CHEFALGIA II

                                                                      CHEFALGIA 
A. DEFINITIONS

 Chefalgia or headache is one of the most important human physical complaints. Headache in fact is a symptom not a disease and can indicate organic disease (neurological or other disease), stress response, vasodilation (migraine), skeletal muscle tension (tension headaches) or a combination of the response (Brunner & Suddart).

B. CLASSIFICATION AND ETYOLOGI

Headache classification of the most recently issued by the Headache Classification Cimitte of the International Headache Society as follows:1. Migraine (with or without aura)2. Sore lump tense3. Cluster headache and paroxysmal hemicrania4. Various dikatkan headache with structural lesions.5. Dikatkan headache with head trauma.6. Headache associated with vascular disorders (eg, subarachnoid hemorrhage).7. Dihuungkan headache with non-vascular intracranial disorders (eg, brain tumors)8. Headaches associated with the use of chemicals tau drug withdrawal.9. Headache associated with non-cephalic infection.10. Headache associated with metabolic disturbances (hypoglycemia).11. Headache or facial pain associated with disorders of the head, neck or around the head structure (eg, acute glaucoma)12. Cranial neuralgia (pain originating from cranial nerves settled)

C. Pathophysiology 

Headache arise as a result of stimulation of the structures of the head and neck region are sensitive to pain. The buildings are pain-sensitive extracranial muscles okspital, temporal and frontal scalp, subcutaneous arteries and periostium. Skull itself is not sensitive to pain. Intracranial structures consisting of pain-sensitive meninges, especially the basal dura and meninges that block off the sinus venosus and the large arteries at the base of the brain. Most of the brain tissue itself is not sensitive to pain.Stimulation of the buildings that can be: Infection of the lining of the brain: meningitis, encephalitis. chemical irritation of the lining of the brain such as subdural hemorrhage or after pneumo or ensefalografi contrast agent. Stretching urged the lining of the brain due to intracranial space, clogging the passage of liquor, spinous venos thrombosis, cerebral edema or intracranial pressure decreases suddenly or quickly. intracranial arterial vasodilation due to toxic circumstances (such as the common infections, alcohol intoxication, CO intoxication, allergic reactions), metabolic disorders (such as hypoxemia, hypoglycemia and hypercapnia), vasodilating drug use, the state of post-contusio cerebri, acute serebrovasculer insufficiency). extracranial vascular disorders, such as vasodilation (migraine and cluster headache) and inflammation (temporal arteritis) Disruption of muscles that have a relationship with the head, such as the cervical deformans spondiloartrosis. propagation pain (pain reffererd) from the eye (glaucoma, iritis), sinuses (sinusitis), baseol cranial (ca. nasopharyngeal), teeth (third molars pulpitis and urgent dental) and the neck (cervical deformans spondiloartritis. Muscle tension head, neck shoulders as a manifestation psikoorganik in a state of depression and stress. In this case sininim headache of headaches.

D. CLINICAL

 a. MigraineMigraine is a complex phenomenon which has the characteristics of an attack at a specific time and severe headaches that occur repeatedly. Obvious cause of migraines is unknown, but it may be caused by a primary vascular disorder that is usually more common in women and has a strong tendency in the family.Signs and symptoms of migraine on the result of cerebral cortical iskhemia varying degrees. The attack began with a scalp artery vasoconstriction dam retinal and cerebral blood vessels. Intra and extracranial blood vessels dilated, which causes pain and discomfort.Classic migraine can be divided into three phases, namely: Phase aura.Lasted approximately 30 minutes, and can provide an opportunity for the patient to determine the drugs used to prevent the attack. This period is a symptom of impaired vision (glare), tingling, itching sensation on the face and hands, a little weak on the extremities and dizziness.Period is associated with vasoconstriction aura without pain that begins with the initial physiological changes. Reduced cerebral blood flow, with a loss of autoregulation laanjut and CO2 responsiveness damage. Phase headachePhase severe throbbing headache and unable to make the dihungkan with photophobia, nausea and vomiting. Duration of this state varies, a few hours in a day or several days. recovery phasePeriods of muscle contraction neck and scalp are associated with local muscle pain and tension. Fatigue usually occurs, and the patient can sleep for a long time.b. Cluster HeadacheCluster Headache pain is beentuk other vascular lump that often occurs in men. The attack came in the form of a pile or in groups, with the excruciating pain and the eye area and temporal spread stricken face. Pain followed by watery eyes and nasal obstruction. The attack ends from 15 minutes to 2 hours and decreased strength gained.This type of headache is associated with dilatation of the surrounding area and ekstrakranualis arteries, caused by alcohol, nitrites, vasodilator and histamine. These headaches unresponsive to chlorpromazine.c. Tension HeadachePhysical and emotional stress can cause contraction of the muscles of the neck and scalp, which causes tension headaches. Characteristics of this headache feeling no pressure on the forehead, temples, or back of the neck. It is often depicted as a "heavy burden of covering the head". These headaches tend to be chronic rather than weight. Patients requiring sobriety, and usually this is the state of fear that can not be uttered. Symptomatic relief may be given to the location of heat, massage, analgesics, antidepressants and muscle relaxants.E. ASSESSMENTSubjective and objective data is very important to determine the causes and nature of headaches. Subjective Dataa. Understanding of the patient's headache and possible causes.b. Aware of the presence of trigger factors, such as stress.c. Measures - measures to reduce symptoms such as drugs.d. Place, frequency, pattern and nature of pain headache including place, time and interval between headaches.e. Headache onset.f. There prodomal symptoms or notg. . There accompanying symptoms.h. History of headaches in the family (especially important when a migraine).i. Situations that make headaches worse.j. There are allergic or not. Objective Dataa. Behavior: showing symptoms of stress, anxiety or pain.b. Changes in the ability to perform daily activities - day.c. There is anormal assessment of physical assessment system cranial nerve system.d. Body temperaturee. Drainage of the sinuses.In the assessment of headache, some important points to consider. Among them are:a. Localized headaches usually associated with migraine headaches or organic disorders.b. Thorough headache is usually caused by psychological causes or increased intracranial pressure.c. Migraine headaches can move from one side to another kesisi.d. Headache accompanied by increased intracranial pressure timbil usually when I wake up or the headache membengunkan patients from sleep.e. Sinus type headaches occur in the morning and the afternoon to get worse.f. Many headaches associated with stress conditions.g. The pain is dull, annoying, intensified and continued to exist, often occurs in headaches psikogenis.h. Organic materials that cause pain and its still getting bigger.i. Kapala migraine pain may accompany mentruasi.sakit head may be preceded eat foods containing monosodium glutamate, nitrates SODIM, tyramine as well as alcohol.j. Sleeping too long, fast, inhale toxic odors in the workplace limngkungan where insufficient ventilation can cause headaches.k. Oral contraceptives can aggravate migraines.l. Found each of the secondary headaches needs to be studied.

F. DIAGNOSTIC

 1. CT Scan, being easily accessible as an easy and safe way to find abnormalities in the central   nervous system.

2. MRI Scan, with the aim of detecting the condition of the brain and spinal cord pathology using a scanning technique with the power of magnets to create a shadow of the body structure.

3. Lumbar puncture, the cerebrospinal fluid to take the examination. It is not known to do when there is an increase in intracranial pressure and brain tumors, due to the sudden decrease in pressure due to CSF ​​collection.