Pemicu 3 Blok Saraf &

Kejiwaan
Liliani Labitta 405120026

Altered
hypothalamic or
brainstem function

Premonitory phase (1 day):

Prodromal fatigue
Cognitive, affective, gastrointestinal sy

Migraine with aura (classic migraine)

Inhibition of neuronal activity Aura

Intracranial vasoconstriction
Extracranial vasodilatation

(1) Pain-sensitive structures/(2)allody

Headache pha
Migraine without aura (common
migraine)

Precipitating factors
Food (tyramine-containing
cheeses, nitrite
preservatives,
phenylethylamine, MSG)
Fasting, emotion, menses,
drugs, bright lights

Treatment:
Acute: Analgesics, Triptan, Ergoid
alkaloids, Telcagepant/olcegeplant
Prophylactic: Tricyclic
antidepressants, -blockers,
anticonvulsants, CCB

CLUSTER
HEADACHE
E/= unkown (attack functional MRI =
hypothalamic activation)
Rare, brief severe headache lasting for 15180 min
+ autonomic symptoms:
burning sensation on nose, pressure on eye,
lacrimation, nassal stuffiness, Horner
symptoms
Precipitating factors: alcohol, vasodilator
drugs
Treatment: constant, non-throbbing
Unilateral,
Acute:onset;
>
inhalation
average
of 100%
25 y.o.
O2 or SC
sumatriptan 6 mg
Prophylaxis:
Maintenace: CCB, triptan, ergot,
verapamil, lithium
Transitional: Prednisone (at the
beginning of cycle)
Chronic: Indometachin
Bilateral hypnic: Lithium
Invasive: if medication is unsuccessful

TENSION-TYPE
HEADACHE
Most common (>40%
worldwide)
Bilateral, mild-moderate
pain without other
symptoms, >
Sourcing from pericranialmyofacial
Treatment:tissue nosiseptor
Acute: aspirin/ NSAIDs/
acetaminophen/
ergotamine
Prophylaxis: amitriptyline/
imipramine/ propanolol
(rarely)
Other medication:
benzodiazepine
Non-pharmacologic:
Psychotherapy, Physical
therapy, relaxation
technique

Trigeminal Neuralgia = tic douloureux

Uncommon, >
Classical: vascular compression
Symptomatic: another underlying cause
Recurrent attacks (1-120 s) of lancinating pain in the
trigeminal nerve distribution + facial spasm
Trigger: talking, chewing, teeth brushing, shaving, light touch,
cool breeze
Unilateral, may occur repeatedly throughout the day
demyelination of trigeminal
root axons ephaptic
impulses transmission
Involve one or more branches
of the trigeminal nerve:
maxillary branch most often,
ophthalmic branch least
right side of the face > left
(1.5:1)

D/ determined clinically
Th/ Carbamazepine DOC initial treatment
Baclofen, gabapentin relief in refractory case
Neurosurgical if medical therapy is unsuccessful or poorly
tolerated

IHS Diagnostic Criteria for Trigeminal Neuralgia

Classical
A. Paroxysmal attacks of pain lasting from a fraction of a second to
two minutes, affecting one or more divisions of the trigeminal
nerve, and fulfilling criteria B and C
B. Pain has at least one of the following characteristics:
1. Intense, sharp, superficial, or stabbing
2. Precipitated from trigger zones or by trigger factors
C. Attacks are stereotyped in the individual patient
D. There is no clinically evident neurologic deficit
E. Not attributed to another disorder
Symptomatic
A. Paroxysmal attacks of pain lasting from a fraction of a second to
two minutes, with or without persistence of aching between
paroxysms, affecting one or more divisions of the trigeminal nerve,
and fulfilling criteria B and C
B. Pain has at least one of the following characteristics:
1. Intense, sharp, superficial, or stabbing
2. Precipitated from trigger zones or by trigger factors
C. Attacks are stereotyped in the individual patient
D. A causative lesion, other than vascular compression, has been

Paroxysmal Hemicrania
Rare, severe throbbing claw-like pain
One side of the face (around/behind
the eye) back of the neck, >
red and tearing eyes, a drooping
or swollen eyelid on the affected side
of the face, nasal congestion
Dull pain, soreness, or tenderness
between attacks
Attacks: 5-40 x/day; 2 - 30 min
Chronic: attack daily 1 yr
Episodic: remit for months or years
Trigger: Certain movements of the
head or neck or external pressure to
the neck
Th/: Indomethacin, CCB,
corticosteroid
Prognosis: Th/ complete to near-

Giant-cell (temporal) Ateritis

Systemic vasculitis in branches of
ECA subacute granulomatous
inflammation (lymphocte,
neutrophils, giant-cells) painsensitive arterial wall headache
& stenosis ischemia
2x>, >50 yr, uni/bilateral, on
scalp
Malaise, myalgia, weight loss,
arthralgia, fever
Examination:
ESR elevated, CRP >2.45 mg/dL,
thrombocytosis (400,000
platelets/L)
Th/:
Prednison
4060 mg/day
oral
D/: biopsy
of affected
temporal
artery*
Prognosis:
ESR normal,
Prompt evaluation
avoid visual
headache
improve dramatically,
loss
blindness irreversible

VERTIGO
False sense of motion
54% of all diziness
E/: BPPV, Menieres disease, acute vestibular neuronitis, others (drugs, CVD, etc)
Symptoms: Aural fullness, ear or mastoid pain, facial weakness, Focal neurologic
findings, headache, hearing loss, imbalance, nystagmus, phonophobia,
photophobia, tinitus

Provoking factors:

Positional changes BPPV

Recent viral URTI Acute vestibular neuronitis
Phonophobia/photophobia associated with migraine
Direct blow/barotrauma/heavy weight bearing/ straining bowel/sneezing
perilymphatic fistula
Tulios phenomenon Peripheral cause of vertigo
Significant psychosocial stress
Neurologic examination:
Th/ BPPV Epley Maneuver
Cranial nerves, balance, walking ability
Meniere antihistamine,
benzodiasepine
B/w episodes: low-salt diet, diuretics,
Head and neck examination:
betahistine
Tympanic membranes vesicles/
Persistent: transtympanic
cholesteatom?
gentamycin/dexamethasone
Henneberts sign* indicates
Acute vestibulopathy prednisone
perilymphatic fistula
Cardiovascular examination:
Orthostatic (standing) systolic BP and pulse