Common Types of Headache

Jenis dan Karakteristik Nyeri Kepala

Type	Site	Age and sex	Clinical characteristics	Diurnal pattern	Life profile	Provoking factors	Associated features	Treatment
Migraine without aura (common migraine)	Frontotemporal	Adolescents, young to middle-aged adults, sometimes children, more common in women	Throbbing (pulsatile); worse behind one eye or ear	Upon awakening or later in day	Irregular intervals, weeks to months	Bright light, noise, tension, alcohol	Nausea and vomiting in some cases	Triptans, ergotamine, nonsteroidal antiinflammatory agents
	Uni- or bilateral		Becomes dull ache and generalized	Duration: 4–24 h in most cases, sometimes longer	Tends to decrease in middle age and during pregnancy	Relieved by darkness and sleep		Propranolol or amitriptyline for prevention
			Scalp sensitive
Migraine with aura (neurologic migraine)	Same as above	Same as above	Same as above	Same as above	Same as above	Same as above	Scintillating lights, visual loss, and scotomas	Same as above
			Family history frequent				Unilateral paresthesias, weakness, dysphasia, vertigo, rarely confusion
Cluster (histamine headache, migrainous neuralgia)	Orbitotemporal	Adolescent and adult males (90%)	Intense, nonthrobbing	Usually nocturnal, 1–2 h after falling asleep	Nightly or daily for several weeks to months	Alcohol in some	Lacrimation	O2, sumatriptan, ergotamine before anticipated attack
	Unilateral			Occasionally diurnal	Recurrence after many months or years		Stuffed nostril	Corticosteroids, verapamil, valproate, and lithium in recalcitrant cases
							Rhinorrhea
							Injected conjunctivum
							Ptosis
Tension headaches	Generalized	Mainly adults, both sexes, more common in women	Pressure (nonthrob-bing), tightness, aching	Continuous, variable intensity, for days, weeks, or months	One or more periods of months to years	Fatigue and nervous strain	Depression, worry, anxiety	Antianxiety and antidepressant drugs
Meningeal irritation (meningitis, subarachnoid hemorrhage)	Generalized, or bioccipital, or bifrontal	Any age, both sexes	Intense, steady deep pain, may be worse in neck	Rapid evolution—minutes to hours	Single episode	None	Neck stiff on forward bending	For meningitis or bleeding (see text)
							Kernig and Brudzinski signs
Brain tumor	Unilateral or generalized	Any age, both sexes	Variable intensity	Lasts minutes to hours; worse in early A.M., increasing severity	Once in a lifetime: weeks to months	None	Papilledema	Corticosteroids
			May awaken patient			Sometimes position	Vomiting	Mannitol
			Steady pain				Impaired mentation	Treatment of tumor
							Seizures
							Focal signs
Temporal arteritis	Unilateral or bilateral, usually temporal	Older than 50 years, either sex	Throbbing, then persistent aching and burning, arteries thickened and tender	Intermittent, then continuous	Persists for weeks to months	None	Loss of vision	Corticosteroids
							Polymyalgia rheumatica
							Fever, weight loss, increased sedimentation rate, jaw claudication

Referensi:
Adams & Victor's Principles of Neurology 9th Edition (McGraw-Hill) 2009

Tags: Lecture Notes