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ABSTRAK 

GAMBARAN KARAKTERISTIK MIGRAIN DI RUMAH SAKIT UMUMPENDIDIKAN (RSUP) DR. HASAN SADIKIN BANDUNG

PERIODE JANUARI 2010 – JUNI 2012

Dwi Nur Pratiwi Sunardi. 2013. Pembimbing I : Dedeh Supantini, dr., Sp.S.,

MPd. Ked.Pembimbing II : Jo Suherman, dr., M.S. AIF.

Latar Belakang: Penelitian mengenai angka kejadian migrain dan karakteristiknya

di Indonesia, terutama di kota Bandung masih terbatas.

Tujuan: Untuk mengetahui angka kejadian migrain dan bagaimana gambaran

karakteristiknya, yaitu: jenis migrain, tanda gejala klinis, faktor resiko, dan faktor komorbid di Rumah Sakit Umum Pendidikan (RSUP) Dr. Hasan Sadikin Bandung.

Metode: Penelitian ini menggunakan studi potong lintang menggunakan data

sekunder, yaitu data rekam medis pasien pada periode Januari 2010  –  Juni 2012.

Hasil: Dari 65 pasien, 49 orang (75,4 %) adalah perempuan, dengan jumlah penderita

tertinggi adalah pada kelompok usia 41 - 64 tahun (46,2 %). Jenis migrain yang paling banyak diderita adalah migrain tanpa aura (44,6%). Aura ditemukan pada 12

 pasien, 11 orang (16,9 %) mengalami aura visual,1 orang (1,5 %) mengalami keluhan

aura auditorik. Distribusi nyeri pada migrain terbanyak adalah unilateral pada 44orang pasien (67,7%). Kekambuhan 48 orang pasien (73,8 %) episodik dan 17 orang

(26,2 %) lainnya kronis. Karakteristik nyeri yang paling banyak didapatkan adalah

nyeri berdenyut (84,6 %), nyeri juga bertambah dengan aktivitas pada 60 % pasien.Gejala penyerta saat serangan adalah  photophobia (23,0 %),  phonophobia (7,7 %),

dan photophobia + phonophobia (29,2 %), mual (44,6%), mual disertai muntah (24,6

%), s yncope (4,6 %), dan 73,8 % pasien masih dapat melakukan aktivitas normal saat

serangan. Faktor resiko yang didapatkan adalah faktor hormonal (jenis kelamin)sebesar 75,4 %, stress (3,0 %), anxiety (3,0 %), depresi (4,6 %). Komorbiditasnya

adalah hipertensi (38,5 %), trauma capitis (15,4 %), miopi (6,2 %), dislipidemia

(30,8 %), dan stroke (4,6 %).

Simpulan:  Nyeri kepala migrain di RSUP Dr. Hasan Sadikin Bandung periode

Januari 2010  –  Juni 2012 lebih banyak diderita oleh dewasa terutama perempuan,

dengan gejala klinis, faktor resiko, dan faktor komorbid yang bervariasi.

Kata Kunci: migrain, karakteristik 

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ABSTRACT 

MIGRAINE CHARACTERISTICS OVERVIEW IN DR. HASAN SADIKI N GENERAL TEACHING HOSPITAL BANDUNG 

PERIOD JANUARY 2010  – JUNI 2012 

Dwi Nur Pratiwi Sunardi. 2013. 1 st 

Tutor : Dedeh Supantini, dr., Sp.S., MPd. Ked.

2nd 

Tutor  : Jo Suherman, dr., M.S. AIF.

Background: Researches on characteristics of migraine headache in Indonesia,

especially in Bandung is still very limited.Objective: To determine characterictics of migraine headache, namely: type of migraine, clinical manifestations, risk factors, and comorbid factors in Dr. Hasan

Sadikin General Teaching Hospital Bandung.Methods: The research applied cross-sectional study using secondary data, whichwere patients medical records in the period of January 2010 - June 2012.

Results: From 65 patients, 49 (75.4%) were women, with the highest number of 

 patients were in the age group 41-64 years (46.2%). Migraine without aura was the

most common type of migraine (44.6%). Aura was found in 12 patients and 11 patients (16.9%) reported having visual aura. 1 patient (1.5%) complainted auditory

aura. Distribution of migraine pain were unilateral in 44 patients (67.7%). From 65

 patients, 48 (73.8%) experienced episodic migraine and 17 patients (26.2%)experienced chronic migraine. Pain characteristics were mostly throbbing pain

(84.6%). Increasing pain during activity reported by 60% of all patients.

 Accompanying symptoms during attacks were photophobia (23.0%), phonophobia

(7.7%), photophobia+phonophobia (29.2%), nausea (44.6%), nausea followed byvomiting (24.6%), and syncope (4.6%). 73.8% of patients reported to still be able to

do normal activities during attacks. Acquired risk factors were hormonal factors

(75.4%), stress (3.0%), anxiety (3,0%), depression (4.6%). Comorbid factors were

hypertension (38.5%), head trauma (15.4%), myopia (6.2%), dyslipidemia (30.8%),and stroke (4.6%).

Conclusions: Migraine headache in Dr. Hasan Sadikin General Teaching Hospital 

 Bandung period January 2010 - June 2012 affected mostly adult women. Symptoms,risk factors, and comorbid factors were varied.

Keywords: migraine, characteristics

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DAFTAR ISI

Halaman

JUDUL ........................................................................................................... i

LEMBAR PERSETUJUAN ......................................................................... ii

SURAT PERNYATAAN .............................................................................. iii

ABSTRAK ..................................................................................................... iv

ABSTRACT .................................................................................................... v

KATA PENGANTAR ................................................................................... vi

DAFTAR ISI .................................................................................................. viii

DAFTAR TABEL........................................................................................... xii

DAFTAR GAMBAR ...................................................................................... xiii

BAB I PENDAHULUAN .............................................................................. 1

1.1 Latar Belakang ................................................................................. 1

1.2 Identifikasi Masalah ......................................................................... 3

1.3 Maksud dan Tujuan .......................................................................... 3

1.4 Manfaat Penelitian ........................................................................... 3

1.5 Kerangka Teoritis ............................................................................. 4

1.6 Metodologi Penelitian ...................................................................... 4

1.7 Lokasi dan Waktu Penelitian ........................................................... 5

BAB II TINJAUAN PUSTAKA ................................................................... 6

2.1 Anatomi ............................................................................................ 62.1.1 Anatomi Kepala ...................................................................... 6

2.1.1.1 Cranium ....................................................................... 6

2.1.1.2 Cerebri ........................................................................ 7

2.1.1.3 Scalp ............................................................................ 8

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2.1.2 Persarafan Kepala .................................................................... 10

2.1.2.1 Nervus Cranialis ......................................................... 10

2.1.2.2 Struktur Peka Nyeri Pada Kepala ................................ 16

2.1.3 Pendarahan Kepala dan Leher .................................................. 17

2.1.3.1 Perdarahan Otak .......................................................... 17

2.1.3.2 Perdarahan Wajah ....................................................... 21

2.1.3.3 Perdarahan Scalp ......................................................... 23

2.2 Nyeri dan Nyeri Kepala

2.2.1 Definisi Nyeri .......................................................................... 24

2.2.2 Patofisiologi Nyeri .................................................................. 24

2.2.3 Definisi Nyeri Kepala ............................................................. 25

2.2.4 Insidensi dan Epidemiologi .................................................... 25

2.2.5 Etiologi .................................................................................... 25

2.2.6 Patofisiologi Nyeri Kepala ...................................................... 26

2.2.7 Klasifikasi Nyeri Kepala ......................................................... 26

2.2.7.1 Nyeri Kepala Primer dan Sekunder ............................. 26

2.2.7.2 Klasifikasi Nyeri Kepala Menurut IHS ........................ 26

2.3 Migrain

2.3.1 Kasifikasi Migrain Menurut IHS ............................................ 29

2.3.2 Definisi Migrain Tanpa Aura .................................................. 30

2.3.3 Definisi Migrain Dengan Aura ................................................ 31

2.3.4 Kriteria Diagnosis Migrain ..................................................... 32

2.3.4.1 Migrain Dengan Aura .................................................... 32

2.3.4.2 Migrain Tanpa Aura ....................................................... 33

2.3.4.3 Migrain Kronis ............................................................... 33

2.3.5 Insidensi, Epidemiologi, dan Faktor Resiko ............................ 33

2.3.6 Etiologi .................................................................................... 34

2.3.7 Faktor Resiko ............................................................................. 34

2.3.7.1 Faktor Genetik ................................................................ 34

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2.3.7.2 Faktor Jenis Kelamin- Hormonal .................................... 35

2.3.7.3 Faktor Stress, Cemas dan Depresi .................................. 35

2.3.7.4 Faktor Makanan dan Minuman ...................................... 36

2.3.7 Patogenesis dan Patofisiologi .................................................. 36

2.3.7.1 Teori Vascular Migrain .................................................. 36

2.3.7.2 Hormon Perempuan dan Patofisiologi Migrain ............. 38

2.3.8 Manifestasi Klinis ................................................................... 39

2.3.8.1 Tipe Serangan Migrain ................................................... 40

2.3.9 Pemeriksaan Penunjang ............................................................. 42

2.3.10 Penatalaksanaan .................................................................... 43

2.3.10.1 Obat Migrain Non Spesifik .......................................... 44

2.3.10.2 Obat Migrain Spesifik .................................................. 47

2.3.11 Komplikasi ............................................................................ 49

2.3.11.1 Status Migrainous ........................................................ 49

2.3.11.2 PAWI ............................................................................ 49

2.3.11.3 Migraine Infarction ...................................................... 49

2.3.11.4 Migraine Seizure .......................................................... 50

2.3.12 Pencegahan ............................................................................ 51

2.3.12.1 Obat Profilaksis Migrain .............................................. 51

2.3.13 Prognosis ............................................................................... 54

BAB III METODE PENELITIAN .............................................................. 55

3.1 Metode Penelitian ............................................................................. 55

3.2 Rancangan Penelitian ....................................................................... 55

3.3 Teknik Pengambilan Data ................................................................ 55

3.4 Instrumen Penelitian ......................................................................... 55

3.5 Sampel Penelitian ............................................................................. 55

3.6 Kriteria Sampel Penelitian ............................................................... 56

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3.7 Definisi Operasional ......................................................................... 56

3.8 Alur Penelitian ................................................................................. 56

BAB IV HASIL DAN PEMBAHASAN........................................................ 57

4.1 Hasil Penelitian ................................................................................ 57

4.1.1 Karakteristik Pasien ................................................................ 58

4.1.2 Tanda dan Gejala Klinis Migrain ............................................ 62

4.1.3 Faktor Resiko Migrain ............................................................ 66

4.1.4 Faktor Komorbid Migrain ....................................................... 67

BAB V SIMPULAN DAN SARAN ............................................................... 70

5.1 Simpulan .......................................................................................... 70

5.2 Saran ................................................................................................. 70

DAFTAR PUSTAKA .................................................................................... 72

RIWAYAT HIDUP ....................................................................................... 77

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DAFTAR TABEL

Halaman

Tabel 4.1 Karakteristik Pasien ........................................................................ 58

Tabel 4.2 Tanda dan Gejala Klinis Migrain .................................................... 62

Tabel 4.3 Faktor Resiko Migrain .................................................................... 66

Tabel 4.4 Faktor Komorbid Migrain ............................................................... 67

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DAFTAR GAMBAR 

Halaman

Gambar 2.1 Tengkorak/ Cranium (tampak depan dan lateral) ........................ 7

Gambar 2.2 Lobi Cerebri ................................................................................ 8

Gambar 2.3 Saraf - Saraf Wajah ..................................................................... 11

Gambar 2.4 Basis Cranii ................................................................................. 11

Gambar 2.5 Pembuluh Darah dan Saraf Kepala (tampak lateral) ................... 15

Gambar 2.6 Circulus Arteriosus Cerebri ......................................................... 18

Gambar 2.7 Arteri dan Vena Kepala ............................................................... 19

Gambar 2.8 Sinus- Sinus Otak ........................................................................ 20

Gambar 2.9 Arteri dan Vena Luar Tengkorak ................................................. 22

Gambar 2.10 Pembuluh Darah dan Saraf Kepala (tampak lateral) ................. 24

Gambar 2.11 Klasifikasi Nyeri Kepala Menurut IHS ..................................... 29

Gambar 2.12 Skema Patofisiologi Migrain ..................................................... 41

Gambar 2.13 Tabel Obat Migrain Non Spesifik ............................................. 45

Gambar 2.14 Tabel Obat Migrain Spesifik ..................................................... 47

Gambar 2.15 Tabel Obat Profilaksis Migrain ................................................. 52