Seringkali gejala migren hanya dianggap sakit kepala biasa, sehingga orang yang mengalaminya hanya mengatasi keluhan tersebut dengan obat-obatan pereda nyeri (analgetik) biasa.
Akibatnya, masalah migren ini menjadi berlarut-larut, dan semakin sulit ditangani. Terkadang migren baru disadari sebagai masalah yang serius, setelah nyeri kepala terjadi terus-menerus dan tidak hilang dengan obat-obatan yang biasa diminum.
GEJALA-GEJALA MIGREN
Secara umum terdapat 4 fase gejala, meskipun tak semua penderita migren mengalami keempat fase ini.
Keempat fase tersebut adalah : fase prodromal, aura, serangan, dan postdromal.
Fase Prodromal
Fase ini terdiri dari kumpulan gejala samar / tidak jelas, yang dapat mendahului serangan migren. Fase ini dapat berlangsung selama beberapa jam, bahkan dapat 1-2 hari sebelum serangan.
Gejalanya antara lain:
- Psikologis : depresi, hiperaktivitas, euforia (rasa gembira yang berlebihan), banyak bicara (talkativeness), sensitif / iritabel, gelisah, rasa mengantuk atau malas.
- Neurologis : sensitif terhadap cahaya dan/atau bunyi (fotofobia & fonofobia), sulit berkonsentrasi, menguap berlebihan, sensitif terhadap bau (hiperosmia)
- Umum : kaku leher, mual, diare atau konstipasi, mengidam atau nafsu makan meningkat, merasa dingin, haus, merasa lamban, sering buang air kecil.
Aura
Umumnya gejala aura dirasakan mendahului serangan migren. Secara visual, aura dinyatakan dalam bentuk positif atau negatif. Penderita migren dapat mengalami kedua jenis aura secara bersamaan. Aura positif tampak seperti cahaya berkilauan, seperti suatu bentuk berpendar yang menutupi tepi lapangan pengelihatan.
Fenomena ini disebut juga sebagai scintillating scotoma (scotoma = defek lapang pandang). Skotoma ini dapat membesar dan akhirnya menutupi seluruh lapang pandang. Aura positif dapat pula berbentuk seperti garis-garis zig-zag, atau bintang-bintang.
Aura negatif tampak seperti lubang gelap/hitam atau bintik-bintik hitam yang menutupi lapangan pengelihatannya. Dapat pula berbentuk seperti tunnel vision; dimana lapang pandang daerah kedua sisi menjadi gelap atau tertutup, sehingga lapang pandang terfokus hanya pada bagian tengah (seolah-seolah melihat melalui lorong).
Beberapa gejala neurologis dapat muncul bersamaan dengan timbulnya aura. Gejala-gejala ini umumnya: gangguan bicara; kesemutan; rasa baal; rasa lemah pada lengan dan tungkai bawah; gangguan persepsi pengelihatan seperti distorsi terhadap ruang; dan kebingungan (confusion).
Fase Serangan
Tanpa pengobatan, serangan migren umumnya berlangsung antara 4-72 jam. Migren yang disertai aura disebut sebagai migren klasik. Sedangkan migren tanpa disertai aura merupakan migren umum (common migraine).
Gejala-gejala yang umum adalah:
- Nyeri kepala satu sisi yang terasa seperti berdenyut-denyut atau ditusuk-tusuk. Nyeri kadang-kadang dapat menyebar sampai terasa di seluruh bagian kepala.
- Nyeri kepala bertambah berat bila melakukan aktivitas
- Mual, kadang disertai muntah
- Gejala gangguan pengelihatan dapat terjadi
- Wajah dapat terasa seperti baal / kebal, atau semutan
- Sangat sensitif terhadap cahaya dan bunyi (fotofobia dan fonofobia)
- Wajah umumnya terlihat pucat, dan badan terasa dingin
Terdapat paling tidak 1 gejala aura (pada migren klasik), yang berkembang secara bertahap selama lebih dari 4 menit. Nyeri kepala dapat terjadi sebelum gejala aura atau pada saat yang bersamaan.
Fase Postdromal
Setelah serangan migren, umumnya terjadi masa prodromal, dimana pasien dapat merasa kelelahan (exhausted) dan perasaan seperti berkabut.
MIGREN PERSISTEN
Pada beberapa kasus, migren berlangsung terus-menerus dan dalam waktu lama. Kondisi ini disebut sebagai migren persisten.
Migren persisten dapat disebabkan oleh beberapa hal:
Rebound Migraine :
Penyebab paling sering terjadinya rebound migraine adalah akibat apa yang disebut sebagai efek-pantulan / efek bola pantul (rebound-effect). Efek-pantulan merupakan suatu siklus yang terjadi akibat penggunaan yang berlebihan (overuse) obat-obatan migren.
Siklus ini melibatkan beberapa aspek: Pasien umumnya telah menggunakan obat anti-nyeri (analgesik) selama lebih dari 3 hari dalam seminggu secara terus-menerus. Nyeri kepala rebound terjadi saat pasien menghentikan pemakaian obat-obatan analgesik tersebut. Akibat nyeri rebound ini, pasien kemudian meminum lagi obat-obatan analgesik. Akhirnya nyeri kepala menjadi persisten dan obat-obatan tidak lagi efektif.
Obat-obatan yang pada penggunaan terus-menerus dalam jangka lama dapat memicu terjadinya rebound migraine meliputi: analgesik ringan (aspirin, parasetamol/ asetaminofen, ibuprofen); hipnotik-sedatif (diazepam, lorazepam, alprazolam, fenobarbital, chloral hydrate, dll); narkotika; obat-obatan migren; obat-obatan yang mengandung kafein (kafein yang berlebihan dapat pula mengakibatkan kondisi ini).
Transformed Migraine:
Pada beberapa kasus, migren dapat berkembang ke arah nyeri kepala harian dan kronik. Kondisi ini disebut juga sebagai transformed migraine. Nyeri kepala ini mirip dengan nyeri kepala tipe tegang. Pasien umumnya mengeluh nyeri akibat rasa tegang, kaku, seperti dijepit. Sering dirasakan pada daerah belakang kepala, leher, dan bahu; namun dapat juga dirasakan di dahi, atau bahkan seluruh kepala).
OBAT-OBATAN YANG DIGUNAKAN DALAM TERAPI MIGREN
Terapi obat dilakukan melalui konsultasi dengan dokter untuk menentukan jenis obat yang akan diberikan, cara penggunaannya. Pemberian obat memerlukan kontrol ketat. Penggunaan yang berlebihan akan menyebabkan terjadinya nyeri kepala kronik yang sukar disembuhkan. Akibatnya dapat terjadi gejala putus obat pada penghentian terapi atau gejala rebound migraine.
Secara umum terapi medikamentosa migren dibagi ke dalam 2 strategi:
- Terapi abortif, yang dilakukan untuk menghentikan serangan. Obat-obatan yang digunakan untuk terapi abortif meliputi : analgesik (paracetamol, aspirin) atau anti-inflamasi non steroid (ibuprofen, naproxen); agonis serotonin (sumatriptan), alkaloid ergot (ergotamine, methysergide); neuroleptik (chlorpromazine,prochlorperazine); dan steroid (deksametason, hidrokortison).
- Terapi profilaksis, yang dilakukan untuk mencegah serangan yang akan datang. Obat-obatan untuk terapi profilaksis meliputi : anti-depressant (amitriptyline, fluoxetine, imipramine); beta-blocker (propanolol, atenolol, metoprolol); calcium channel blocker (diltiazem, nifedipine, verapamil); OAINS; antagonis serotonin (methysergide, cyproheptadine); dan anti-konvulsan.
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