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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)
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

O2, sumatriptan, ergotamine before anticipated attack


Occasionally diurnal

Recurrence after many months or years

Stuffed nostril

Corticosteroids, verapamil, valproate, and lithium in recalcitrant cases

Injected conjunctivum
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



May awaken patient

Sometimes position
Vomiting Mannitol

Steady pain

Impaired mentation

Treatment of tumor

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

Polymyalgia rheumatica

Fever, weight loss, increased sedimentation rate, jaw claudication

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

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