HEADACHES (CEPHALGIA)

Headachesis a pain or discomfort that

occurs over the superior portion of the head.
Between the orbit and occiput
Spreads into the face, teeth, jaws and neck.
Arising from pain sensitive structures of the
cranial.
Character of pain are dull, aching throbbing,
shooting, sharp, stabbing, and lightening-like.
 Pain-sensitive structure
Extracranial:
Scalp vessel and muscles,periost, mucous
membrances of nasal and paranasal space
orbital contents, external & middle ear, neck
teeth and gum
Intracranial:
cortical vein, venous sinuses, basal arteries,
nerves, duramater of anterior, middle and
posterior fossa cranium.
 Points from the history
1 Character of headaches
2 Site unilateral, bilateral, frontal, temporal
. occipital.
3 Mode of onsetsudden, gradual.
4 Frequency/ duration acute attack, recurrent
. attacks, chronic
5 Timingmorning, night.
6 Accompannying symptoms nausea, vomting
double vision,watering eye etc
 7 Precipitating factor exercise, food, .
. hunger, noise, posture, stress, coughing
. menstruation

The Inervation of pain sensitive structure:

N V, IX, X and 1-3 Cervical N
 Cause of headaches
. Causes of headaches are varied.
. In view of many causes of head pain
an accurate history and examination
should be the first step in determining
the necessary treatment.
. The Causes are make stimulation the
pain structure
 In Summary, caused by
Traction on or displacement of the venous
sinuses, and their cortical vein
Traction, dilatation, or inflammation involving
intra/ extracranial arteries, include brain tumor
Traction, displacement, or diseases of the N
V,IX, X and N Cervicalis 1-3
Changes in blood & intracranial pressure
Disease of the tissues of pain structur in intra/
extra cranial, etc: scalp, face, eye. Nose, ear
 More frequent in nature
Hipertensi, or rising the ICP
Nasal , throat and teeth problem
Eye, ear/ inner problem/
TMJ ( temporomandular joint prb), muscle
tension, arteri problem
Metabolic, systemic problem
Psycological F, stress, emotional
Post head/ neck traumatic
Genetic, and enviroment
 Classification
H are classified by the International
Headache Societys : International
Classification of Headache Disorder (ICHD
which published the 2 edition, 2004.
ICHD 1, was published in 1988
Other Classification : National Institutes of
Health (NIH), developed a cls syst in 1962
Classified : Primary H
Secondary H
 Primary Headaches
Based on the symptoms
Migraines
Tension headaches
Cluster headaches
Trigeminal Neuralgia
Chronic paroxysmal hemcrania
 Secondary H
Based on the caused that can elsewhere in the
head or neck
cervicogenik H, post traumatic H
H due to ICH/ IH or ICP raised
Giant cell (Tempora) Arteritis
Thunderclap H (Sub A hem)
Hormone H
Sinus H, Chronic progressive H ( Traction or
inflammatory H ).
 Children
Children can suffer from the same types
headaches as adults, their symptoms
may vary.
The causes, include one factor or
a combination of factors, the most
common include genetic predisposition.
. Common for H to start in childhood or
adolescent.
 Incidence in C
Very common, one study reported, 56% of boys
and 74 % of girl, that age between 12-17,having
experienced a form of H.
20% of adult, who suffer H, start < 10 age
50% of adult, they start < 20 age
Tension H, migraines, cluster H, sinuses H
(infection), cold & flu,chronic daily H, orthodontic
headgear, head trauma, emotional f, stress,
anxiety, food, enviroment F, tumor, abscess.
 Diagnosis approach
Asking guestions about the symptoms,
would involve a case history of H
Description, characteristics of H and
evaluation as completely as possible.
History present ilness, past medical histo
Family histo
Perform a complete physical exam (vital
sign and neurological review)
Laboratory studies, lP,X foto,CTsca,MRI
 Migraine
Recurrent H, generally unilat, but some bilat
(bifrontal), pouding and throbbing pain of
moderate to severe intensity.
Onset: Childhood and adult life( 10 -45)
Ratio F and M: 2:1
Incidence: 5-10% of population
Family histo: 60%-70% of all sufferers.
Associated with personality change,
nausea,vomiting, prostration, Neur disturbances
 Symptom M
Classic migraine
Preceded by visual symptom (Aura),
10-15 before the headache ( it may few
minutes to 24 hours)
scintillating scotoma, streaks of light,
scotoma (fortication spectra)
homonymous hemianopsia
olfactory hallucinations
 Symptom M classic
. After the aura begin headaches,ussualiy
bifrontal, but may be unilateral (50%).
The pain initially pulsatile,throbbing,pounding,
increases inseverity, and becomes a
continue,intensive ache.
The pain may feel the entire head, spread down
into the neck and face.
Nausea, vomiting, photophobic & phonop.
2 -3 days.and then can feel fatique, loss appite.
It can decrease after sleep.
 Symptom Common M
Without preceding Aura, ussulaly dull ache
Bifrontal aor unilateral
Accompanied by nausea and vomiting
Longer than classical m, several days
Be becomes worse, when theres a mild
phisical activity (walking)
 Another type M
Hemiplegic migraine
Familial HM
Non Familial HM
Unssually,Headahe acommpany with
numbness or weakness in hand/ upper
limb,and can also with disphasia/ aphasia.
It may can for several days,presumbably
associated with vasoconstriction artery.
 Basilar M
Headache accompany with vertigo,ataxia,
dysarthria, defects of visual field
bilateral,hemparetic,and appear confused,
restless, dysphasic, theres may some
impairment of consciousness,occasionally
followed by period of stupor, several hours
The pain usually the lateral part, occipital.
EEG can N or show spike w complexes.
 Complicated M..
Associated with vasocotriction and
reduction of cerebral blood flow.
Can caused infraction of the brain.
Migraine In Children
Estimated only 5 % of Ch in age 11 years
history of periodic cyclic vomiting and
vertigo or other neurology deficit.
Its precipitated by fatique, anxiety
exercise and illness.
Occur 26 hours, once or twice/ month.
 Ophthalmoplegic M
M develops ipsilateral ophthalmoplegic,
belived to be compression of N, III,IV, VI
and V 1,by dilated of Int carotid artery.
Theres history of Comm or classic M.
Unilateral and the paresis outlast the pain.
 Nyeri Kepala
Nyeri didaerah kepala, bisa sebagian atau
seluruh kepala, bisa bersfat mendadak
atau menahun dan bisa menimbulkan rasa
sakit yang ber-denyut2 atau terus-
menerus tanpa henti, dan yg jadi
penyebabnya, bisa diaerah kepala atau
organ lain ditubuh .[ faktor resiko dari
penyakit sistemik lainnya]
 MIGRAIN
Lokasi : Unilateral ( 60-70%)
Bifrontal 30%
Gejala2: onset pelan2 meningkat rasa
nyerinya. Ber denyut2 atau
intensitas nyeri meningkat,
sesuai dng aktifitas fisik
lebih banyak pada wanita dp laki2,
lbh senang tempat yg tenang dan redup
 Durasi : 4 72 jam
Keluhan : mual, muntah, fotophobia,
fonofobia, bisa ada aura
. Bervariasi : Intensitas, durasi & frekwensi
Aktivitas meningkat, NK juga meningkat
M Klasik ada aura ( sensorik, motork, psiks
M. Umum, tanpa Aura
 Tension head ache
Lokasi : bilateral
G klinik : nyeri kepala, spt diikat, ditekan
dimana disertai emosi meningkt
Lb banyak wanita, dpt melakukan aktivits
spt biasa atau beristirahat
Durasi: bbrp menit bbrp minggu2
keluhan rasa nyeri pada kulit kepala,
leher,otot bahu,
insomnia, rasa lelah, peka (iritabel)
 Cluster
Biasanya Unilateral
daerah periorbital dan temporal
Rasa nyeri terasa cepat meningkat dlm
bbrp menit, terasa dalam dan lama,
sgt menyiksa, ber-dentum2
Lb banyak pada laki2
tetap dpt beraktivitas, melangkah, ajun2
menolak utk tidur
 30 menit 3 jam
keluhan ada lakrimasi ipsilateral
kongesti ( hidung tersumbat), hidung be
air, muka pucat, diaphorisis