UI Proceedings on Health and Medicine Vol.

4 2019

Classical Music Therapy as The Intervention to Relieve Headache in A

Meningitis Patient
Gayatri Mauly Purwandari1, Sri Yona2
1,2
Faculty of Nursing, Universitas Indonesia, UI Depok Campus, Jalan Margonda Raya, Beji, Pondok Cina,
Depok, West Java, Indonesia 16424

*Email : gayatrimaulyp@gmail.com, sriyona@ui.ac.id

Abstract
Objective: Headache is a manifestation of inflammatory response from meningeal infection. Headache may affect
client physically and psychologically thus it requires treatment. This paper aimed to analyze implementation of classical
music therapy as non-pharmacological intervention in relieving headache in patient with meningitis.

Methods: This was a case study to evaluate the effectiveness of classical music therapy to relieve patient’s headache.
The intervention was implemented for 3 days long by playing Beethoven Symphony 6. The headache was evaluated by
using McGill Pain Questionnaire.

Results: The result indicated a decrease in pain intensity from score of 8 to 6 in the third day of implementation.

Conclusion: Classical music therapy relieved headache in patient with meningitis. Nurses are suggested to implement
classical music therapy on client with headache in order to relieve and alleviate pain.

Key words: Classical music, meningitis, pain

Introduction
Meningitis is a neurological inflammatory disease that
causes high mortality. Among 50% not treat meningitis
cases caused of brain damage and death 1. The death
from meningitis occurred in 303.500 world population
2013 due to Streptococcus pneumonia, Neisseria
meningitidis, Haemophilus influenza type b, and other
agents2. The spread of microorganisms from meningitis
is caused by various predisposing factors such as age,
demography, exposure, immunity, drugs, and disease.
Headache is the most frequent symptom experienced by
meningitis patients. Headache is usually persistent, or
throbbing- like due to meningeal irritation3. The
continuous headache can give an impact on the patient’s
quality of life, can limit patients’ social life, and can
increase anxiety due to the fear of the disease4.
According to one study, the frequency of headache can
be relieved by listening to music. Listening to music is a
self-therapy that influences relaxation, soothing
stressors, and improves sleep quality5.
Methods
This study was conducted on a TB meningitis client who
complained of headache. The patient listened to classical
music by Bethoven Smphony 6 Instrument for 12
minutes and 15 seconds on each session for three
consecutive days. The evaluation used to measure the
patient’s pain was the McGill Pain Questionnaire.
Results
The implementation of classical music therapy was
carried out for 3 days along on June 7, 8, 9, 2018. The
evaluation used the McGill Pain Questionnaire (MPQ)
instrument which was translated in Indonesian to assess
pain quantitatively and qualitatively.
The results of pain evaluation is presented on table 1.

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Table 1. Pain evaluation amygdale, there are a lot of endorphin hormones. The
Quality Day 1 Day 2 Day 3 activation in central nerve area stimulates the release of
endorphin hormones. As a result, nociceptive
Pre Post Pre Post Pre Post transmission fibers inhibited by endorphin hormones.
Throbbing 3 3 3 3 3 3 Besides inhibiting pain transmission, the endorphin
hormones gives a feeling of pleasure and relaxation.
Shooting 0 0 0 0 0 0
Stabbing 0 0 0 0 0 0 According to the gate control theory, providing a painless
Sharp 0 0 0 0 0 0 stimulus can stimulate nerve fibers which block pain
impulses on dorsal horn. Music therapy can inhibit
Cramping 0 0 0 0 0 0 neuron sensory pain. When clients listen to music,
Gnawing 0 0 0 0 0 0 sensory input through the senses stimulates impulses in
Hot burning 0 0 0 0 0 0 the spinal cord. Sensory music stimuli form A beta fibers
will dominate, bigger, and faster than pain responses, so
Aching 0 0 0 0 0 0 sensory neurons will block neuronal impulses pain8.
Heavy 3 3 3 3 3 2 Then, the descending and sensory ascending nervous
system are connected and distribute pain inhibitor fibers.
Tender 0 0 0 0 0 0 These fibers contain endorphin enkephalins that activate
Splitting 0 0 0 0 0 0 nonnociceptive nerve fibers3.
Tiring- exhausting 3 2 3 2 2 1
Classical music that was listened by client can relieve the
Fearful 0 0 0 0 0 0 quality of pain and provide psychological relaxation. This
Cruel punishing 0 0 0 0 0 0 result is supported by the research of Siauta & Yusuf9.
There was a decrease of blood systolic pressure in the
Total 9 8 9 8 8 6
hypertensive patient and she reported the relieve of pain
on the third day. Music related to human psychology can
improve unconscious emotions through elements of
Discussion mode, rhythm, and tempo. The effect of relaxation from
this music can relieve psychological problems of fear of
Meningitis TB occurs due to inflammation in the pain so that it has been developed as a therapeutic
arachnoid and piamater, and bacterial invasion of the method10. This supports the results of music therapy on
subarachnoid space6. At the process, bacteria invade our client, Mrs. E who reported that her tiring feeling of
through the bloodstream or areas with high vasculrization headache diminished on the third day.
like the blood brain barrier. Furthermore, inflammation in
meningitis TB produces exudates and spreads in the The client took initiative to listen to music then the pain
meningeal area that covers the cranial nerves and blood began. On the third day, the client looked more excited
vessels in the subarachnoid. and was able to talk with nurses longer than the first day
of intervention.
Meningitis headache can be caused by inflammatory
mediators response that induces nociceptive nerves.
Based on the process, music can relieve pain by inhibiting
Conclusions
nociceptive transmission and closing the gate control.
Classical music has a frequency characteristic of 750- Headache in meningitis occurs due to inflammatory
3000 Hertz which can be absorbed by human body response from infection resulting in exudates and
toimprove respiratory function, circulation, and parts of irritating meninges. Meningitis headaches affect the
brain activation. The process of pain barrier when physiology of the body and psychologically and therefore
listening to music involves the nervous and endocrine requires management to relieve pain. The intervention
systems. that can be given to clients with meningitis headache is
with classical music therapy. This intervention can
When listening to music, Blood Oxygenation Level expedite brain blood flow, reduce pressure on clients.
Dependent (BOLD) increases so that the functional The intervention have been applied to clients for 3
network of the brain especially auditory, limbic, and consecutive days. The results of our study showed that
motor regions becomes active7. Through MRI imaging classical music therapy can relieve the intensity of
research, BOLD activation increases in arterial cerebral headaches and reduce the emotional stress of clients.
stroke clients who routinely listen to music for about 10
to 20 minutes. The other parts that are activated and have
an impact on the structure of the neurons are cortex,
amygdala, hippocampus, and hypothalamus.
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