Headache

HeadacheDr. M. Aufa N

Nyeri kepala

primer

migrain

Tension type

headache

Cluster headache

sekunder

Headache

PRIMARY HEADACHE

Pulsatile Unilateral 4 – 72 hours Can’t do ADL (not relieving by rest) Can followed by : Photophobia &

Phonophobia (classical / aura)

Migrain

Stress Foods : MSG, tyramine, nitrite Coffein withdrawal Too little or too much sleep

Precipitating migrain

Non pharmacology :◦ Relaxation technique◦ Biofeedback◦ Dark, quite room◦ Avoid trigger◦ Adequate sleep, Avoid excessive sleep◦ Regular exercise

Migraine management

Pharmacologic :◦ Abortive

Ergotamine Sumatriptan

◦ Preventive Beta blocker Tricyclic antidepressant Asam valproate Calcium channel blocker

Migraine management

All round Tight like headache Pericranial muscle tenderness Relieving by rest Stress factor

Tension type headache

Strictly unilateral Ipsilateral autonomic symptoms –at least one of:

conjunctival injection, nasal blockage, facial sweating, miosis,ptosis

Bouts-typically 1/year lasting 6-12 weeks with discrete headaches 1-8times /day each lasting 30-60 mins

Age 20-40 M>F=7:1 Headache severe/excrutiating- restless

“banging head against wall”

Cluster headache

Subcutaneous sumatriptan 6mg

High dose/high flowrate oxygen

Intranasal triptans- not so effective

Cluster headaches-abortive treatment

Verapamil 240-960mg/day ( ECG)-bradycardia,hypotension,arrythmias,constipation,fatigue,oedema

Lithium 400-2000mg/day hypothyroidism,Diabetes insipidus, tremor,nausea, wt gain ataxia drowsiness, confusion seizure

Methylsergide 3-12mg/day vascular constrictive phenomena, fibrotic reactions ,muscle cramps, abdominal discomfort weight gain, mood change

Transitional treatments:High dose corticosteroids- 1mg/kg ( up to 60mg

daily for 5 days tapering over 2-3 weeks

rapid onset of action. Attack recurs once dose reduced. Initial add-on until other preventatives are effective

Cluster headache- preventive treatments

vertigo

Periferberputar

Neuritis vestibularis &

LabirinitisRiw infeksi +

lama

BPPV Perub posisi

+ detik

Menieretinitus

Sentraldizzines

- Cerebellum- Brain stem

13

vertigo

14

15

Dix Hallpike manouver (1)

16

Dix Hallpike manouver (1)

17

Pengobatan – Brand daroft

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