas of your face, head, neck and shoulders
One-sided pain
Restlessness
Excessive tearing
Redness in your eye on the affected side
Stuffy or runny nasal passage in your nostril
on the affected side of your face
Sweaty, pale skin (pallor) on your face
Swelling around your eye on the affected
side of your face
Drooping eyelid

In contrast to people with migraine,

people with cluster headache usually
avoid lying down during an attack
because this position seems to increase
the pain.
Some migraine-like symptoms including
nausea, sensitivity to light and sound, and
aura may occur with a cluster
headache, though usually on one side.

A cluster period generally lasts from six to

12 weeks.
In episodic cluster headaches, the cluster
headaches occur for one week to a year,
followed by a pain-free remission period that
may last as long as 12 months before
another cluster headache develops.
Chronic cluster periods may continue for
more than a year, or pain-free periods may
last less than one month.

During a cluster period:

Headaches usually occur every day,
sometimes several times a day.
A single attack may last from 15 minutes
to three hours.
The attacks often happen at the same
time within each 24-hour day.
The majority of attacks occur at night,
usually one to two hours after you go to
bed.

The exact cause of cluster headaches is

unknown, but abnormalities in the
hypothalamus likely play a role
Unlike migraine and tension headache,
cluster
headache
generally
isn't
associated with triggers, such as foods,
hormonal changes or stress.

Neurological examination

A neurological examination may help your doctor

detect physical signs of a cluster headache.
Sometimes the pupil of your eye may appear smaller,
or your eyelid may droop, even between attacks.
Imaging tests

If you have unusual or complicated headaches or an

abnormal neurological examination, your doctor may
recommend other tests to rule out other serious
causes of head pain, such as a tumor or aneurysm.
Common brain imaging tests include:
Computerized tomography (CT) scan.A CT scan
uses a series of X-rays to create detailed crosssectional images of your brain.
Magnetic resonance imaging (MRI).An MRI uses
a powerful magnetic field and radio waves to produce
detailed images of your brain and blood vessels.

ACUTE TREATMENT

Oxygen

Sumatriptan

Dihydroergotamine.The intravenous form of

dihydroergotamine (D.H.E. 45)
Preventive treatments

Calcium channel blocker : verapamil

Corticostreroid : prednisone

Lithium carbonate

Ergotamine

anti-seizure medications such as divalproex

(Depakote) and topiramate (Topamax).

DEFINITION
A migraine headache can cause intense
throbbing or a pulsing sensation in one
area of the head and is commonly
accompanied by nausea, vomiting, and
extreme sensitivity to light and sound.

Migraines may progress through four stages,

including prodrome, aura, headache and postdrome,
though you may not experience all the stages.
Prodrome

One or two days before a migraine, you may notice

subtle changes that signify an oncoming migraine,
including:

Constipation

Depression

Food cravings

Hyperactivity

Irritability

Neck stiffness

Uncontrollable yawning

Aura

Aura may occur before or during migraine

headaches. Auras are nervous system symptoms
that are usually visual disturbances, such as flashes
of light. Sometimes auras can also be touching
sensations (sensory), movement (motor) or speech
(verbal) disturbances. Most people experience
migraine headaches without aura. Each of these
symptoms usually begins gradually, builds up over
several minutes, and then commonly lasts for 20 to
60 minutes. Examples of aura include:

Visual phenomena, such as seeing various shapes,

bright spots or flashes of light

Vision loss

Pins and needles sensations in an arm or leg

Speech or language problems (aphasia)

Less commonly, an aura may be associated with

limb weakness (hemiplegic migraine)

Attack

When untreated, a migraine usually lasts from

four to 72 hours, but the frequency with which
headaches occur varies from person to person.
You may have migraines several times a month
or much less often. During a migraine, you may
experience the following symptoms:

Pain on one side or both sides of your head

Pain that has a pulsating, throbbing quality

Sensitivity to light, sounds and sometimes

smells

Nausea and vomiting

Blurred vision

Lightheadedness, sometimes followed by

fainting

Postdrome
The final phase, known as postdrome,
occurs after a migraine attack. During
this time you may feel drained and
washed out, though some people report
feeling mildly euphoric.

cause of migraines isn't understood,

genetics and environmental factors
appear to play a role.
Migraines may be caused by changes in
the brainstem and its interactions with the
trigeminal nerve, a major pain pathway.
Imbalances in brain chemicals including
serotonin, which helps regulate pain in
your nervous system also may be
involved. Researchers continue to study
the role of serotonin in migraines.

Serotonin levels drop during migraine

attacks. This may cause your trigeminal
system to release substances called
neuropeptides, which travel to your
brain's outer covering (meninges). The
result is headache pain.

Migraine headache triggers

Hormonal changes in women.
Foods (Aged cheeses, salty foods and
processed foods may trigger migraines.
Skipping meals or fasting also can trigger
attacks)
Food additives.The sweetener
aspartame and the preservative
monosodium glutamate, found in many
foods, may trigger migraines.

Blood tests.To test for blood vessel

problems, infections in your spinal cord or
brain, and toxins in your system.
Computerized tomography (CT) scan.
Magnetic resonance imaging (MRI).
Spinal tap (lumbar puncture).suspects
an underlying condition, such as infections
or bleeding in your brain, he or she may
recommend a spinal tap (lumbar
puncture).

Pain relieve : (ibuprofen, acetaminofen)

Drugs marketed specifically for migraines,
such as the combination of acetaminophen,
aspirin and caffeine (Excedrin Migraine),
also may ease moderate migraine pain, but
aren't effective alone for severe migraines.
Triptan : sumatriptan
Ergot : ergotamine
Anti- nausea : metoclopramid
Opioid : codein, if cannot use ergot or
triptan
Do not use corticosteroid in migraine

Preventive treatment

Beta blocker
If pasien is older than age 60, use tobacco, or
have certain heart or blood vessel conditions,
should recommend to take alternate medications
instead of beta blockers.

Another class of cardiovascular medications

(calcium channel blockers) used to treat high
blood pressure and keep blood vessels from
becoming narrow or wide, also may be helpful in
preventing migraines and relieving symptoms
from migraines. Verapamil (Calan, Verelan, others)
is a calcium channel blocker that may help you.
Antidepressants : amitriptilyne
Anti-seizure drug : valproate sodium (depacote)
Pain relievers : NSAID naproxen

DEFINITION
A tension headache is generally a diffuse,
mild to moderate pain in your head that's
often described as feeling like a tight
band around your head. A tension
headache (tension-type headache) is the
most common type of headache, and yet
its causes aren't well understood.

Signs and symptoms of a tension headache

include:
Dull, aching head pain
Sensation of tightness or pressure across
your forehead or on the sides and back of
your head
Tenderness on your scalp, neck and
shoulder muscles

Tension headaches are divided into two

main categories episodic and chronic.
Episodic tension headaches
Episodic tension headaches can last from
30 minutes to a week. Frequent episodic
tension headaches occur less than 15 days
a month for at least three months. Frequent
episodic tension headaches may become
chronic.
Chronic tension headaches
This type of tension headache lasts hours
and may be continuous. If your headaches
occur 15 or more days a month for at least
three months, they're considered chronic.

Tension headaches vs. migraines

Tension headaches can be difficult to

distinguish from migraines. Plus, if you have
frequent episodic tension headaches, you can
also have migraines.

Unlike some forms of migraine, tension

headache usually isn't associated with visual
disturbances, nausea or vomiting. Although
physical activity typically aggravates migraine
pain, it doesn't make tension headache pain
worse. An increased sensitivity to either light
or sound can occur with a tension headache,
but these aren't common symptoms.

Causes
The cause of tension headache is not
known. Experts used to think tension
headaches
stemmed
from
muscle
contractions in the face, neck and scalp,
perhaps as a result of heightened
emotions, tension or stress. But research
suggests muscle contractions aren't the
cause.

Pain relivers : OTC drugs ( aspirin,

ibuproven, naproxen) prescription drugs
(naproxen, indometacin, ketorolac)
Combination medications.Aspirin or
acetaminophen or both are often
combined with caffeine or a sedative
drug in a single medication.
Triptans
Preventive drug : antidepressants
(amitriptilyne)