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Journal of Pain, Vertigo and Headache
Published by Universitas Brawijaya
ISSN : 27233979     EISSN : 27233960     DOI : https://doi.org/10.21776/ub.jphv
Core Subject : Science,
Neuroscience
JPHV - Journal of Pain, Headache and Vertigo is a peer-reviewed and open access journal that focuses on promoting pain, headache and vertigo. This journal publishes original articles, reviews, and also interesting case reports. JPHV - Journal of Pain, Headache and Vertigo is an international scientific journal, published twice a year by PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia.
Arjuna Subject : Ilmu Syaraf - Neorologi
Articles 98 Documents
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RIVASTIGMINE TRANSDERMAL PATCH FOR ALZHEIMER’S DISEASE: A SYSTEMATIC REVIEW Baskoro, Firza Yoga; Hassa, Nazwan; Hajar, Nabil; Balqis, Indira Aura
Journal of Pain, Headache and Vertigo Vol. 6 No. 2 (2025): September
Publisher : PERDOSNI (Perhimpunan Dokter Spesialis Neurologi Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Alzheimer's disease (AD) is the most common type of dementia disease. Acetylcholinesterase inhibitors (AChE-I) plays a pivotal role by increasing acetylcholine levels in the brain to improve cognitive function of Alzheimer's patients. Several agents including cholinesterase inhibitors such as donepezil and galantamine, as well as the NMDA receptor antagonist memantine are known for its benefit in increasing acetylcoline . However, Rivastigmin is the only AChE-I agent available in patch preparation. Objective : This study aims to evaluate the efficacy of Rivastigmin patch in improving cognitive function using the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog) in Alzheimer's disease patients. Methods: This research was conducted in accordance with the Systematic Review without Meta-Analysis (SWiM) guideline. A systematic database search was conducted in Medline, Google Scholar, and Cochrane Central Libraries using a pre-determined search query. Articles were screened by independent reviewers for eligibility to be included in the study. After risk of bias was conducted, seven studies were included for this research. Results: The included studies reported varied outcomes regarding cognitive improvement in Alzheimer's disease (AD) patients, depending on the dosage of Rivastigmine used. Overall, Rivastigmine was found to slow the progression of cognitive decline, as measured by the ADAS-Cog, and in some cases, even reduced ADAS-Cog scores by up to 3 points . Rivastigmine patch is known to inhibit the action of acetylcholinesterase enzyme which causes degradation of acetylcholine in the synapse gap, ultimately improving the cognitive of AD patients. Studies also mention that Rivasitgmine patch preparation has better tolerance to side effects compared to capsules or placebo. Conclusion: Rivastigmine patch shows improvement of cognitive status in Alzheimer's patients and has good tolerability compared to placebo or capsule preparations. the long-term efficacy and safety of the rivastigmine patch remain underexplored, and the generalizability of the findings to diverse patient populations is uncertain.
PATHOPHYSIOLOGY, DIAGNOSIS, AND MANAGEMENT OF NEUROPATHIC PAIN Puteri, Lintang Firdhani Nabila; Rahmawati, Dessika
Journal of Pain, Headache and Vertigo Vol. 6 No. 2 (2025): September
Publisher : PERDOSNI (Perhimpunan Dokter Spesialis Neurologi Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Neuropathic pain is a type of chronic pain resulting from lesions or disorders of the somatosensory nervous system. This condition is often difficult to recognize and manage due to the complexity of its mechanisms and the variation in clinical symptoms. Objective: This article aims to review the pathophysiological mechanisms, diagnostic approaches, and management strategies for neuropathic pain based on current scientific literature. Result: The main mechanisms of neuropathic pain include ectopic activity, central sensitization, dysfunction of descending inhibitory pathways, and glial cell activation. Diagnosis is established through a combination of detailed history taking, neurological examination, screening tools such as DN4, and supporting investigations such as EMG-NCV, QST, skin biopsy, ultrasonography, and MRI. Pharmacological therapy includes the use of tricyclic antidepressants, SNRIs, anticonvulsants, and topical agents, with an individualized and stepwise approach. Advanced imaging techniques such as MRI and CT play a critical role in detecting structural lesions. Conclusion: The diagnostic and therapeutic approaches to neuropathic pain should be multimodal and mem-based. Integration of clinical and supporting examinations is key to improving diagnostic accuracy and therapeutic effectiveness.
DESCRIPTIVE OF KNOWLEDGE LEVEL ON PARACETAMOL USE AND THE EFFECTIVENESS OF RECOVERY FROM PRIMARY CEPHALGIA AMONG MEDICAL STUDENTS Alifia, Khalisya; Kosasih, Robert
Journal of Pain, Headache and Vertigo Vol. 7 No. 1 (2026): March
Publisher : PERDOSNI (Perhimpunan Dokter Spesialis Neurologi Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jphv.2026.007.01.01

Abstract

Primary cephalgia is a commonly experienced neurological condition, frequently self-managed by university students using over-the-counter medications such as paracetamol. While accessible and widely used, improper use of paracetamol—due to limited knowledge—can result in suboptimal symptom relief or serious adverse effects such as overdose and hepatotoxicity. This study aims to describe the level of knowledge regarding paracetamol use and its perceived effectiveness in alleviating primary cephalgia symptoms among medical students class of 2022 and 2024 at Tarumanagara University. This descriptive research utilized a cross-sectional design. Data were collected through a structured and validated questionnaire that assessed students’ knowledge about appropriate dosage, indications, side effects, and contraindications of paracetamol. To evaluate effectiveness, participants rated the intensity of their cephalgia before and after paracetamol intake using a standardized pain scale. The results revealed varied levels of knowledge across the respondents. While a considerable proportion of students demonstrated adequate knowledge—especially regarding dosage and indications—knowledge gaps were evident in understanding potential side effects and overdose risks. Furthermore, a statistically significant positive correlation was identified between higher knowledge scores and greater reported reduction in pain severity after paracetamol use. In conclusion, students with a stronger understanding of paracetamol usage experienced more effective relief of primary cephalgia symptoms. These findings underscore the necessity of targeted educational interventions that promote the rational and safe use of over-the-counter analgesics. Enhancing students’ pharmacological literacy is essential to improving therapeutic outcomes and minimizing the risks associated with self-medication practices.
THE CORRELATION OF CARDIOMEGALY AND STROKE SEVERITY: AN ANALYTICAL STUDY Awwalia, Fildza; Rahmawati, Vita Kusuma
Journal of Pain, Headache and Vertigo Vol. 7 No. 1 (2026): March
Publisher : PERDOSNI (Perhimpunan Dokter Spesialis Neurologi Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Stroke is characterized as a neurological deficit attributed to an acute injury of Central Nervous System (CNS) by a vascular cause. Cardiomegaly means enlargement of heart. Both stroke and cardiomegaly are related to vascular problems, but the correlation between them remains unclear. Objective: This study was conducted to examine risk factors related to stroke severity (based on National Institute of Health Stroke Scale) especially cardiomegaly at Lumajang Islamic Hospital in January to June 2025. Method: This study is an analytic observational study, retrospective data by using hospital medical records. Data were obtained from 124 inpatients cases admitted between January to June 2025 in Lumajang Islamic Hospital. The risk factors were studied are cardiomegaly, hypertension, diabetes mellitus, age, time of patient arrival. Results: The Pearson Chi-Square test indicated no significant correlation between cardiomegaly and NIHSS (stroke severity) with p = 0,080, nor with hypertension (p = 0,621), diabetes mellitus (p = 0,345) or age (p = 0,721). A statistically significant correlation was observed between the patient's arrival time and the severity of stroke (p = 0.000), including the arrival time of patients with cardiomegaly at the hospital (p = 0.020). Conclusion: This study demonstrated no significant correlation between cardiomegaly, hypertension, diabetes or age to stroke severity. However, significant correlation was found in patients arrival time including in cardiomegaly patients. These findings highlight the critical importance of early detection and timely medical intervention in stroke cases, particularly for patients with cardiomegaly.
QUALITY OF LIFE PATIENT EPILEPSY: EXPLORING THE ROLE OF SOCIODEMOGRAPHIC AND CLINICAL FACTORS IN AN INDONESIAN COHORT Permatasari, Desita; Rakhmi, Najmi Hidayatur; Dewi, Meilda Sartika
Journal of Pain, Headache and Vertigo Vol. 7 No. 1 (2026): March
Publisher : PERDOSNI (Perhimpunan Dokter Spesialis Neurologi Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Epilepsy is a chronic neurological disorder characterized by recurrent seizures, with substantial impact not only on clinical outcomes but also on psychosocial and quality of life domains. Assessing quality of life (QoL) has become essential in evaluating treatment success, as it encompasses dimensions beyond seizure control. Objective: This study aimed to analyze the relationship between sociodemographic and clinical factors with QoL among epilepsy patients at the Neurology Polyclinic of Dr. Ansari Saleh Regional Hospital, Banjarmasin. Method: An observational analytic study with a cross-sectional design was [A2.1]conducted on 50 patients diagnosed with epilepsy. Consecutive sampling was applied. QoL was assessed using the Indonesian-validated version of the Quality of Life in Epilepsy Inventory-10 (QOLIE-10). Sociodemographic and clinical data were collected through interviews and medical records. Data were analyzed using the Shapiro-Wilk test for normality and one-way ANOVA for comparisons, with p<0.05 considered significant Results: ANOVA revealed no significant associations between QoL and age, sex, education, age at first seizure, duration of epilepsy, seizure duration, or EEG findings. However, medication adherence was significantly associated with QoL (p<0.001), and polytherapy showed a trend towards lower QoL compared with monotherapy (p=0.088). The findings emphasize that modifiable factors, particularly medication adherence, have greater influence on QoL than fixed sociodemographic or clinical variables. This suggests that patient education, psychosocial support, and adherence-focused interventions are crucial in improving QoL in epilepsy care. Conclusion: Medication adherence is the most important determinant of QoL among epilepsy patients in this setting. Clinical practice should prioritize strategies to enhance adherence, while future studies with larger and more diverse samples are needed to confirm these findings and explore psychological determinants.
POSTERIOR-TO-ANTERIOR COLLATERAL PATHWAY IN BILATERAL INTERNAL CAROTID ARTERY STENOSIS: A CASE REPORT Permana, Andi; Rakhmatiar, Rodhiyan
Journal of Pain, Headache and Vertigo Vol. 7 No. 1 (2026): March
Publisher : PERDOSNI (Perhimpunan Dokter Spesialis Neurologi Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Introduction: Bilateral internal carotid artery (ICA) stenosis is a rare condition with potential for serious neurological complications. However, sufficient collateral circulation may mitigate clinical manifestations. Case Report: A 75-year-old man presented with progressive discomfort in his left leg and had a history of hypertension and coronary artery disease. The neurological examination revealed deficits in cranial nerves VII and XII, as well as left-sided weakness. Imaging revealed bilateral ICA stenosis with hypoperfusion of anterior and middle cerebral arteries, yet maintained cerebral perfusion via collateral flow from the posterior cerebral arteries (PCA) through the posterior communicating arteries. Digital subtraction angiography confirmed the diagnosis. The patient was managed conservatively with antiplatelet, antihypertensive, and lipid-lowering therapy. He remained neurologically stable during hospitalization. Conclusion: This case highlights a rare collateral configuration in bilateral ICA stenosis. Adequate posterior circulation via the PCA can maintain perfusion to anterior territories, potentially preventing major neurological deficits.
EFFICACY OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION FOR PERSISTENT POSTURAL-PERCEPTUAL DIZZINESS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS Okhotan, Cindy Anastasia; Okhotan, Esther Ivana
Journal of Pain, Headache and Vertigo Vol. 7 No. 1 (2026): March
Publisher : PERDOSNI (Perhimpunan Dokter Spesialis Neurologi Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Persistent Postural-Perceptual Dizziness (PPPD) is a chronic functional vestibular disorder that significantly impairs quality of life. Conventional treatments often provide limited relief. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising non-invasive adjunctive therapy for PPPD. Objective: To evaluate the efficacy of rTMS in reducing the severity of dizziness and associated psychological symptoms in patients with PPPD. Methods: A systematic review was conducted following PRISMA guidelines across six databases through August 2025. Randomized controlled trials (RCTs) comparing rTMS with sham stimulation or standard treatment were included. The primary outcome was dizziness severity, assessed using the Dizziness Handicap Inventory (DHI). Secondary outcomes included anxiety and depression severity, measured with the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD). Pooled effect sizes were calculated as mean differences (MD) using fixed or random effects models. Results: Five RCTs comprising 332 participants were included. rTMS significantly reduced dizziness severity (DHI: MD = –16.60; 95% CI –21.58 to –11.62; p < 0.0001). It also decreased anxiety symptoms (HAMA: MD = –7.81; 95% CI –11.58 to –4.03; p < 0.0001) and alleviated depressive symptoms (HAMD: MD = –6.55; 95% CI –11.12 to –1.98; p < 0.0001). No serious adverse effects were reported. Conclusion: rTMS appears to be an effective and safe adjunctive treatment for PPPD, providing significant improvements in dizziness, anxiety, and depression. Larger, high-quality RCTs are warranted to refine stimulation protocols and assess long-term outcomes.
BRAIN ARTERIOVENOUS MALFORMATION WITH ORBITAL INVOLVEMENT PRESENTING AS PROPTOSIS: A CASE REPORT Trihardi, Rizfan; Ramadhani, Nur'aina Isna Dewi
Journal of Pain, Headache and Vertigo Vol. 7 No. 1 (2026): March
Publisher : PERDOSNI (Perhimpunan Dokter Spesialis Neurologi Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Brain arteriovenous malformation (AVM) is a rare vascular anomaly of the central nervous system that may present with headache, seizures, or focal neurological deficits. Orbital involvement leading to proptosis is extremely uncommon and may delay the diagnosis if not properly recognized. Case Report: A 35-year-old female presenting with chronic headache, focal seizures, left-sided hemiparesis, hemihypoesthesia, and progressive right eye proptosis. Neurological examination confirmed motor weakness and sensory impairment on the left side. Brain MRI and CT angiography revealed a large cerebral AVM with orbital venous drainage causing orbital congestion and proptosis. Discussion: AVM with orbital involvement is exceedingly rare, with only few cases described in the literature. Proptosis usually results from venous hypertension [A2.1][A2.2]secondary to abnormal arteriovenous shunting and orbital venous drainage. This unusual presentation poses diagnostic challenges, often mimicking orbital or ophthalmologic disorders. Recognition of the clinical spectrum is crucial to avoid misdiagnosis and ensure timely management. Conclusion: This case highlights the importance of considering cerebral AVM in the differential diagnosis of patients presenting with proptosis accompanied by neurological manifestations. Early identification and appropriate referral are essential to improve patient outcomes.

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