Cephalgia

WANTIYAH

Kompetensi Dasar
Mahasiswa mampu:

Menguraikan konsep dasar cephalgia

2. Mengaplikasikan asuhan keperawatan pada klien
dengan cephalgia
1.

Cephalgia???
Nyeri kepala/cephalgia keluhan >>
USA: 25 juta pasien hilangnya 180 juta hari kerja

dan biaya terbuang 10 milyar dolar

Keluhan paling sering: migren
Sakit kepala pusing (vertigo)

Pembagian nyeri kepala

Kelainan lokal pada kranial, ex: temporalis arteritis
Nyeri yang berasal dari saraf kranial, ex: trigeminal

neuralgia
Nyeri kepala yg berasal dari intrakranial
Nyeri rujukan (referred pain), ex: sinusitis, glaukoma
Nyeri kepala vaskuler episodik, ex: migren
Nyeri kepala yg berasal dari kontraksi otot
Nyeri kepala pasca traumatik
Nyeri kepala psikogenik

Headache
These types of headache include migraine, tension-type, and cluster

headaches (Lin, 2001).

Migraine is a symptom complex characterized by periodic
and recurrent attacks of severe headache. The cause of migraine has
not been clearly demonstrated, but it is primarily a vascular
disturbance that occurs more commonly in women and has a strong
familial tendency. The typical time of onset is puberty, and the
incidence is highest in adults 20 to 35 years of age. There are seven
subtypes of migraine, including migraine with and without aura.
Most patients have migraine without an aura.
The tension headache is characterized by a steady, constant
feeling of pressure that usually begins in the forehead, temple, or
back of the neck. It is often bandlike or may be described as a weight
on top of my head.Tension headaches tend to be more chronic than
severe and are probably the most common type of headache.

Cluster headaches are unilateral and come in

clusters of one to eight daily, with excruciating pain

localized to the eye and orbit and radiating to the
facial and temporal regions. The pain is accompanied
by watering of the eye and nasal congestion. Each
attack lasts 30 to 90 minutes and may have a
crescendodecrescendo pattern. Cluster headaches
are a severe form of vascular headache. They are
seen five times more frequently in men than women
(Greenberg, 2001).

Migren ???
Menurut Research Group on Migraine and

Headache of The World Federation on Neurology:

kelainan familial dengan karakteristik serangan
rekuren pada kepala dengan intensitas, frekuensi,
dan lama serangan yang bervariasi.
Serangan lbh banyak bersifat unilateral dan biasanya
disertai anoreksia, nausea dan muntah.
Dpt didahului atau disertai gangguan mood atau
neurologik

Migraine
The migraine with aura can be divided into four

phases: prodrome,aura, the headache, and recovery

(headache termination and postdrome).

Prodrome
The prodrome phase is experienced by 60%

of patients with symptoms that occur hours to days

before a migraine headache.
Symptoms: depression, irritability, feeling cold, food
cravings, anorexia, change in activity level, increased
urination, diarrhea, or constipation.
Patients usually experience the same prodrome with
each migraine headache.

Aura Phase
Aura occurs in up to 31% of patients who have migraines

(Goadsby et al., 2002). The aura usually lasts less than an hour and may
provide enough time for the patient to take the prescribed medication to
avert a full-blown attack (described in a later section).
This period is characterized by focal neurologic symptoms. Visual
disturbances (ie, light flashes and bright spots) are common and
may be hemianopic (affecting only half of the visual field). Other
symptoms that may follow include numbness and tingling of the lips,
face, or hands; mild confusion; slight weakness of an extremity;
drowsiness; and dizziness.
This period of aura corresponds to the painless vasoconstriction that is
the initial physiologic change characteristic of classic migraine.
Cerebral blood flow studies performed during migraine headaches
demonstrate that during all phases of the attack, cerebral blood flow
is reduced throughout the brain, with subsequent loss of
autoregulation and impaired CO2 responsiveness.

Headache Phase
As vasodilation and a decline in serotonin

levels occur, a throbbing headache (unilateral in

60% of patients) intensifies over several hours. This
headache is severe and incapacitating and is often
associated with photophobia, nausea,and vomiting.
Its duration varies, ranging from 4 to 72 hours
(Goadsby et al., 2002).

Recovery Phase
In the recovery phase (termination and postdrome),

the pain gradually subsides. Muscle contraction in

the neck and scalp is common, with associated
muscle ache and localized tenderness, exhaustion,
and mood changes.
Any physical exertion exacerbates the headache
pain.
During this postheadache phase, patients may sleep
for extended periods.

Etiologi
Herediter
2. Lingkungan: internal (menstruasi, kelelahan fisik
dan mental, tidur, hipertensi) dan eksternal (iklim,
cahaya menyilaukan, makanan (coklat,pisang),
alkohol, lapar, stress
3. Ketidakstabilan saraf otonom
1.

Patofisiologi
Penyebab migren bukan primer pada pembuluh darah tetapi

pada jaringan otak 2 faktor utama: hipoksia dan depresi

yang menyebar (terjadi neuronal depolarisasi yang secara
perlahan meluas ke korteks serebri)
Hilangnya ion Kalium hipoksia dan aktivitas listrik yang
berlebihan
Hilangnya K dari sel neuron konsentrasi K ekstrasel
meningkat depolarisasi sel di dekatnya dan masuknya ion
Ca ke dlm sel.
Ca intrasel >> pelepasan neurotransmitter berlebihan
ambilan kalsium mitokondria >> vasospasme, disfungsi
neuron kematian sel otak

Pengkajian
Anamnesis: Keluhan utama kaji nyeri PQRST
Pemeriksaan neurologis

Pemeriksaan penunjang
CT scan / MRI
Pemeriksaan EEG

Diagnosa keperawatan
Masalah utama: Nyeri (akut) b/d injury biologis:

hipoksia neuron
Masalah lain:gangguan persepsi-sensori, cemas,
defisit self care

Intervensi
Kolaborasi terapi untuk mencegah serangan
migren: anti serotonin, anti platelet (aspirin),
antidepresan, Ca antagonis utama: aspirin dan
ergotamin
2. Mencegah faktor pemicu: keju, coklat, pisang
3. Manajemen nyeri Terapi komplementer:
hipnoterapi, biofeedback
1.