In phase 1 of the study, 3 mg/kg daily of cannabidiol (CBD) was given for 30 days to 8 healthy human volunteers. Another 8 volunteers received the same number of identical capsules containing glucose as placebo in a double-blind setting. Neurological and physical examinations, blood and urine analysis, ECG and EEG were performed at weekly intervals. In phase 2 of the study, 15 patients suffering from secondary generalized epilepsy with temporal focus were randomly divided into two groups. Each patient received, in a double-blind procedure, 200-300 mg daily of CBD or placebo. The drugs were administered for as long as 4½ months. Clinical and laboratory examinations, EEG and ECG were performed at 15- or 30-day intervals. Throughout the experiment the patients continued to take the antiepileptic drugs prescribed before the experiment, although these drugs no longer controlled the signs of the disease. All patients and volunteers tolerated CBD very well and no signs of toxicity or serious side effects were detected on examination. 4 of the 8 CBD subjects remained almost free of convulsive crises throughout the experiment and 3 other patients demonstrated partial improvement in their clinical condition. CBD was ineffective in 1 patient. The clinical condition of 7 placebo patients remained unchanged whereas the condition of 1 patient clearly improved. The potential use of CBD as an antiepileptic drug and its possible potentiating effect on other antiepileptic drugs are discussed.

The purpose of this study was to investigate the prevalence of migraine in medical students, as well as its clinical aspects and impact. All 595 medical students of Santa Casa School of Medicine of São Paulo, Brazil were asked if they had experienced any kind of headache in the past year. Those who responded positively were further investigated by an appropriate questionnaire. Diagnosis of migraine was based on the International Headache Society criteria of 1988. Forty percent of students suffered from some kind of headache; 40.2% of these headaches were migraine. The prevalence of migraine was 54.4% in women and 28.3% in men. Migraine headaches were unilateral in 24.2%, had a gradual onset in 69%, and were of a throbbing type in 88.3%. Migraine was considered incapacitating by 53.9% of students. Migraine with aura caused more disability than migraine without aura. Women experienced more intense migraine than men, and migraine with aura was especially more severe than migraine without aura. Photophobia, phonophobia, and nausea were more commonly encountered in migraine with aura. Despite the high prevalence, the high rate of disability, and the need for analgesic medication, only 7.1% of students with migraine had sought medical treatment.

-The so-called short lasting primary headaches include heterogenic entities that can be divided between those without pronounced autonomic activation and those where this activation is evident, which includes the cluster-tic syndrome. We report five new cases with age closer to the trigeminal neuralgia's one, and concomitance of cluster headache and trigeminal neuralgia, which is less frequent in the literature. We also discuss briefly the pathophysiology of these clinical entities, suggesting that the trigeminus nerve is a common pathway of pain manifestation.KEY WORDS: cluster headache, trigeminal neuralgia, overlapping syndromes.Síndrome da cefaléia em salvas -neuralgia do trigêmio: relato de cinco novos casos RESUMO -As assim chamadas cefaléias primárias de curta duração incluem entidades heterogêneas podendo ser divididas entre aquelas sem importante ativação autonômica e aquelas onde esta ativação é evidente, nestas se inclui a síndrome cefaléia em salvas -neuralgia do trigêmeo (cluster-tic). Apresentamos cinco novos casos com faixa etária mais próxima da neuralgia do trigêmeo e com concomitância entre a cefaléia em salvas e a neuralgia do trigêmeo o que é muito menos frequente na literatura. Discute-se também brevemente a fisiopatologia desta entidade clínica sugerindo que o nervo trigêmeo é a via comum da manifestação dolorosa. PALAVRAS-CHAVE: cefaléia em salvas, neuralgia trigeminal, síndromes de superposição.The so-called short lasting primary headache syndromes include a heterogenic group of entities that can arise with remarkable autonomic activation, as in cluster headache, paroxystic chronic and episodic hemicrania, and in SUNCT (short lasting unilateral headache with conjuntival injection and tearing), oposed to those the autonomic features are virtually absent, as in continuous hemicrania and hypnic headache. This paper intends to discuss an uncommon affection, with just 39 reports in the literature, in which coexist trigeminal neuralgia and cluster headache, the so-called cluster-tic syndrome 1-3 , aiming to add five new occurrences with overlapping symptoms, which does not occur in the majority of the reported cases.The cluster-tic syndrome is characterized by the coexistence of two kinds of pain. One is strictly unilateral, usually periocular, with evident autonomic features, and daily attacks for weeks or months (cluster). The other is characterized by paroxysms similar to electric shocks (tics).In the reported cases the diagnosis of the overlapping conditions was made based on the criteria of the International Headache Society. The discussion will refer to the involvement of the V cranial nerve as a probable common pathway of two affections. All patients were treated with drug associations for neuralgia of the V pair and cluster headache.

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RESUMO -A cefaléia numular (CN) ou cefaléia em forma de moeda (coin-shaped headache) foi descrita pela primeira vez por Pareja e colaboradores em 2002. É uma cefaléia de curso crônico, aparentemente primária, sendo a dor restrita a uma área circunscrita do crânio, cuja forma pode ser elíptica ou em moeda. Evolui ao longo do tempo com períodos de dor, intercalados por períodos assintomáticos. Na série de treze casos apresentada por esses autores ou não ocorreu concomitância com outras formas de cefaléias primárias ou relação temporal com trauma craniano. Apresentamos o primeiro caso em nosso país, com características clínicas superponíveis às da publicação de Pareja e col, com o intuito de chamar a atenção não só de especialistas em dor de cabeça, mas de neurologistas em geral, para esta forma não usual de cefaléia, bem como fazer considerações sobre o diagnóstico diferencial com esta entidade.PALAVRAS-CHAVE: cefaléia em moeda, cefaléia numular. Nummular headache: case reportABSTRACT -Nummular headache or coin shaped cephalalgia was first described by Pareja and coworkers in 2002. It seems to be a primary headache that has a chronic course, with a circumscribed area of pain described by the patients as elliptic or coin shaped. Patients experience periods without pain followed by bouts of daily headache. In the original series of thirteen cases it was sometimes associated with other primary headaches, but not necessarily. It could also be related to cranial trauma. We present the first case of of nummular headache described in our country with clinical features similar to the original series. We intend to alert neurologists and pain specialists to the existence of this unusual headache and also discuss the possible differential diagnosis of this cephalalgia.KEY WORDS: coin shaped headache, nummular headache.A cefaléia numular (CN) ou cefaléia em forma de moeda (coin-shaped headache) foi descrita pela primeira vez por Pareja e colaboradores em 2002. É uma cefaléia de curso crônico, aparentemente primária, sendo a dor restrita a uma área circunscrita do crânio, cuja forma pode ser elíptica ou em moeda. Evolui ao longo do tempo com períodos de dor, intercalados por períodos assintomáticos.Apresentamos o primeiro caso observado em nosso país CASOMulher de 72 anos, do lar, natural de Portugal. Há cerca de sete anos queixa-se de cefaléia descrita como diária, contínua quando de baixa intensidade e assumindo característica latejante nos picos de maior intensidade. A graduação das crises numa escala analógica de zero a dez, está entre três e dez, atingindo o grau máximo de intensidade várias vezes ao dia, quando passa a ser muito incomodativa. Estas exacerbações chegam a durar horas. As crises nunca foram acompanhadas de náuseas, vômitos ou outros comemorativos de enxaqueca, tão pouco apresentando sinais de ativação autonômica. Os períodos com dor diária variam entre sete e dezoito dias, e se repetem por cerca de cinco vezes ao ano. No restante do tempo é assintomática. A dor, no seu pico mais forte, pode ser causa de int...