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-This is the first headache survey in the region of Vitória, ES Brazil. A high prevalence of headache sufferers was found (52.8%). Headache was more common among women (63.9%) and less common among people older than 55 years old. The type of professional activity was not related with the headache prevalence. The most frequent causal attribution was stress. Most headache sufferers are not under regular medical treatment (9%), and most of them use analgesic drugs without proper orientation. The most used compounds are combinations with caffeine (33%) and simple analgesics (52.3%).KEY WORDS: headache, prevalence, self medication. Epidemiologia da cefaléia em Vitória, Espírito SantoRESUMO -Este estudo é o primeiro a avaliar a prevalência da cefaléia na região de Vitória, ES. Demonstrouse alta prevalência de portadores de cefaléia (52,8%), com maior freqüência no sexo feminino (63,9%) e em pessoas com menos de 55 anos. Não houve diferença de prevalência em relação ao tipo de atividade profissional. O estresse foi apontado como o fator causal mais freqüente. Verificou-se que poucos portadores de cefaléia fazem acompanhamento médico regular (9%) e que a maioria usa medicamentos analgésicos sem orientação adequada, sendo os medicamentos mais utilizados combinações contendo cafeína (33%) e os analgésicos comuns (52,3%). PALAVRAS-CHAVE: cefaléia, prevalência, auto-medicação.The importance of primary headaches is related to the high frequency of headache disorders, considerable impact of headache on work and social activities, and to the consequences of a considerable consumption of drugs by headache sufferers Here we report the results of the first large epidemiological headache survey among inhabitants of the region of Great Vitória, Espírito Santo Brazil. This study aimed to identify the prevalence of headache symptoms, the causal attributions of headache, the medical assistance sought by the headache patients, and the pattern analgesic use reported by headache sufferers in this region of the country. METHODA questionnaire was administered by a group of medical students attending a specialized headache service. This questionnaire was randomly applied to Great Vitória region inhabitants, including the cities of Vitória, Vila Velha, Cariacica, and Serra. The interviewers have randomly selected people in public areas such as bus stations, schools, churches, supermarkets, banks, shopping centers, and sidewalks. Gender, age, and main occupation data were recorded. The individuals were grouped in three age groups: <30, 30-55, and >55 years. The occupation type was classified into the following categories: home, employed, liberal professional, unemployed, rested, or student. The prevalence of headache symptom was assessed asking if the individual consider him or herself as a headache sufferer. People answering no were not considered to have headache and no further questions were done. For the ones that considered him or herself as a headache sufferer the second question has evaluated the causal attributions of headach...

-Topiramate was administered to eight patients with classical trigeminal neuralgia with or without previous symptomatic therapy with other antiepileptic drugs. The topiramate doses ranged from 50 to 100 mg a day, according to the clinical response and the reported side effects. Three patients had complete symptoms remission, three reported moderate improvement, and the treatment was not effective in two. The most frequently registered side effects were dizziness, somnolence and weight loss. Topiramate can be considered an alternative treatment for patients with trigeminal neuralgia.Key WoRdS: trigeminal neuralgia, topiramate, antiepileptic drugs. Tratamento da neuralgia do trigêmeo com baixas doses de topiramatoReSumo -oito pacientes com neuralgia do trigêmeo, com ou sem tratamentos prévios com anticonvulsivantes, foram submetidos a tratamento com topiramato. As doses de topiramato variaram de 50 a 100 mg ao dia, de acordo com a resposta clínica e com os efeitos colaterais relatados. Três pacientes obtiveram remissão completa, três relataram melhora parcial e o tratamento com topiramato foi ineficaz em dois pacientes. os efeitos colaterais mais frequentemente citados foram tontura, sonolência e perda de peso. o topiramato pode ser considerado uma alternativa potencialmente eficaz para o tratamento de pacientes com neuralgia do trigêmeo.PAlAvRAS-ChAve: neuralgia do trigêmio, topiramato, drogas anti-epilépticas. [4][5][6][7] . Topiramate is a new antiepileptic drug that blocks sodium channels, enhances GABA activity by interacting with a non-benzodiazepine site on GABA A receptors, and selectively blocks AmPA/kainite glutamate receptors 8 . Some studies have demonstrated that topiramate can be considered an alternative treatment for classical and symptomatic trigeminal neuralgia 9,10 .We report our experience on the use of topiramate for trigeminal neuralgia. METHODeight patients attended in the emeSCAm headache Clinic were included in this study. All of them were diagnosed as having classical trigeminal neuralgia according to the International Classification of headache disorders 11 . Previous treatments for TN were recorded. All of them reported frequent and intense pain episodes when topiramate was started. The initial dose was 25 mg once a day.

Background: Stroke is the fourth leading killer in the US, the first in Brazil and a leading cause of adult long-term disability in both countries. In spite of widespread recommendation, clinical practice guidelines have had limited effect on changing physician behavior. Recognizing that both knowledge and acceptance of guidelines do not necessarily imply guideline adherence, the American Heart Association/American Stroke Association (AHA/ASA) developed a national stroke quality improvement program, the ‘Get With The Guidelines (GWTG) stroke’. Even though GWTG has produced remarkable results in the US, other countries have not adopted the program. Methods: We compared the stroke treatment quality indicators from a private Brazilian tertiary hospital to those published by the GWTG stroke program. Seven predefined performance measures selected by the GWTG stroke program as targets for stroke quality improvement were evaluated: (1) tissue plasminogen activator use in patients who arrived <2 h from symptom onset; (2) antithrombotic medication use within 48 h of admission; (3) deep vein thrombosis prophylaxis within 48 h of admission for nonambulatory patients; (4) discharge use of antithrombotics; (5) discharge use of anticoagulation for atrial fibrillation; (6) dosing of LDL and treatment for LDL >100 mg/dl in patients meeting the National Cholesterol Education Program Adult Treatment Panel (NCEP) III guidelines, and (7) counseling for smoking cessation. Results: A total of 343 consecutive patients with acute ischemic stroke (70.8%) or transient ischemic attack (29.2%) were evaluated from August 2008 to December 2010. Antithrombotic medication within 48 h was used in 98.5% of the eligible patients and deep vein thrombosis prophylaxis in 100%. A total of 123 patients arrived within 2 h from symptoms onset, 23 were eligible for intravenous thrombolysis and 16 were treated (69.5%). All eligible patients were discharged using antithrombotic medication, and 86.9% of the eligible patients who had atrial fibrillation received anticoagulation. Only 56.1% of the eligible patients were treated according to the NCEP III guidelines. Counseling for smoking cessation was done in 63.6% of the eligible patients. Conclusions: Our study is the first in Brazil and the second outside the US to analyze compliance with the GWTG recommendations. Close attention to a better implementation of these measures may produce an improvement in such results similar to what happened after the full implementation of the program in the US. Whether or not a US disease-based registry such as GWTG can be adopted with success beyond the US is still a matter of debate.

-Few trials have evaluated combination of two or more drugs in the preventive treatment of migraine. In this study three therapeutic regimens were compared: (a) propranolol, at a dose of 40 mg per day, (b) nortriptyline, at a dose of 20 mg per day, and (c) the combination of these two drugs in these dosages. The groups were matched according to age, gender, and frequency of migraine attacks prior to treatment. The period of treatment was two months and the frequency and intensity of headache attacks of the 30 days pretreatment period were compared with the frequency of headaches in the treatment period. Fourteen patients in groups A and B and sixteen patients in group C have completed the study. Treatment with propranolol, alone or in combination, was shown to be effective. Treatment with nortriptyline alone was not effective. All three therapeutic regimens were safe and side effects were minimal. The frequency of discontinuation of the study was the same in the 3 groups but no patient left the study due to adverse reactions. The combined therapy proved to be as safe as the monotherapy. Further studies evaluating this and other possible combinations of drugs in higher doses and for longer periods, should more clearly elucidate the role of combined therapy in the treatment of migraine.Key Words: combined therapy, migraine, nortryptiline, propranolol.Estudo controlado, randomizado e duplo cego do uso de baixas doses de propranolol, nortriptilina e a combinação destas duas drogas no tratamento preventivo da migrânea Resumo -Poucos ensaios clínicos têm avaliado o tratamento preventivo da migrânea através da combinação de drogas. Neste estudo, três regimes terapêuticos foram comparados: (a) popranolol, na dose de 40 mg por dia, (b) nortriptilina, na dose de 20 mg por dia e (c) combinação destas duas drogas nestas dosagens. os grupos foram pareados de acordo com idade, sexo e freqüência de crises previamente ao tratamento. o período de tratamento foi de dois meses e a frequência e a intensidade das crises de cefaléia do período pré-tratamento foram comparadas com as do período de tratamento. Concluíram o estudo 14 pacientes do grupo A, 14 do grupo B e 16 do grupo C. os tratamentos com propranolol, isolado ou em associação mostraram-se eficazes. o tratamento com nortriptilina isolada não se mostrou eficaz para a redução do número de dias com cefaléia. Todos os três regimes terapêuticos foram seguros e os efeitos colaterais foram mínimos. A freqüência de abandono do estudo foi a mesma nos 3 grupos e nenhum paciente abandonou o estudo devido a reações adversas. A terapia combinada mostrou-se tão segura quanto a monoterapia. estudos futuros avaliando esta e outras possíveis combinações de drogas, em doses maiores e por períodos mais longos, deverão elucidar mais claramente o papel da terapia combinada no tratamento da migrânea.PAlAvrAs-ChAve: migrânea, nortriptilina, propranolol, tratamento combinado.

This is the first study to assess the prevalence of headache and migraine among Pomeranian descendents in Brazil. A high prevalence of headache in the last 6 months was found (53.2%). Most headache sufferers were diagnosed as having migraine (55%). More women reported to have headache than men (65% and 33.8%, respectively). Migraine was the most common headache found among women (62.2%). Among men migraine was responsible for only 37.8% of the cases of headache. A high impact of headache was found, especially among migraineurs. Most of the headache sufferers declared to seek medical assistance for headache (67%) and most of them used to take common analgesics for headache relief. None of them was under prophylactic therapy.

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