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Friday, March 20, 2015

Jakarta


From Wikipedia, the free encyclopedia

Jakarta
Daerah Khusus Ibu Kota Jakarta
Batavia
Special Capital Region of Jakarta
(From top, left to right): Jakarta Old Town, Hotel Indonesia Roundabout, Jakarta Skyline, Gelora Bung Karno Stadium, Taman Mini Indonesia Indah, Monumen Nasional, Merdeka Palace, Istiqlal Mosque
Flag of Jakarta
Flag
Coat of arms of Jakarta
Coat of arms
Nickname(s): The Big Durian,[1][2] J-Town[3]
Motto: Jaya Raya (Sanskrit)
(meaning: Victorious and great)
Jakarta is located in Indonesia
Jakarta
Jakarta
Location of Jakarta in Indonesia
Coordinates: 6°12′S 106°49′E / 6.200°S 106.817°E / -6.200; 106.817Coordinates: 6°12′S 106°49′E / 6.200°S 106.817°E / -6.200; 106.817
Country Indonesia
Province Jakarta
Government
 • Type Special administrative area
 • Governor Basuki Tjahaja Purnama[5]
 • Vice Governor Djarot Saiful Hidayat
Area
 • City 664.00 km2 (256.37 sq mi)
 • Water 6,977.5 km2 (2,694.0 sq mi)
Elevation 8 m (26 ft)
Population (2010)
 • City 11,374,022 [4]
 • Density 14,440/km2 (37,400/sq mi)
 • Metro 30,326,103[6]
 • Metro density 4,383.53/km2 (11,353.3/sq mi)
Demonym Jakartan, Indonesian: warga Jakarta
Time zone WIB (UTC+7)
Area code(s) +62 21
Vehicle registration B
Website www.jakarta.go.id (official site)
Jakarta is not part of any province, it is controlled directly by the national government and is designated as the Special Capital Region

Jakarta /əˈkɑrtə/,[note 1] officially known as the Special Capital Region of Jakarta (Indonesian: Daerah Khusus Ibu Kota Jakarta), is the capital and largest city of Indonesia, and one of the most populous urban agglomerations in the world.

Located on the northwest coast of Java, Jakarta is the country's economic, cultural and political centre, and with a population of 9,761,407 as of December 2012,[7] it is the most populous city in Indonesia and in Southeast Asia.[8] The official metropolitan area, known as Jabodetabek (a name formed by combining the initial syllables of Jakarta, Bogor, Depok, Tangerang and Bekasi), is the second largest in the world, yet the metropolis's suburbs still continue beyond it.

Established in the fourth century, the city became an important trading port for the Kingdom of Sunda. It was the de facto capital of the Dutch East Indies (known as Batavia at that time). Today, the city has continued as the capital of Indonesia since the country's independence was declared in 1945. The city is currently the seat of the ASEAN Secretariat.

Jakarta is listed as a global city in the 2008 Globalization and World Cities Study Group and Network (GaWC) research.[9] Based on survey by Brooking Institute, in 2011 economic growth in Jakarta ranked 17th among the world's 200 largest cities, a jump from its 2007 ranking of 171. Jakarta has grown more rapidly than Kuala Lumpur, Beijing and Bangkok.[10]

In 2014 global consultant A.T. Kearney released the Emerging Cities Outlook 2014 which ranked Jakarta first among 35 emerging world cities in terms of potential to improve their global standing in the next few decades.[11]

Etymology and nicknames

The place that is now called Jakarta has been home to multiple settlements along with their respective names: Sunda Kelapa (397–1527), Jayakarta (1527–1619), Batavia (1619–1949), and Djakarta (1949–1972).

Its current name derives from the word "Jayakarta". The origins of this word can be traced to the Old Javanese and ultimately to the Sanskrit language. "Jayakarta" translates as "victorious deed", "complete act", or "complete victory".

Jakarta is nicknamed the Big Durian, the thorny foul-smelling fruit native to the region,[1] as the city is seen as the Indonesian equivalent of New York City (the Big Apple).[12] In the colonial era, the city was also known as Koningin van het Oosten (Queen of the Orient), initially in the 17th century for the urban beauty of downtown Batavia's canals, mansions and ordered city layout.[13] After expanding to the south in the 19th century, this nickname came to be more associated with the suburbs (e.g. Menteng and the area around Merdeka Square), with their wide lanes, many green spaces and villas.[14]

History

The 5th century Tugu inscription discovered in Tugu district, North Jakarta

Pre-colonial era

The area in and around modern Jakarta was part of the fourth century Sundanese kingdom of Tarumanagara, one of the oldest Hindu kingdoms in Indonesia.[15] Following the decline of Tarumanagara, its territories, including the Jakarta area, became part of the Kingdom of Sunda. From 7th to early 13th century port of Sunda is within the sphere of influence of Srivijaya maritime empire. According to the Chinese source, Chu-fan-chi, written circa 1200, Chou Ju-kua reported in the early 13th century Srivijaya still ruled Sumatra, the Malay peninsula, and western Java (Sunda). The source reports the port of Sunda as strategic and thriving, pepper from Sunda being among the best in quality. The people worked in agriculture and their houses were built on wooden piles.[16] The harbour area became known as Sunda Kelapa and by the fourteenth century, it was a major trading port for Sunda kingdom.

The first European fleet, four Portuguese ships from Malacca, arrived in 1513 when the Portuguese were looking for a route for spices.[17] The Kingdom of Sunda made an alliance treaty with Portugal by allowing the Portuguese to build a port in 1522 in order to defend against the rising power of the Sultanate of Demak from central Java.[18] In 1527, Fatahillah, a Javanese general from Demak attacked and conquered Sunda Kelapa, driving out the Portuguese. Sunda Kelapa was renamed Jayakarta,[18] and became a fiefdom of the Sultanate of Banten which became a major Southeast Asia trading centre.

Through the relationship with Prince Jayawikarta from the Sultanate of Banten, Dutch ships arrived in Jayakarta in 1596. In 1602, the English East India Company's first voyage, commanded by Sir James Lancaster, arrived in Aceh and sailed on to Banten where they were allowed to build a trading post. This site became the centre of English trade in Indonesia until 1682.[19]

Jayawikarta is thought to have made trading connections with the English merchants, rivals of the Dutch, by allowing them to build houses directly across from the Dutch buildings in 1615.[20]

Colonial era

The former Stadhuis of Batavia, the seat of Governor General of VOC. The building now houses the Jakarta History Museum, Jakarta Old Town.

Dutch Batavia built in what is now Jakarta, by Andries Beeckman c. 1656

When relations between Prince Jayawikarta and the Dutch deteriorated, Jayawikarta's soldiers attacked the Dutch fortress. Prince Jayawikarta's army and the English were defeated by the Dutch, in part owing to the timely arrival of Jan Pieterszoon Coen (J.P. Coen). The Dutch burned the English fort, and forced the English to retreat on their ships. The victory consolidated Dutch power and in 1619 they renamed the city Batavia.

Commercial opportunities in the capital of the Dutch colony attracted Indonesian and especially Chinese immigrants. This sudden population increase created burdens on the city. Tensions grew as the colonial government tried to restrict Chinese migration through deportations. Following a revolt, 5,000 Chinese were massacred by the Dutch and natives on 9 October 1740 and the following year, Chinese inhabitants were moved to Glodok outside the city walls.[21] The city began to expand further south as epidemics in 1835 and 1870 caused more people to move away from the port. The Koningsplein, now Merdeka Square was completed in 1818, the housing park of Menteng was started in 1913,[22] and Kebayoran Baru was the last Dutch-built residential area.[21] By 1930 Batavia had more than 500,000 inhabitants,[23] including 37,067 Europeans.[24]

After World War II, the city of Batavia was renamed "Jakarta" (short form of Jayakarta) by the Indonesian nationalists after achieving independence from the Dutch in 1946.[25]

Independence era


Jalan Jenderal Sudirman, Jakarta's main avenue and business district

Following World War II, Indonesian Republicans withdrew from Allied-occupied Jakarta during their fight for Indonesian independence and established their capital in Yogyakarta. In 1950, once independence was secured, Jakarta was once again made the national capital.[21] Indonesia's founding president, Sukarno, envisaged Jakarta as a great international city, and instigated large government-funded projects with openly nationalistic and modernist architecture.[26][27] Projects included a clover-leaf highway, a major boulevard (Jalan MH Thamrin-Sudirman), monuments such as The National Monument, Hotel Indonesia, a shopping centre, and a new parliament building. In October 1965, Jakarta was the site of an abortive coup attempt in which 6 top generals were killed, precipitating a violent anti-communist purge in which half-a million people were killed, including many ethnic Chinese,[28] and the beginning of Suharto's New Order. A monument stands where the generals' bodies were dumped.

In 1966, Jakarta was declared a "special capital city region" (daerah khusus ibukota), thus gaining a status approximately equivalent to that of a state or province.[29] Lieutenant General Ali Sadikin served as Governor from the mid-60's commencement of the "New Order" through to 1977; he rehabilitated roads and bridges, encouraged the arts, built several hospitals, and a large number of new schools. He also cleared out slum dwellers for new development projects—some for the benefit of the Suharto family[30][31]—and tried to eliminate rickshaws and ban street vendors. He began control of migration to the city in order to stem overcrowding and poverty.[32] Foreign investment contributed to a real estate boom which changed the face of the city.[33]

The boom ended with the 1997/98 East Asian Economic crisis putting Jakarta at the centre of violence, protest, and political maneuvering. After 32 years in power, support for President Suharto began to wane. Tensions reached a peak in when four students were shot dead at Trisakti University by security forces; four days of riots and violence ensued that killed an estimated 1,200, and destroyed or damaged 6,000 buildings.[34] Much of the rioting targeted Chinese Indonesians.[35] Suharto resigned as president, and Jakarta has remained the focal point of democratic change in Indonesia.[36] Jemaah Islamiah-connected bombings occurred almost annually in the city between 2000 and 2005,[21] with another bombing in 2009.[37]

Administration

Administrative Divisions of Jakarta


Map of the municipalities (kotamadya) in Jakarta province. Each city is divided into districts (kecamatan).

Jakarta is administratively equal to a province with special status as the capital of Indonesia. It has a governor (instead of a mayor). As a province, the official name of Jakarta is Daerah Khusus Ibukota Jakarta ("Special Capital City District of Jakarta"), which in Indonesian is abbreviated to DKI Jakarta.

Jakarta is divided into five kota or kotamadya ("cities" – formerly municipalities), each headed by a mayor – and one regency (kabupaten) headed by a regent (bupati).

The cities/municipalities of Jakarta are:
  • Central Jakarta (Jakarta Pusat) is Jakarta's smallest city and home to most of Jakarta's administrative and political centre. It is characterized by large parks and Dutch colonial buildings. Landmarks include the National Monument (Monas), the Istiqlal Mosque, Jakarta, the Jakarta Cathedral, and museums.[38]
  • West Jakarta (Jakarta Barat) has the highest concentration of small-scale industries in Jakarta. The area includes Jakarta's Chinatown and Dutch colonial landmarks such as the Chinese Langgam building and Toko Merah. West Jakarta contains part of Jakarta Old Town.[39]
  • South Jakarta (Jakarta Selatan), originally planned as a satellite city, is now the location of large upscale shopping centres and affluent residential areas. Jakarta Selatan functions as Jakarta's ground water buffer,[40] but recently the green belt areas are threatened by new developments. Much of the CBD area of Jakarta is concentrated in Setia Budi, South Jakarta, bordering the Tanah Abang/Sudirman area of Central Jakarta.
  • East Jakarta (Jakarta Timur) territory is characterized by several industrial sectors erected in this city.[41] Also located in East Jakarta are Taman Mini Indonesia Indah and Halim Perdanakusuma International Airport.
  • North Jakarta (Jakarta Utara) is the only city in Jakarta that is bounded by the sea (Java Sea). It is the location of the Tanjung Priok Port. Large-scale and medium-scale industries are concentrated in North Jakarta. North Jakarta contains part of Jakarta Old Town, formerly known as Batavia since the 17th century, and was a centre of VOC trade activity in Dutch East Indies. Also located in North Jakarta is Ancol Dreamland (Taman Impian Jaya Ancol), currently the largest integrated tourism area in South East Asia.[42]
The only regency (kabupaten) of Jakarta is:
  • Thousand Islands (Kepulauan Seribu), formerly a district within the city of North Jakarta, is a collection of 105 small islands located on the Java Sea. It has a high conservation value because of its unique and special ecosystems. Marine tourism, such as diving, water bicycle, and wind surfing, is the most important touristic activity in this territory. The main mode of transportation between the islands are speed boats or small ferries.[43]
Jakarta's Cities/Municipalities (Kota Administrasi/Kotamadya)
City/Regency Area (km2) Total population (2010 Census) Total population (2014 Estimate) Population Density
(per km2)
in 2010
South Jakarta (Jakarta Selatan) 141.27 2,057,080 2,175,400 14,561
East Jakarta (Jakarta Timur) 188.03 2,687,027 2,841,728 14,290
Central Jakarta (Jakarta Pusat) 48.13 898,883 952,525 18,676
West Jakarta (Jakarta Barat) 129.54 2,278,825 2,407,170 17,592
North Jakarta (Jakarta Utara) 146.66 1,645,312 1,735,968 11,219
Thousand Islands (Kepulauan Seribu) 8.7 21,071 22,238 2,422

Government

In September 1945, the government of Jakarta City was changed from the Japanese Djakarta Toku-Betsu Shi into the Jakarta National Administration. This first government was held by a Mayor until the end of 1960 when the office was changed to that of a Governor. The last mayor of Jakarta was Sudiro, until he was replaced by Dr Sumarno as Governor of the province (as the city had now become).

In 1974, Based on the Act No. 5 of 1974 relating to the Fundamentals of Regional Government, Jakarta was confirmed as the capital of Indonesia and one of Indonesia's (then) 26 provinces.[44]

In August 2007, Jakarta held its first ever election to choose a governor, whereas previously the city's governors were appointed by the local house of representatives. The poll is part of a country-wide decentralization drive, allowing for direct local elections in several areas.[45]

Municipal finances

The ability of the regional government to respond to the many problems of Jakarta is constrained by extremely limited finances. In 2013 the total budget available to the Jakarta regional government was approved at around Rp 50 trillion (about $US 5.2 billion), equivalent to around $US 380 per citizen. Priority areas of spending were listed as education, transport, flood control measures, environment programs, and various types of social spending (such as health and housing).[46]

The Jakarta provincial government, like all other provincial governments in Indonesia, relies on transfers from the central government for the bulk of budget income. Local (non-central government) sources of revenue are incomes from various taxes such as vehicle ownership and vehicle transfer fees and so on.[47]

In recent years, the Jakarta provincial government has consistently run a surplus of between 15–20% of total planned spending, largely because of delays in procurement procedures and other inefficiencies in the spending process.[48] Regular underspending is a matter of frequent public comment but the legal and administrative blockages that cause the underspending problem seem very difficult to overcome.[49]

Jakarta city finances: 2007 – 2012 (Rp trillion)
Year Revenue Expenditure
2007 Actual 18.7 18.7
2008 Actual 32.9 16.4
2009 Actual 23.7 19.6
2010 Actual 26.8 21.6
2011 Actual 31.8 31.7
2012 Actual 41.4 41.4
Indonesian Statistics Bureau: Jakarta in Figures[50]

Geography and climate

Geography

Jakarta is located on the northwest coast of Java, at the mouth of the Ciliwung River on Jakarta Bay, which is an inlet of the Java Sea. Officially, the area of the Jakarta Special District is 662 km2 (256 sq mi) of land area and 6,977 km2 (2,694 sq mi) of sea area.[51] The Thousand Islands, which are administratively a part of Jakarta, are located in Jakarta Bay, north of the city.

Jakarta lies in a low, flat basin, ranged from −2 to 50 metres (−7 to 164 ft) with average elevation 8 metres (26 ft) above sea level;[citation needed] 40% of Jakarta, particularly the northern areas, is below sea level,[52] while the southern parts are comparatively hilly. Rivers flow from the Puncak highlands to the south of the city, across the city northwards towards the Java Sea; the most important[clarification needed] is the Ciliwung River, which divides the city into the western and eastern principalities. Other rivers include the Pesanggrahan, and Sunter.

All these rivers, combined with the wet season rains and insufficient drainage due to clogging, make Jakarta prone to flooding. Moreover, Jakarta is sinking about 5 to 10 centimeters each year, even up to 20 centimeters in the northern coastal areas. To help cope with the threat from the sea, the Netherlands will give $4 million for a feasibility study to build a dike around Jakarta Bay. The ring dike will be equipped with a pumping system and retention areas to defend against seawater. Additionally, the dike will function as a toll road. The project will be built by 2025.[53] In January 2014, Central Government agreed to build 2 dams in Ciawi, Bogor and a 1.2 kilometers tunnel from Ciliwung River to Cisadane River to ease Jakarta floods. Construction costs will be paid by Central Government, but land acquisitions is responsibility of Jakarta Authority.[54]
Panorama of Jakarta

Climate

Jakarta has a tropical monsoon climate (Am)[55] according to the Köppen climate classification system. Despite being located relatively close to the equator, the city has distinct wet and dry seasons. The wet season in Jakarta covers the majority of the year, running from October through May. The remaining four months (June through September) constitute the city's dry season (each of these 4 months has an average monthly rainfall of less than 100 mm). Located in the western part of Java, Jakarta's wet season rainfall peak is January with average monthly rainfall of 389 millimetres (15.3 in), and its dry season low point is September with a monthly average of 30 mm (1.2 in).
Climate data for Jakarta
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Average high °C (°F) 29.9
(85.8)
30.3
(86.5)
31.5
(88.7)
32.5
(90.5)
32.5
(90.5)
31.4
(88.5)
32.3
(90.1)
32
(90)
33
(91)
32.7
(90.9)
31.3
(88.3)
32
(90)
31.78
(89.23)
Daily mean °C (°F) 26.8
(80.2)
26.8
(80.2)
27.3
(81.1)
27.9
(82.2)
28
(82)
27.6
(81.7)
27.4
(81.3)
27.7
(81.9)
28
(82)
28.3
(82.9)
27.9
(82.2)
27.4
(81.3)
27.59
(81.58)
Average low °C (°F) 24.2
(75.6)
24.3
(75.7)
25.2
(77.4)
25.1
(77.2)
25.4
(77.7)
24.8
(76.6)
25.1
(77.2)
24.9
(76.8)
25.5
(77.9)
25.5
(77.9)
24.9
(76.8)
24.9
(76.8)
24.98
(76.97)
Rainfall mm (inches) 402
(15.83)
284
(11.18)
219
(8.62)
131
(5.16)
113
(4.45)
90
(3.54)
58
(2.28)
61
(2.4)
64
(2.52)
101
(3.98)
128
(5.04)
204
(8.03)
1,855
(73.03)
Avg. rainy days 19 17 16 11 9 7 6 5 6 8 12 14 130
 % humidity 85 85 83 82 82 81 78 76 75 77 81 82 80.6
Mean daily sunshine hours 6.1 6.4 7.7 8.5 8.4 8.5 9.1 9.5 9.7 9 7.7 7.1 8.1
Source #1: World Meteorological Organization,[56] Climate-Data.org for mean temperatures and precipitation[55]
Source #2: climatemps.com for rain days, sunshine and humidity,[57] Danish Meteorological Institute (sun and relative humidity)[58]

Culture

As the economic and political capital of Indonesia, Jakarta attracts many domestic immigrants who bring their various languages, dialects, foods and customs.

The Golden Snail (Keong Emas), established in the 1970s during the New Order era, is an IMAX theatre located in Taman Mini Indonesia Indah, East Jakarta

Festival Beach in Ancol Dreamland, North Jakarta

The "Betawi" (Orang Betawi, or "people of Batavia") are the descendants of the people living in and around Batavia, and recognized as an ethnic group from around the 18th–19th century. The Betawi people are mostly descended from various Southeast-Asian ethnic groups brought or attracted to Batavia to meet labor needs, and include people from different parts of Indonesia.[59] The language and Betawi culture are distinct from those of the Sundanese or Javanese, forming itself as a language island in the surrounding area. The language is mostly based on the East Malay dialect and enriched by loan words from Dutch, Portuguese, Sundanese, Javanese, Minangkabau, Chinese, and Arabic. Nowadays, the Jakarta dialect (Bahasa Jakarta), used as a street language by people in Jakarta, is loosely based on the Betawi language.

Betawi arts have a low profile in Jakarta, and most Betawi have moved to the suburbs of Jakarta, displaced by new migrants. It is easier to find Java or Minang based wedding ceremonies rather than Betawi weddings in Jakarta. It is easier to find Javanese Gamelan instead of Gambang Kromong (a mixture between Betawi and Chinese music) or Tanjidor (a mixture between Betawi and Portuguese music) or Marawis (a mixture between Betawi and Yaman music). However, some festivals such as the Jalan Jaksa Festival or Kemang Festival include efforts to preserve Betawi arts by inviting artists to give performances.[60]

There has been a significant Chinese community in Jakarta for many centuries. The Chinese in Jakarta traditionally reside around old urban areas, such as Pinangsia, Pluit and Glodok (Jakarta Chinatown) areas. They also can be found in old chinatowns of Senen and Jatinegara. Officially, they make up 5.5% of the Jakartan population, although this number may be under-reported.[61] Chinese culture also had influenced Betawi culture, such as the popularity of Chinese cakes and sweets, firecrackers, to Betawi wedding attire that demonstrates Chinese and Arab influences.

Jakarta has several performing art centres, such as the classical concert hall Aula Simfonia Jakarta in Kemayoran, Taman Ismail Marzuki (TIM) art centre in Cikini, Gedung Kesenian Jakarta near Pasar Baru, Balai Sarbini in Plaza Semanggi area, Bentara Budaya Jakarta in Palmerah area, Pasar Seni (Art Market) in Ancol, and traditional Indonesian art performances at the pavilions of some provinces in Taman Mini Indonesia Indah. Traditional music is often found at high-class hotels, including Wayang and Gamelan performances. Javanese Wayang Orang performances can be found at Wayang Orang Bharata theater near Senen bus terminal. As the nation's largest city and capital, Jakarta has lured much national and regional talent who hope to find a greater audience and more opportunities for success.

Jakarta hosts several prestigious art and culture festivals, and exhibitions, such as the annual Jakarta International Film Festival (JiFFest), Jakarta International Java Jazz Festival, Jakarta Fashion Week, Jakarta Fashion & Food Festival (JFFF), Jakarta Fair, Indonesia Creative Products and Jakarta Arts and Crafts exhibition. Flona Jakarta is a flora-and-fauna exhibition, held annually in August at Lapangan Banteng Park, featuring flowers, plant nurseries, and pets. The Jakarta Fair is held annually from mid-June to mid-July to celebrate the anniversary of the city and is largely centred around a trade fair. However, this month-long fair also features entertainment, including arts and music performances by local bands and musicians.

Several foreign art and culture centres are also established in Jakarta, and mainly serve to promote culture and language through learning centres, libraries, and art galleries. Among these foreign art and cultural centres are China Confucius Institute, Netherlands Erasmus Huis, UK British Council, France Centre Culturel Français, Germany Goethe-Institut, Japan Foundation, and the Jawaharlal Nehru Indian Cultural Centre.

Museum


The museums in Jakarta cluster around the Central Jakarta Merdeka Square area, Jakarta Old Town, and Taman Mini Indonesia Indah.

The Jakarta Old Town contains museums that are former institutional buildings of Colonial Batavia. Some of these museums are: Jakarta History Museum (former City Hall of Batavia), Wayang Museum (Puppet Museum) (former Church of Batavia), the Fine Art and Ceramic Museum (former Court House of Justice of Batavia), the Maritime Museum (former Sunda Kelapa warehouse), Bank Indonesia Museum (former Javasche Bank), and Bank Mandiri Museum (former Nederlandsche Handels Maatschappij). There is also a very famous museum in Jakarta, dedicated to the famous music producer MOBZERO. It feature lots of his music and artworks. Several museums clustered in central Jakarta around the Merdeka Square area include: National Museum of Indonesia (also known as Gedung Gajah ("the Elephant Building")), Monas (National Monument), Istiqlal Islamic Museum in Istiqlal Mosque, Jakarta, and Jakarta Cathedral Museum on the second floor of Jakarta Cathedral. Also in the central Jakarta area is the Taman Prasasti Museum (former cemetery of Batavia), and Textile Museum in Tanah Abang area. The recreational area of Taman Mini Indonesia Indah in East Jakarta contains fourteen museums, such as Indonesia Museum, Purna Bhakti Pertiwi Museum, Asmat Museum, Bayt al-Qur'an Islamic Museum, Pusaka (heirloom) Museum, and other science-based museum such as Research & Technology Information Centre, Komodo Indonesian Fauna Museum, Insect Museum, Petrol and Gas Museum, plus the Transportation Museum. Other museums are Satria Mandala Military Museum, Museum Sumpah Pemuda, and Lubang Buaya.

Cuisine

Gado-gado is a popular dish in Jakarta

The local cuisine of Jakarta is the Betawi cuisine, which reflects various foreign culinary traditions that have influenced the inhabitants of Jakarta for centuries. Betawi cuisine is heavily influenced by Chinese Peranakan, Malay cuisine, neighboring Sundanese and Javanese cuisine, but also includes Indian, Arabic and European colonial influences. One of the most popular local dishes in Jakarta is Soto Betawi which is made from chunks of beef meat and offals in rich and spicy cow's milk or coconut milk broth. Other popular Betawi dishes includes soto kaki, nasi uduk, kerak telor (spicy omelette), nasi ulam, asinan, ketoprak, rujak and gado-gado Betawi (vegetables in peanut sauce).

Jakarta has a vast range of food available at hundreds of eating venues and foodcourts located all over the city, from modest street-side warung foodstalls and traveling vendors to high-end fine dining restaurants. Since Jakarta is regarded as the 'melting-pot' and a miniature version of Indonesia, many traditional foods from far-flung regions in Indonesia can be found in Jakarta. For example, traditional Padang restaurants and low-budget Warteg (Warung Tegal) foodstalls are ubiquitous in the capital. Other popular street foods include nasi goreng (fried rice), sate (skewered meats), pecel lele (fried catfish), bakso (meatballs), bakpau (Chinese bun) and siomay (fish dumplings).

Next to a myriad of Indonesian food and regional specialties from all over Indonesia, foreign food is also represented: Chinese, Japanese, Korean, Thai, Indian, American, French, Italian, Vietnamese, Middle Eastern, and modern fusion food can all be found in Jakarta.[62]

Media


A Metro TV news van parking in Merdeka Square, Jakarta
Daily newspapers in Jakarta include
Television stations include:
Many TV stations are analog PAL, but some are now are converting to digital signals using DVB-T2 following government plan to digital television migration.[64]
Radio:

Economy and infrastructure

Economy

Bank Indonesia headquarters

Jakarta's economy depends highly on service sectors, banking, trading, financial service, and manufacturing. Most of Industries in Jakarta include electronics, automotive, chemicals, mechanical engineering and biomedical sciences manufacturing.

The economic growth of Jakarta in 2007 was 6,44% up from 5.95% the previous year, with the growth in the transportation and communication (15.25%), construction (7.81%) and trade, hotel and restaurant sectors (6.88%).[44] In 2007, GRDP (Gross Regional Domestic Product) was Rp. 566 trillion (around $US 56 billion). The largest contributions to GRDP were by finance, ownership and business services (29%); trade, hotel and restaurant sector (20%), and manufacturing industry sector (16%).[44] In 2007, the increase in per capita GRDP of DKI Jakarta inhabitants was 11.6% compared to the previous year[44]

Both GRDP by at current market price and GRDP by at 2000 constant price in 2007 for the Municipality of Central Jakarta (Jakarta Pusat), which was Rp 146 million and Rp 81 million, was higher than other municipalities in DKI Jakarta.[44]

Jakarta has a bustling luxury property market. Knight Frank, a global real estate consultancy based in London, reported in 2014 that Jakarta offered the highest return on high-end property investment in the world in 2013, citing supply shortage and a sharply depreciated currency as reasons.[65]

Shopping


Plaza Indonesia, the high end shopping centre in Jakarta

Jakarta is a shopping hub in the nation and is also one of the best places to shop in South East Asia. The city has numerous shopping malls and traditional markets. The annual "Jakarta Great Sale" is held every year in June and July to celebrate Jakarta's anniversary, with about 73 participating shopping centres in 2012.[66]

Malls such as Grand Indonesia Shopping Town, Plaza Indonesia, Plaza Senayan and Senayan City provides numerous selections of luxury brands. Mall Taman Anggrek, Pondok Indah Mall, Mal Kelapa Gading, and Central Park Jakarta cater high-street brands such as UK's Topshop and Europe's Zara[67]

United Kingdom's number one department store, Debenhams has 3 outlets in the city, the first one on Senayan City, Supermall Karawaci and Lippo Mall Kemang Village. Japan's international Sogo department store has about 6 department stores which spread around shopping malls in the city. Seibu flagship store is located on Grand Indonesia Shopping Town. And French luxury department store, Galeries Lafayette will open its doors for the first time on South East Asia in Pacific Place Jakarta.

Internationally known luxury brands such as Louis Vuitton, Bulgari, Chanel, Gucci, Christian Louboutin, Balenciaga, and Giorgio Armani can be easily found on Jakarta's luxury shopping malls.

Satrio-Casablanca corridor, 3.5 kilometre-long street that is a new shopping belt in Jakarta.[68] Many multistorey shopping centres are located here, such as Kuningan City, Mal Ambassador, and Kota Kasablanka. Also Satrio-Casablanca's largest shopping centre, LOTTE Shopping Avenue, opened in 22 June 2013.

Traditional markets include Blok M, Tanah Abang, Senen, Pasar Baru, Glodok, Mangga Dua, Cempaka Mas, and Jatinegara. In Jakarta there are also markets that sells specified collectable items, such as antique goods in Surabaya Street and gemstones in Rawabening Market.

Water supply

Two private companies, PALYJA and Aetra, provide piped water supply in the western and eastern half of Jakarta respectively under 25-year concession contracts signed in 1998. A public asset holding company called PAM Jaya owns the infrastructure. 80% of the water distributed in Jakarta comes through the West Tarum Canal system from Jatiluhur reservoir on the Citarum River 70 km (43 mi) southeast of the city. Water supply had been privatized by government of then President Suharto in 1998 to the French company Suez Environnement and the British company Thames Water International. Both foreign companies subsequently sold their concessions to Indonesian companies. Customer growth in the 7 first years of the concessions had been lower than before, despite substantial inflation-adjusted tariff increases during this period. In 2005 tariffs were frozen, leading the private water companies to cut down on investments.
According to PALYJA in its western half of the concession the service coverage ratio increased substantially from 34% in 1998 to 59% in 2007 and 65% in 2010.[69] According to data by the Jakarta Water Supply Regulatory Body, access in the eastern half of the city served by PTJ increased from about 57% in 1998 to about 67% in 2004, but stagnated after that.[70] However, other sources cite much lower access figures for piped water supply to houses, excluding access provided through public hydrants: One study estimated access as low as 25% in 2005,[71] while another source estimates it to be as low as 18.5% in 2011.[72] Those without access to piped water supply get water mostly from wells that are often salty and polluted with bacteria.

Demography

Year Population
1870 65,000
1875 99,100
1880 102,900
1883 97,000
1886 100.500
1890 105.100
1895 114.600
1901 115.900
1905 138.600
1918 234.700
Year Population
1920 253,800
1925 290,400
1928 311,000
1930 435,184
1940 533,000
1945 600,000
1950 1,733,600
1959 2,814,000
1961 2,906,533
1971 4,546,492
Year/Date Population
31 October 1980 6,503,449
31 October 1990 8,259,639
30 June 2000 8,384,853
1 January 2005 8,540,306
1 January 2006 7,512,323
June 2007 7,552,444
2010 9,588,198
* 2010 Population census
Ethnicities of Jakarta – 2000 Census[73]
ethnic group percent
Javanese
  
35.16%
Betawi
  
27.65%
Sundanese
  
15.27%
Chinese
  
5.53%
Batak
  
3.61%
Minangkabau
  
3.18%
Malays
  
1.62%
Religion in Jakarta – 2010 Census[4]
religion percent
Islam
  
85.36%
Protestantism
  
7.53%
Buddhism
  
3.30%
Catholicism
  
3.15%
Hinduism
  
0.21%
Confucianism
  
0.06%

The 2010 census counted some 9.58 million people, well above all government estimates.[74] The area of DKI Jakarta is 664 km2, suggesting a population density of 14,464 people/km2 as the ninth largest urban population density in the world.[75] Inwards immigration tended to negate the effect of family planning programs.[44] The population has risen from 4.5 million in 1970 doubled to 9.5 million in 2010, counting only its legal residents.[citation needed] While the population of Greater Jakarta (Jabodetabek Region) has risen from 8.2 million in 1970 jump to 28.5 million in 2010.[76]

The city's population in 2000 was 35.16% Javanese, 27.65% Native Jakarta (known as Betawi), 15.27% Sundanese and 5.53% Chinese. Jakarta is home to the largest population of overseas Chinese in Indonesia. The Sumatran people of the city is very diverse. According to 2010 Census, there were roughly 346,000 Batak, 305,000 Minangkabau, and 155,000 The Malays. Batak ethnic group has increased in ranking, from eighth in 1930 to fifth in 2000.

According to the Government's Jakarta in Figures document, the population stood at 10,187,595 in 2011 and 9,761,407 in 2012.[77]

Transportation


Jakarta pedestrians, joggers and bicyclists take over the main avenue during Car-Free Day

Taxi in Jakarta

With 28 million people in the metropolitan area, nearly 10 million vehicles in daily use, and limited rapid transit system[78] Jakarta is strained by transportation problems.[79] The city suffers a lack of urban public transport services due to prioritized development of road networks, which were mostly designed to accommodate private vehicles.[80] Most trips, however, are undertaken by non-motorized transportation (particularly walking) and numerous modes of public or demand-responsive transportation services.[81]

Transport mode No. trips ('000)  % share
walking 14,073 37.7
small bus 7,818 20.9
motorcycle 4,890 13.1
sedan/MPV/SUV 2,783 7.5
medium bus 2,012 5.4
large bus 1,224 3.3
ojek (motorcycle taxi) 1,073 2.9
bicycle 787 2.1
school/company bus 466 1.2
economy train 434 1.2
patas AC (bus) 422 1.1
colt/mini cab 298 0.8
omprengan 295 0.8
bajaj 217 0.6
becak 202 0.5
pick up 131 0.4
taxi 126 0.3
express train 39 0.1
truck 33 0.1
other 8 0.0
total 37,330 100
[82]

Road


Inner Ring road of Jakarta, some major roads in Jakarta are implementing 3 passengers in a car regulation during rush hours

A structured road network had been developed in the early 19th century as a part of the Java Great Post Road by former Governor-General Daendels, which connects most major cities throughout Java. During the following decades, the road network was expanded to a great extent, although it could not keep up with the rapidly increasing numbers of motorized vehicles, resulting in highly congested traffic.

A notable feature of Jakarta's present road system is the toll road network. Composed of an inner and outer ring road and five toll roads radiating outwards, the network provides inner as well as outer city connections. The outer ring road is under construction, but it is largely in use. Six elevated toll roads are in tender progress.

The five radiating toll roads are the:
Throughout the years, several attempts have been made to reduce traffic congestion on Jakarta's main arteries. Implemented solutions include a 'three-in-one' rush-hour law, during which cars with fewer than three passengers are prohibited from driving on the main avenues. Another example is the ban on trucks passing main avenues during the day.[83]

Public transport

Public transport in Jakarta depends largely upon TransJakarta and other road-based transport, as rail-based transport only consisted solely by KRL Jabotabek commuter rail system. Jakarta Mass Rapid Transit construction is currently underway.

TransJakarta

A TransJakarta bus. TransJakarta has the world's longest bus rapid transit routes.

The TransJakarta bus rapid transit service (known as Busway) was developed in the context of development reforms (or reformasi) and used Bogota's TransMilenio system as a model.[84] Jakarta's first busway line, from Blok M to Jakarta Kota opened in January 2004 and as of 14 February 2013, twelve out of fifteen corridors are in use. Currently TransJakarta has the world's longest bus rapid transit routes (172 km in length) and has more than 669 buses in operation.

KRL Jabotabek

KRL Jabodetabek or commonly known as Commuterline is a commuter rail system which serves commuters in Jakarta, Bogor, Depok, Tangerang, South Tangerang, and Bekasi. The commuter system was started in 2000.[85] The number of passengers in 2014 reached 208 million, rising from 158 million in the previous year.[86] KRL Jabotabek serves all municipalities in Jakarta excluding the Thousand Islands, as well as any neighboring cities and regencies. Currently KRL Jabotabek is the only rail-based transit system in Jakarta, as the Jakarta Mass Rapid Transit in under construction.

Jakarta Mass Rapid Transit

Jakarta Mass Rapid Transit is currently under construction, with a north–south line between Kota and Lebak Bulus; and an east–west line, which will connect to the north–south line at Sawah Besar Station. Jakarta MRT will be a combination of both subways and elevated rails. Preparation works started in April 2012,[87] and groundbreaking was done in October 2013, with the first, 15.2 km-long line between Hotel Indonesia and Lebak Bulus scheduled to be operational by 2018, and the north–south line MRT network is scheduled to be operational by 2020.[88] The Jakarta Capital City Government had decided to build rail-based mass transits because of its capability of carrying passengers in large quantities quickly and cheaply.[89] As of 2013 plans were underway to invest $4 billion in mass transit over the next few years including commencement of a subway.[78]

Jakarta Monorail

There had been plans for building a monorail system and part of it was already under construction, but the project stalled in 2004 and was officially abandoned as of 2008, mostly due to a lack of investors to fund it all. The monorail project was relaunched in 2013 and the groundbreaking was done in October 2013.[90] However the project cancelled in January 2015, due to disagreements between the Jakarta administration and PT Jakarta Monorail over the monorail's route.[91]

Conventional buses

The Kopaja and MetroMini economy minibus systems also provide important services for Jakarta commuters with numerous routes throughout the city. Since January 2013, Jakarta Government allow some Kopaja RaaC bus to enter TransJakarta bus lanes. For the future, Metromini AC bus it is also possible to enter TransJakarta bus lanes to enhance integrated bus rapid transit system.

Traditional transports

In 1966, an estimated 160 thousand pedicabs (becak) operated in the city; as much as 15% of Jakarta's total workforce was engaged in becak driving. In 1971, becak were banned from major roads, and shortly thereafter the government attempted a total ban, which substantially reduced their numbers but did not eliminate them. A campaign to eliminate them succeeded in 1990 and 1991, but during the economic crisis of 1998, some returned amid less effective government attempts to control them.[92]

"Auto rickshaws", called bajaj, provide local transportation in the back streets of some parts of the city. From the early 1940s to 1991 they were a common form of local transportation in the city.

Motorcycle taxi/ ojek

Although ojeks are not an official form of public transport, they can be found throughout Indonesia and in Jakarta. They are especially useful on the crowded urban roads and narrow alleyways, which other vehicles cannot reach. In November 2011, Taxijek was launched in Jakarta. It is essentially a taxi, but with a motorcycle instead of an automobile. Besides a taximeter and the company's driver identity card, the passenger has access to a helmet, disposable shower caps to use underneath the helmet and an extra raincoat. Contrary to common ojeks, Taxijeks are allowed to enter gated communities and they usually charge a lower fare.[93]

Electronic Road Pricing

Due to the city's acute gridlock, the Jakarta administration will implement Electronic Road Pricing (ERP) in 10 districts: Tanah Abang, Menteng, Setiabudi, Tebet, Matraman, Senen, Gambir, Tambora, Sawah Besar and Taman Sari. The projects will initiate once approved by the Finance Ministry.[94] The ERP will be implemented in the three-in-one zone and along Jl. Rasuna Said in Kuningan by the first quarter of 2014. Vehicles passing through the ERP areas will be charged Rp 21,072.[95]

Railway


A KRL Jabotabek commuter train

Long-distance railways and local tram services were first introduced during the Dutch colonial era. While the trams were replaced with buses in the post-colonial era, long-distance railways continued to connect the city to its neighbouring regions as well as cities throughout Java. The surrounding cities of Jakarta are served by KRL Jabotabek, a commuter rail system which serves commuters both in and around Jakarta. The major rail stations are Gambir, Jakarta Kota, Jatinegara, Pasar Senen, Manggarai, and Tanah Abang. During rush hours, the number of passengers greatly exceeds the system's capacity, and crowding is common.

Air


Front view of Soekarno–Hatta International Airport Terminal 3

Soekarno–Hatta International Airport (CGK) is the main airport serving the greater Jakarta area. The airport is named after the first President of Indonesia, Soekarno, and the first vice-president, Mohammad Hatta. The airport is often called Cengkareng or Soetta by Indonesians. The airport's IATA code, CGK, originates from the name of the Cengkareng locality, Tangerang, Banten, although the location of this airport is located outside of the city, it is used as a gate out by the Jakartans and citizen of the surrounding areas, therefore at the main gate of the airport, there is an inscription "Jakarta Airports".[96] It is Indonesia's busiest airport handling over 50 million passengers annually.[97] A second airport, Halim Perdanakusuma Airport (HLP) serves domestic flight of low cost airline, private and VIP/presidential flights. Other airports in the Jakarta metropolitan area include Pondok Cabe Airport and an airfield on Pulau Panjang, part of the Thousand Island archipelago.

Waterway

On 6 June 2007, the city administration introduced the Waterway (officially Angkutan Sungai), a new river boat service along the Ciliwung River.[79][98] However, because of the large amount of floating garbage which kept jamming the propeller, it is no longer in service. The varying water levels during the dry and wet seasons were also a contributing factor to the close-down.

Sea

Jakarta's main seaport Tanjung Priok serves many ferry connections to different parts of Indonesia. Tanjung Priok is the largest seaport in Indonesia, with an annual traffic capacity of around 45 million tonnes of cargo and 4,000,000 TEU's. The port is also an important employer in the area, with more than 18,000 employees who provide services to more than 18,000 ships every year. The Port of Jakarta has 20 terminals: general cargo, multipurpose terminal, scraps terminal, passenger terminal, dry bulk terminal, liquid bulk terminal, oil terminal, chemicals terminal and three container terminals, 76 berths, a quay length of 16,853 metres, a total storage area of 661,822 m2 and a storage capacity of 401,468 tonnes.[99]

In December 2011, Muara Angke Port has been renovated yet with cost Rp130 billion ($14.4 million) in 3 hectares area. Next, Muara Angke Port will be used for public transport port to Thousand Islands, while Marina Ancol Port will be used as tourist ship port.[100]

Tourism


Istiqlal Mosque, Jakarta with Cathedral in the background

Most of the visitors attracted to Jakarta are domestic tourists from all over Indonesia. As the gateway of Indonesia, Jakarta often serves as the stop-over for foreign visitors on their way to Indonesian popular tourist destinations such as Bali and Yogyakarta. Other than attracted to monuments, landmarks, and museums around Merdeka square and Jakarta Old Town, tourist attractions include Taman Mini Indonesia Indah, Ragunan Zoo, Sunda Kelapa old port and the Ancol Dreamland complex on Jakarta Bay, including Dunia Fantasi theme park, Sea World, Atlantis Water Adventure, and Gelanggang Samudra.

Tourism is contributing a growing amount of income to the city. In 2012, the tourism sector contributed 2.6 trillion rupiah (US$268.5 million) to the city's total direct income of 17.83 trillion rupiah, a 17.9 per cent increase over 2011. Tourism stakeholders are expecting greater marketing of the Jakarta as a tourism destination.[101]

In February 2014, the Jakarta Government started providing double-decker bus tours that offers sightseeing in Central Jakarta. The buses' route covers tourist attractions, such as Monas, Istiqlal Mosque, the Cathedral, National Museum, Sarinah, and Plaza Indonesia, as well as Grand Indonesia shopping centers.[102]

Arjuna Wijaya chariot statue and fountain in Merdeka Square, Central Jakarta. The statue is based on the story of Mahabharata, one of the oldest and famous Hinduism legend.

Landmarks

Most of Jakarta's landmarks, monuments and statues were built during the Sukarno era beginning in the 1960s, then completed in the Suharto era, while some originated in the colonial Dutch East Indies period. The most famous Jakarta's landmark that become the symbol of the city is the 132 m (433 ft) tall obelisk of National Monument (Monumen Nasional or Monas) right in the center of Merdeka Square, Jakarta's Central Park. On its southwest corner stands a Mahabharata themed Arjuna Wijaya chariot statue and fountain. Further south through Jalan Thamrin, the main avenue of Jakarta, the Selamat Datang monument stands on the fountain in the centre of Hotel Indonesia roundabout. Other landmarks include the Istiqlal Mosque, the Jakarta Cathedral and Immanuel Church. The former Batavia Stadhuis in Jakarta Old Town is also the city's landmark. The Wisma 46 building in Central Jakarta is currently the highest building in Jakarta and Indonesia.

Some of statues and monuments in Jakarta are nationalist, such as the West Irian Liberation monument and Dirgantara statue. Several Indonesian national heroes are commemorated in statues, such as Diponegoro and Kartini statues in Merdeka Square, Sudirman and Thamrin statues located in each respectable avenues, also Sukarno and Hatta statues in Proclamation Monument also on the entrance of Soekarno–Hatta International Airport.

Parks


The National Monument in the centre of Merdeka Square

Lapangan Banteng (Buffalo Field Park) is located in Central Jakarta near the Istiqlal Mosque, Jakarta, Jakarta Cathedral, and the Jakarta Central Post Office. It is about 4.5 hectares. Initially it was called Waterlooplein of Batavia and functioned as the ceremonial square during the Netherlands East Indies colonial period. A number of colonial monuments and memorials erected on the square during the colonial period were demolished during the Sukarno era. The most notable monument in the square is the Monumen Pembebasan Irian Barat (Monument of the Liberation of West Irian). During the 1970s and 1980s the park was used as a bus terminal. In 1993 the park was turned into a public space again. It has become a recreation place for people and is occasionally also used as an exhibition place or for other events.[103] The Jakarta Flona (Flora dan Fauna), the flower and decoration plants and pet exhibition, is held in this park around August annually.

Taman Mini Indonesia Indah (Miniature Park of Indonesia), in East Jakarta, has 10 mini parks.

Taman Suropati is located in Menteng city subdistrict in Central Jakarta. The park is surrounded by several Dutch colonial buildings. Taman Suropati was known as Burgemeester Bisschopplein during the Dutch colonial time. The park is circular shaped with a surface area of 16,322 m2. There are several modern statues in the park made by artists of the ASEAN countries, which contributes to the nickname of the park "Taman persahabatan seniman ASEAN" ("Park of the ASEAN artists friendship").[104] Also located in the Menteng area are the Taman Menteng and Situ Lembang pond parks. The Taman Menteng was built on the former Persija football Stadium.

Taman Monas (Monas Park) or Taman Medan Merdeka (Merdeka Square Park) is a huge square where the symbol of Jakarta, Monas or Monumen Nasional (National Monument) is located. The enormous space was created by Dutch Governor General Herman Willem Daendels (1810) and was originally named Koningsplein (Kings Square). On 10 January 1993, President Soeharto initiated action for the beautification of the square. Several features in the square are a deer park and 33 trees that represents the 33 provinces of Indonesia.[105]

In June 2011, Jakarta has only 10.5 percent Ruang Terbuka Hijau (Green Open Space) and will be added to 13.94 percent Public Green Open Space. Public Parks are included in Public Green Open Space. By 2030, the administration also hope there are 16 percent Private Green Open Space.[106]

Sports


The Bung Karno Stadium during football match between Indonesia vs South Korea in 2007 AFC Asian Cup

Jakarta was host to the Asian Games in 1962[107] and in 2014, was chosen for the second time to host the pancontinental, multi-sport event in 2018, with Palembang and Bandung as supporting hosts.[108] Jakarta was also host of the Asian Football Cup in 2007 beside Malaysia, Thailand and Vietnam,[109] and has hosted the regional-scale Southeast Asian Games in 1979, 1987 and 1997. In 2011, Jakarta again hosted the Southeast Asian Games, but this time as co-hosts with Palembang.

Jakarta's most popular home football club is Persija, which plays its matches in their home stadium at Bung Karno Stadium. The home match of Persija often draws its large fan – cladded with Persija's typical orange kit – to watch the match in the main stadium. The large spectators flocking to the main stadium usually worsen the traffic congestion in Jakarta. Another premiere division team is Persitara which plays its matches in the Kamal Muara Stadium in Kamal area. The biggest stadium in Jakarta is the Gelora Bung Karno Stadium with a capacity of 88,083 seats.[110] The Senayan sports complex has several sport venues, including the Bung Karno football stadium, Madya Stadium, Istora Senayan, aquatic arena, baseball field, basketball court, badminton court, a shooting range, several indoor and outdoor tennis court and a golf driving range. The Senayan complex was built in 1959 to accommodate the Asian Games in 1962. For basketball, the Kelapa Gading Sport Mall in Kelapa Gading, North Jakarta, with a capacity of 7,000 seats, is the home arena of the Indonesian national basketball team.

The Jakarta Car-Free Days are held weekly on Sunday on the main avenues of the city, Jalan Sudirman and Jalan Thamrin, from 6 am to 11 am. The briefer Car-Free Day which lasts from only 6 am to 9 am is held on every other Sunday. The event invites local pedestrians to do sports and exercise and have their activities on the streets that are normally full of cars and traffic. Along the road from the Senayan traffic circle on Jalan Sudirman, South Jakarta, to the "Selamat Datang" Monument at the Hotel Indonesia traffic circle on Jalan Thamrin, all the way north to the National Monument in Central Jakarta, cars are cleared out for pedestrians. Morning gymnastics, calisthenics and aerobic exercises, futsal games, jogging, bicycling, skateboarding, badminton, karate, and on-street library and musical performances take over the roads and the main parks in Jakarta.[111]

Education

Faculty of Medicine, University of Indonesia

Jakarta is home to a number of universities, of which the University of Indonesia is the largest. It is state-owned with campuses in Salemba and Depok.[112] Jakarta is home to two other state universities: the Syarif Hidayatullah State Islamic University Jakarta and the State University of Jakarta. Some major private universities in Jakarta are Trisakti University, Tarumanagara University, Atma Jaya University, Pelita Harapan University and Bina Nusantara University.

STOVIA (School tot Opleiding van Indische Artsen) was the first high school in Jakarta, established in 1851.[113] As the largest city and the capital, Jakarta houses many students from around Indonesia, many of whom reside in dormitories or home-stay residences. For basic education, there are a variety of primary and secondary schools, tagged with public (national), private (national and bi-lingual national plus) and international schools. Four of the major international schools located in Jakarta are the Gandhi Memorial International School, IPEKA International Christian School, Jakarta International School and the British International School (BIS). Other international schools include the Jakarta International Korean School, Bina Bangsa School, Jakarta International Multicultural School,[114] Australian International School,[115] New Zealand International School,[116] Singapore International School, and Sekolah Pelita Harapan.[117]

International relations

Jakarta signed sister city agreement with other cities, one of them is Casablanca, Morocco's largest city, that have signed sister city agreement on 21 September 1990. To promote friendship between two cities, Jalan Casablanca, a main avenue famous for its shopping and business centers in South Jakarta, was named after Jakarta's Moroccan sister city. Currently there is no street in Casablanca named after Jakarta, however on the other hand in Rabat, Morocco's capital city, an avenue was named after Sukarno, Indonesia's first president, to commemorate his visit in 1960 also as a token of friendship.[118] Jakarta is also a member of the Asian Network of Major Cities 21 and the C40 Cities Climate Leadership Group.

Twin towns – Sister cities

Asia
  1. India New Delhi, India
  2. Proposed Flag of Islamabad Capital Territory.svg Islamabad, Pakistan
  3. Emblem of Tokyo.svg Tokyo, Japan
  4. China Beijing, China
  5. Ph seal ncr manila.svg Manila, Philippines
  6. Seal of Seoul.svg Seoul, South Korea[119][120]
  7. Flag of Abu Dhabi.svg Abu Dhabi, United Arab Emirates
  8. Coat of arms of Saudi Arabia.svg Jeddah, Saudi Arabia
  9. North Korea Pyongyang, North Korea
  10. Hanoi Logo.svg Hanoi, Vietnam
  11. Seal Bangkok.png Bangkok, Thailand
  12. Iran Yazd, Iran
Europe
  1. Insigne Berolini.svg Berlin, Germany[121]
  2. Lesser Coat of Arms of The City of London.svg London, United Kingdom
  3. Turkey Istanbul, Turkey
  4. Coat of Arms of Moscow.svg Moscow, Russia
  5. Rotterdam wapen klein.svg Rotterdam, Netherlands, as a partner city[122]
  6. COA of Kyiv Kurovskyi.svg Kiev, Ukraine
America
  1. Seal of Los Angeles, California.svg Los Angeles, United States
  2. Coat of arms of Mexican Federal District.svg Mexico City, Mexico
  3. Seal of New York City.svg New York City, United States
Africa
  1. Flag of Casablanca province.svg Casablanca, Morocco[118]

Headache


From Wikipedia, the free encyclopedia

Headache
Migraine.jpg
Woman with a headache
ICD-10 G43-G44, R51
ICD-9 339, 784.0
DiseasesDB 19825
MedlinePlus 003024
eMedicine neuro/517 neuro/70
MeSH D006261

A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck.[1]

Headaches can result from a wide range of causes both benign and more serious. Brain tissue itself is not sensitive to pain as it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. Nine areas of the head and neck have these pain-sensitive structures, which are the cranium (the periosteum of the skull), muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinuses and mucous membranes. There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society. Headache is a non-specific symptom, which means that it has many possible causes, including fatigue and sleep deprivation, stress, the effects of medications and recreational drugs, viral infections and common colds, head injury, rapid ingestion of a very cold food or beverage, dental or sinus issues, and many more.

Treatment of a headache depends on the underlying cause, but commonly involves pain killers. Some form of headache is one of the most commonly experienced of all physical discomforts.

Cause

There are more than 200 types of headaches. Some are harmless and some are life-threatening. The description of the headache and findings on neurological examination, determine whether additional tests are needed and what treatment is best.[2]

Primary vs. secondary headaches

Headaches are broadly classified as "primary" or "secondary".[3] Primary headaches are benign, recurrent headaches not caused by underlying disease or structural problems. For example, migraine is a type of primary headache. While primary headaches may cause significant daily pain and disability, they are not dangerous. Secondary headaches are caused by an underlying disease, like an infection, head injury, vascular disorders, brain bleed or tumors. Secondary headaches can be harmless or dangerous. Certain "red flags" or warning signs indicate a secondary headache may be dangerous.[4]

Primary headaches

90% of all headaches are primary headaches. Primary headaches usually first start when people are between 20 and 40 years old .[5] The most common types of primary headaches are migraines and tension-type headaches.[5] They have different characteristics. Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light) and phonophobia (sensitivity to sound). Tension-type headaches usually present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms.[6] Other very rare types of primary headaches include:[4]
  • cluster headaches: short episodes (15–180 minutes) of severe pain, usually around one eye, with autonomic symptoms (tearing, red eye, nasal congestion) which occur at the same time every day. Cluster headaches can be treated with triptans and prevented with prednisone, ergotamine or lithium.
  • trigeminal neuralgia: shooting face pain
  • hemicrania continua: continuous unilateral pain with episodes of severe pain. Hemicrania continua can be relieved by the medication indomethacin.
  • primary stabbing headache: recurrent episodes of stabbing "ice pick pain" or "jabs and jolts" for 1 second to several minutes without autonomic symptoms (tearing, red eye, nasal congestion). These headaches can be treated with indomethacin.
  • primary cough headache: starts suddenly and lasts for several minutes after coughing, sneezing or straining (anything that may increase pressure in the head). Serious etiologies(see secondary headaches red flag section) must be ruled out before a diagnosis of "benign" primary cough headache can be made.
  • primary exertional headache: throbbing, pulsatile pain which starts during or after exercising, lasting for 5 minutes to 24 hours. The mechanism behind these headaches is unclear, possibly due to straining causing veins in the head to dilate, causing pain. These headaches can be prevented by not exercising too strenuously and can be treated with medications such as indomethacin.
  • primary sex headache: dull, bilateral headache that starts during sexual activity and becomes much worse during orgasm. These headaches are thought to be due to lower pressure in the head during sex. It is important to realize that headaches that begin during orgasm may be due to a subarachnoid hemorrhage, so serious causes must be ruled out first. These headaches are treated by advising the person to stop sex if they develop a headache. Medications such as propranolol and diltiazem can also be helpful.
  • hypnic headache: moderate-severe headache that starts a few hours after falling asleep and lasts 15–30 minutes. The headache may recur several times during night. Hypnic headaches are usually in older women. They may be treated with lithium.

Secondary headaches

Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache (pain arising from the neck muscles). Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.[2]

More serious causes of secondary headaches include:[4]
  • meningitis: inflammation of the meninges which presents with fever and meningismus, or stiff neck
  • bleeding inside the brain (intracranial hemorrhage)
  • subarachnoid hemorrhage (acute, severe headache, stiff neck WITHOUT fever)
  • ruptured aneurysm, arteriovenous malformation, intraparenchymal hemorrhage (headache only)
  • brain tumor: dull headache, worse with exertion and change in position, accompanied by nausea and vomiting. Often, the person will have nausea and vomiting for weeks before the headache starts.
  • temporal arteritis: inflammatory disease of arteries common in the elderly (average age 70) with fever, headache, weight loss, jaw claudication, tender vessels by the temples, polymyalgia rheumatica
  • acute closed angle glaucoma (increased pressure in the eyeball): headache that starts with eye pain, blurry vision, associated with nausea and vomiting. On physical exam, the person will have a red eye and a fixed, mid dilated pupil.

Pathophysiology

The brain itself is not sensitive to pain, because it lacks pain receptors, also called nociceptors. However, several areas of the head and neck do have nociceptors, and can thus sense pain. These include the extracranial arteries, middle meningeal artery, large veins, venous sinuses, cranial and spinal nerves, head and neck muscles, the meninges, falx cerebri, parts of the brainstem, eyes, ears, teeth and lining of the mouth.[7][8] Pial arteries, rather than pial veins are responsible for pain production.[4]

Headaches often result from traction to or irritation of the meninges and blood vessels. The nociceptors may be stimulated by head trauma or tumors and cause headaches. Blood vessel spasms, dilated blood vessels, inflammation and/or infection of meninges and muscular tension can also stimulate nociceptors and cause pain.[8]
Once stimulated, a nociceptor sends a message up the length of the nerve fiber to the nerve cells in the brain, signaling that a part of the body hurts.

Primary headaches are more difficult to understand than secondary headaches. The exact mechanisms which cause migraines, tension headaches and cluster headaches are not known. There have been different theories over time which attempt to explain what happens in the brain to cause these headaches.

Migraines are currently thought to be caused by dysfunction of the nerves in the brain.[9] Previously, migraines were thought to be caused by a primary problem with the blood vessels in the brain.[10] This vascular theory, which was developed in the 20th century by Wolff, suggested that the aura in migraines is caused by constriction of intracranial vessels (vessels inside the brain), and the headache itself is caused by rebound dilation of extracranial vessels (vessels just outside of the brain). Dilation of these extracranial blood vessels activates the pain receptors in the surrounding nerves, causing a headache. The vascular theory is no longer accepted.[9][11] Studies have shown migraine head pain is not accompanied by extracranial vasodilation, but rather only has some mild intracranial vasodilation.[12]

Currently, most specialists think migraines are due to a primary problem with the nerves in the brain.[9] Auras are thought to be caused by a wave of increased activity of neurons in the cerebral cortex (a part of the brain) known as cortical spreading depression[13] followed by a period of depressed activity.[14] Some people think headaches are caused by the activation of sensory nerves which release peptides, such as serotonin, causing inflammation in arteries, dura and meninges and also cause some vasodilation. Triptans, medications which treat migraines, blocks serotonin receptors and constrict blood vessels.[15]

People who are more susceptible to experience migraines without headache are those who have a family history of migraines, women, and women who are experiencing hormonal changes or are taking birth control pills or are prescribed hormone replacement therapy.[16]

Tension headaches are thought to be caused by activation of peripheral nerves in the head and neck muscles [17]

Cluster headaches involve over activation of the trigeminal nerve and hypothalamus in the brain, but the exact cause is unknown.[18]

Diagnosis

Differential diagnosis of headaches
Tension headache New daily persistent headache Cluster headache Migraine
mild to moderate dull or aching pain severe pain moderate to severe pain
duration of 30 minutes to several hours duration of at least four hours daily duration of 30 minutes to 3 hours duration of 4 hours to 3 days
Occur in periods of 15 days a month for three months may happen multiple times in a day for months periodic occurrence; several per month to several per year
located as tightness or pressure across head located on one or both sides of head located one side of head focused at eye or temple located on one or both sides of head
consistent pain pain describable as sharp or stabbing pulsating or throbbing pain
no nausea or vomiting nausea, perhaps with vomiting
no aura no aura auras
uncommonly, light sensitivity or noise sensitivity may be accompanied by running nose, tears, and drooping eyelid, often only on one side sensitivity to movement, light, and noise
exacerbated by regular use of acetaminophen or NSAIDS may exist with tension headache[19]

Most headaches can be diagnosed by the clinical history alone.[4] If the symptoms described by the person sound dangerous, further testing with neuroimaging and/or lumbar puncture may be necessary. Electroencephalography (EEG) is not useful for headache diagnosis.[20]

The first step to diagnosing a headache is to determine if the headache is old or new.[21] A "new headache" can be a headache that has started recently, or a chronic headache that has changed character.[21] For example, if a person has chronic weekly headaches with pressure on both sides of his head, and then develops a sudden severe throbbing headache on one side of his head, he has a new headache.

Red flags

It can be challenging to differentiate between low-risk, benign headaches and high-risk, dangerous headaches since symptoms are often similar.[22] Headaches that are possibly dangerous require further lab tests and imaging to diagnose.

The American College for Emergency Physicians published criteria for low-risk headaches. They are as follows:[23]
  • age younger than 30 years
  • features typical of primary headache
  • history of similar headache
  • no abnormal findings on neurologic exam
  • no concerning change in normal headache pattern
  • no high-risk comorbid conditions (for example, HIV)
  • no new concerning history or physical examination findings
A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes which may be life-threatening or cause long-term damage. These "red flag" symptoms means that a headache warrants further investigation with neuroimaging and lab tests.[5]

In general, people complaining of their "first" or "worst" headache warrant imaging and further workup.[5] People with progressively worsening headache also warrant imaging, as they may have a mass or a bleed that is gradually growing, pressing on surrounding structures and causing worsening pain.[22] People with neurological findings on exam, such as weakness, also need further workup.[22]

The American Headache Society recommends using "SSNOOP", a mnemonic to remember the red flags for identifying a secondary headache:[21]
  • Systemic symptoms (fever or weight loss)
  • Systemic disease (HIV infection, malignancy)
  • Neurologic symptoms or signs
  • Onset sudden (thunderclap headache)
  • Onset after age 40 years
  • Previous headache history (first, worst, or different headache)
Other red flag symptoms include:[5][21][22][24]
Red Flag Possible causes Reason why red flag indicates possible causes Diagnostic tests
New headache after age 50 Temporal arteritis, mass in brain Temporal arteritis is an inflammation of vessels close to the temples in older people, which decreases blood flow to the brain and causes pain. May also have tenderness in temples and/or jaw claudication. Some brain cancers are more common in older people. Erythrocyte sedimentation rate (diagnostic test for temporal arteritis), neuroimaging
Very sudden onset headache (thunderclap headache) Brain bleed (subarachnoid hemorrhage, hemorrhage into mass lesion, vascular malformation), pituitary apoplexy, mass (especially in posterior fossa) A bleed in the brain irritates the meninges which causes pain. Pituitary apoplexy (bleeding or impaired blood supply to the pituitary gland at the base of the brain) is often accompanied by double vision or visual field defects, since the pituitary gland is right next to the optic chiasm (eye nerves). Neuroimaging, lumbar puncture if computed tomography is negative
Headaches increasing in frequency and severity Mass, subdural hematoma, medication overuse As a brain mass gets larger, or a subdural hematoma (blood outside the vessels underneath the dura) it pushes more on surrounding structures causing pain. Medication overuse headaches worsen with more medication taken over time. Neuroimaging, drug screen
New onset headache in a person with possible HIV or cancer Meningitis (chronic or carcinomatous), brain abscess including toxoplasmosis, metastasis People with HIV or cancer are immunosuppressed so are likely to get infections of the meninges or infections in the brain causing abscesses. Cancer can metastasize, or travel through the blood or lymph to other sites in the body. Neuroimaging, lumbar puncture if neuroimaging is negative
Headache with signs of total body illness (fever, stiff neck, rash) Meningitis, encephalitis (inflammation of the brain tissue), Lyme disease, collagen vascular disease A stiff neck, or inability to flex the neck due to pain, indicates inflammation of the meninges. Other signs of systemic illness indicates infection. Neuroimaging, lumbar puncture, serology (diagnostic blood tests for infections)
Papilledema brain mass, benign intracranial hypertension (pseudotumor cerebri), meningitis Increased intracranial pressure pushes on the eyes (from inside the brain) and causes papilledema. Neuroimaging, lumbar puncture
Severe headache following head trauma Brain bleeds (intracranial hemorrhage, subdural hematoma, epidural hematoma), post-traumatic headache Trauma can cause bleeding in the brain or shake the nerves, causing a post-traumatic headache Neuroimaging of brain, skull, and possibly cervical spine
Inability to move a limb Arteriovenous malformation, collagen vascular disease, intracranial mass lesion Focal neurological signs indicate something is pushing against nerves in the brain responsible for one part of the body Neuroimaging, blood tests for collagen vascular diseases
Change in personality, consciousness, or mental status Central nervous system infection, intracranial bleed, mass Change in mental status indicates a global infection or inflammation of the brain, or a large bleed compressing the brainstem where the consciousness centers lie Blood tests, lumbar puncture, neuroimaging
Headache triggered by cough, exertion or while engaged in sexual intercourse Mass lesion, subarachnoid hemorrhage Coughing and exertion increases the intra cranial pressure, which may cause a vessel to burst, causing a subarachnoid hemorrhage. A mass lesion already increases intracranial pressure, so an additional increase in intracranial pressure from coughing etc. will cause pain. Neuroimaging, lumbar puncture

Old headaches

Old headaches are usually primary headaches and are not dangerous. They are most often caused by migraines or tension headaches. Migraines are often unilateral, pulsing headaches accompanied by nausea and/or vomiting.
There may be an aura (visual symptoms, numbness or tingling) 30–60 minutes before the headache, warning the person of a headache. Migraines may also not have auras.[24] Tension type headaches usually have bilateral "bandlike" pressure on both sides of the head usually without nausea or vomiting. However, some symptoms from both headache groups may overlap. It is important to distinguish between the two because the treatments are different.[24]

The mnemonic 'POUND' helps distinguish between migraines and tension type headaches. POUND stands for Pulsatile quality, 4–72 hOurs in length, Unilateral location, Nausea or vomiting, Disabling intensity.[6] One review article found that if 4–5 of the POUND characteristics are present, migraine is 24 times as likely a diagnosis than tension type headache (likelihood ratio 24). If 3 characteristics of POUND are present, migraine is 3 times more likely a diagnosis than tension type headache (likelihood ratio 3).[6] If only 2 POUND characteristics are present, tension type headaches are 60% more likely (likelihood ratio 0.41). Another study found the following factors independently each increase the chance of migraine over tension type headache: nausea, photophobia, phonophobia, exacerbation by physical activity, unilateral, throbbing quality, chocolate as headache trigger, cheese as headache trigger.[25]

Cluster headaches are relatively rare (1–3 in 10,000 people) and are more common in men than women. They present with sudden onset explosive pain around one eye and are accompanied by autonomic symptoms (tearing, runny nose and red eye).[4]

Temporomandibular jaw pain (chronic pain in the jaw joint), and cervicogenic headache (headache caused by pain in muscles of the neck) are also possible diagnoses.[21]

For chronic, unexplained headaches, keeping a headache diary can be useful for tracking symptoms and identifying triggers, such as association with menstrual cycle, exercise and food. The National Migraine Center has free headache diaries to download at their website.[26] While mobile electronic diaries for smartphones are becoming increasingly common, a recent review found most are developed with a lack of evidence base and scientific expertise.[27]

New headaches

New headaches are more likely to be dangerous secondary headaches. They can, however, simply be the first presentation of a chronic headache syndrome, like migraine or tension-type headaches.

One recommended diagnostic approach is as follows.[28] If any urgent red flags are present such as visual loss, new seizures, new weakness, new confusion, further workup with imaging and possibly a lumbar puncture should be done (see red flags section for more details). If the headache is sudden onset (thunderclap headache), a computed tomography test to look for a brain bleed (subarachnoid hemorrhage) should be done. If the CT scan does not show a bleed, a lumbar puncture should be done to look for blood in the CSF, as the CT scan can be falsely negative and subarachnoid hemorrhages can be fatal. If there are signs of infection such as fever, rash, or stiff neck, a lumbar puncture to look for meningitis should be considered. If there is jaw claudication and scalp tenderness in an older people, a temporal artery biopsy to look for temporal arteritis should be performed and immediate treatment should be started.

Neuroimaging

Old headaches

The US Headache Consortium has guidelines for neuroimaging of non-acute headaches.[29] Most old, chronic headaches do not require neuroimaging. If a person has the characteristic symptoms of a migraine, neuroimaging is not needed as it is very unlikely the person has an intracranial abnormality.[30] If the person has neurological findings, such as weakness, on exam, neuroimaging may be considered.

New headaches

All people who present with red flags indicating a dangerous secondary headache should receive neuroimaging.[24] The best form of neuroimaging for these headaches is controversial.[5] Non-contrast computerized tomography (CT) scan is usually the first step in head imaging as it is readily available in Emergency Departments and hospitals and is cheaper than MRI. Non-contrast CT is best for identifying an acute head bleed. Magnetic Resonance Imaging (MRI) is best for brain tumors and problems in the posterior fossa, or back of the brain.[5] MRI is more sensitive for identifying intracranial problems, however it can pick up brain abnormalities that are not relevant to the person's headaches.[5]

The American College of Radiology recommends the following imaging tests for different specific situations:[31]

Clinical Features Recommended neuroimaging test
Headache in immunocompromised people (cancer, HIV) MRI of head with or without contrast
Headache in people older than 60 with suspected temporal arteritis MRI of head with or without contrast
Headache with suspected meningitis CT or MRI without contrast
Severe headache in pregnancy CT or MRI without contrast
Severe unilateral headache caused by possible dissection of carotid and/or arterial arteries MRI of head with or without contrast, Magnetic Resonance Angiography or Computed Tomography Angiography of head and neck.
Sudden onset headache or worst headache of life CT of head without contrast, Computed Tomography Angiography of head and neck with contrast, Magnetic Resonance Angiography of head and neck with and without contrast, MRI of head without contrast

Lumbar puncture

A lumbar puncture is a procedure in which cerebral spinal fluid is removed from the spine with a needle. A lumbar puncture is necessary to look for infection or blood in the spinal fluid. A lumbar puncture can also evaluate the pressure in the spinal column, which can be useful for people with idiopathic intracranial hypertension (usually young, obese women who have increased intracranial pressure), or other causes of increased intracranial pressure. In most cases, a CT scan should be done first.[4]

Classification

Headaches are most thoroughly classified by the International Headache Society's International Classification of Headache Disorders (ICHD), which published the second edition in 2004.[32] This classification is accepted by the WHO.[33]

Other classification systems exist. One of the first published attempts was in 1951.[34] The National Institutes of Health developed a classification system in 1962.[35]

ICHD-2

The International Classification of Headache Disorders (ICHD) is an in-depth hierarchical classification of headaches published by the International Headache Society. It contains explicit (operational) diagnostic criteria for headache disorders. The first version of the classification, ICHD-1, was published in 1988. The current revision, ICHD-2, was published in 2004.[36]
The classification uses numeric codes. The top, one-digit diagnostic level includes 13 headache groups. The first four of these are classified as primary headaches, groups 5-12 as secondary headaches, cranial neuralgia, central and primary facial pain and other headaches for the last two groups.[37]

The ICHD-2 classification defines migraines, tension-types headaches, cluster headache and other trigeminal autonomic cephalalgias as the main types of primary headaches.[32] Also, according to the same classification, stabbing headaches and headaches due to cough, exertion and sexual activity (coital cephalalgia) are classified as primary headaches. The daily-persistent headaches along with the hypnic headache and thunderclap headaches are considered primary headaches as well.

Secondary headaches are classified based on their etiology and not on their symptoms.[32] According to the ICHD-2 classification, the main types of secondary headaches include those that are due to head or neck trauma such as whiplash injury, intracranial hematoma, post craniotomy or other head or neck injury. Headaches caused by cranial or cervical vascular disorders such as ischemic stroke and transient ischemic attack, non-traumatic intracranial hemorrhage, vascular malformations or arteritis are also defined as secondary headaches. This type of headaches may also be caused by cerebral venous thrombosis or different intracranial vascular disorders. Other secondary headaches are those due to intracranial disorders that are not vascular such as low or high pressure of the cerebrospinal fluid pressure, non-infectious inflammatory disease, intracranial neoplasm, epileptic seizure or other types of disorders or diseases that are intracranial but that are not associated with the vasculature of the central nervous system. ICHD-2 classifies headaches that are caused by the ingestion of a certain substance or by its withdrawal as secondary headaches as well. This type of headache may result from the overuse of some medications or by exposure to some substances. HIV/AIDS, intracranial infections and systemic infections may also cause secondary headaches. The ICHD-2 system of classification includes the headaches associated with homeostasis disorders in the category of secondary headaches. This means that headaches caused by dialysis, high blood pressure, hypothyroidism, and cephalalgia and even fasting are considered secondary headaches. Secondary headaches, according to the same classification system, can also be due to the injury of any of the facial structures including teeth, jaws, or temporomandibular joint. Headaches caused by psychiatric disorders such as somatization or psychotic disorders are also classified as secondary headaches.

The ICHD-2 classification puts cranial neuralgias and other types of neuralgia in a different category. According to this system, there are 19 types of neuralgias and headaches due to different central causes of facial pain. Moreover, the ICHD-2 includes a category that contains all the headaches that cannot be classified.

Although the ICHD-2 is the most complete headache classification there is and it includes frequency in the diagnostic criteria of some types of headaches (primarily primary headaches), it does not specifically code frequency or severity which are left at the discretion of the examiner.[32]

NIH

The NIH classification consists of brief definitions of a limited number of headaches.[38]
The NIH system of classification is more succinct and only describes five categories of headaches. In this case, primary headaches are those that do not show organic or structural etiology. According to this classification, headaches can only be vascular, myogenic, cervicogenic, traction and inflammatory.

Management


An old advertisement for a headache medicine.

Primary headache syndromes have many different possible treatments. In those with chronic headaches the long term use of opioids appears to result in greater harm than benefit.[39]

Migraines

Migraine can be somewhat improved by lifestyle changes, but most people require medicines to control their symptoms.[4] Medications are either to prevent getting migraines, or to reduce symptoms once a migraine starts.
Preventive medications are generally recommended when people have more than four attacks of migraine per month, headaches last longer than 12 hours or the headaches are very disabling.[4][40] Possible therapies include beta blockers, antidepressants, anticonvulsants and NSAIDS.[40] The type of preventive medicine is usually chosen based on the other symptoms the person has. For example, if the person also has depression, an antidepressant is a good choice.

Abortive therapies for migraines may be oral, if the migraine is mild to moderate, or may require stronger medicine given intravenously or intramuscularly. Mild to moderate headaches should first be treated with NSAIDs, like ibuprofen, and/or acetaminophen. If accompanied by nausea or vomiting, an antiemitic such as metoclopramide (Reglan) can be given orally or rectally. Moderate to severe attacks should be treated first with an oral triptan, a medication which mimics serotonin (an agonist) and causes mild vasoconstriction. If accompanied by nausea and vomiting, parenteral (through a needle in the skin) triptans and antiemetics can be given.

Several complementary and alternative strategies can help with migraines. The American Academy of Neurology guidelines for migraine treatment in 2000 stated relaxation training, electromyographic feedback and cognitive behavioral therapy may be considered for migraine treatment, along with medications.[41]

Tension-type headaches

Tension-type headaches can usually be managed with NSAIDs (ibuprofen, naproxen), acetaminophen or aspirin.[4] Triptans are not helpful in tension-type headaches unless the person also has migraines. For chronic tension type headaches, amitriptyline is the only medication proven to help.[4][42][43] Amitriptyline is a medication which treats depression and also independently treats pain. It works by blocking the reuptake of serotonin and norepinephrine, and also reduces muscle tenderness by a separate mechanism.[42] Studies evaluating acupuncture for tension-type headaches have been mixed.[44][45][46][47][48] Overall, they show that acupuncture is probably not helpful for tension-type headaches.

Cluster headaches

Abortive therapy for cluster headaches include subcutaneous sumatriptan (injected under the skin) or triptan nasal sprays. High flow oxygen therapy also helps with relief.[4]

For people with extended periods with cluster headaches, preventive therapy can be necessary. Verapamil is recommended as first line treatment. Lithium can also be useful. For people with shorter bouts, a short course of prednisone (10 days) can be helpful. Ergotamine is useful if given 1–2 hours before an attack.[4] See cluster headaches for more detailed information.

Secondary headaches

Treatment of secondary headaches involves treating the underlying cause. For example, a person with meningitis will require antibiotics. A person with a brain tumor may require surgery, chemotherapy and/or brain radiation.

Epidemiology

Approximately 64–77% of people have a headache at some point in their lives. During each year, on average, 46–53% of people have headaches.[49][50] Most of these headaches are not dangerous. Only approximately 1–5% of people with headaches who go to the emergency room have a serious underlying cause.[51]

More than 90% of headaches are primary headaches.[52] Most of these primary headaches are tension headaches.[50] Most people with tension headaches have "episodic" tension headaches that come and go. Only 3.3% of adults have chronic tension headaches, with headaches for more than 15 days in a month.[50]

Approximately 12–18% of people in the world have migraines.[50] More women than men experience migraines. In Europe and North America, 5–9% of men experience migraines, while 12–25% of women experience migraines.[49]

Cluster headaches are very rare. They affect only 1–3 per thousand people in the world. Cluster headaches affect approximately three times as many men as women.[50]

History


An 1819 caricature by George Cruikshank depicting a headache.

The first recorded classification system that resembles the modern ones was published by Thomas Willis, in De Cephalalgia in 1672. In 1787 Christian Baur generally divided headaches into idiopathic (primary headaches) and symptomatic (secondary ones), and defined 84 categories.[38]

Children

In general, children suffer from the same types of headaches as adults do, but their symptoms may be slightly different. The diagnostic approach to headache in children is similar to that of adults. However, young children may not be able to verbalize pain well.[53] If a young child is fussy, they may have a headache.[54]

Approximately 1% of Emergency Department visits for children are for headache.[55][56] Most of these headaches are not dangerous. The most common type of headache seen in pediatric Emergency Rooms is headache caused by a cold (28.5%). Other headaches diagnosed in the Emergency Department include post-traumatic headache (20%), headache related to a problem with a ventriculoperitoneal shunt (a device put into the brain to remove excess CSF and reduce pressure in the brain) (11.5%) and migraine (8.5%).[56][57] The most common serious headaches found in children include brain bleeds (subdural hematoma, epidural hematoma), brain abscesses, meningitis and ventriculoperitoneal shunt malfunction. Only 4–6.9% of kids with a headache have a serious cause.[54]

Just as in adults, most headaches are benign, but when head pain is accompanied with other symptoms such as speech problems, muscle weakness, and loss of vision, a more serious underlying cause may exist: hydrocephalus, meningitis, encephalitis, abscess, hemorrhage, tumor, blood clots, or head trauma. In these cases, the headache evaluation may include CT scan or MRI in order to look for possible structural disorders of the central nervous system.[58] If a child with a recurrent headache has a normal physical exam, neuroimaging is not recommended. Guidelines state children with abnormal neurologic exams, confusion, seizures and recent onset of worst headache of life, change in headache type or anything suggesting neurologic problems should receive neuroimaging.[54]

When children complain of headaches, many parents are concerned about a brain tumor. Generally, headaches caused by brain masses are incapacitating and accompanied by vomiting.[54] One study found characteristics associated with brain tumor in children are: headache for greater than 6 months, headache related to sleep, vomiting, confusion, no visual symptoms, no family history of migraine and abnormal neurologic exam.[59]

Some measures can help prevent headaches in children. Drinking plenty of water throughout the day, avoiding caffeine, getting enough and regular sleep, eating balanced meals at the proper times, and reducing stress and excess of activities may prevent headaches.[60] Treatments for children are similar to those for adults, however certain medications such as narcotics should not be given to children.[54]

Children who have headaches will not necessarily have headaches as adults. In one study of 100 children with headache, eight years later 44% of those with tension headache and 28% of those with migraines were headache free.[61] In another study of people with chronic daily headache, 75% did not have chronic daily headaches two years later, and 88% did not have chronic daily headaches eight years later.[62]

Education

From Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Education Education is the transmissio...