During the 13-year period from January 2008 to December 2020, a total of 10,705 new patients (3,238 males and 7467 females) with headache as the main complaint came to the headache outpatient department at Umenotsuji Clinic. Of these, six patients (0.06%) had a diagnosis of subarachnoid hemorrhage.　All patients came to the hospital on their own, and four patients were referred from other hospitals. Five cases were due to ruptured cerebral aneurysms, and one case was due to reversible cerebral vasoconstriction syndrome. Medical histories of five patients of aneurysmal SAH are described in detail. In all five cases, the onset was sudden, even if it was mild; in four cases, the headache was prolonged and not relieved; in three cases, the patient was vomiting at the onset. These were the key points for diagnosis: sudden onset, persistent headache, and vomiting．

　We investigated the headache education among undergraduates at the University of Tsukuba using a survey. The results indicated little experience and low confidence concerning primary and secondary headaches. We presented these results at the annual meeting of the Japanese Headache Society in 2019. Following these results, we conducted a national survey concerning headache education among undergraduates at Japanese medical schools．　　　
　We sent a questionnaire to professors in the Department of Neurology and Neurosurgery at 80 Japanese medical schools in December 2019. The total number of replies was 58. Respondents reported a maximum number of 4 lectures on headache, with a mean of 1.3; most had delivered only 1 or 2 lectures. No lectures were delivered in 15%．Opportunities for clinical clerkship in the headache field were few in 40% and moderate in 40%．While none reported no opportunities, little answered as always. Headache education at each medical school was considered sufficient in only three. About half reported as inevitable, and 42% reported the need for improvement．
　Some overseas reports have described a lack of headache education among undergraduates. Headache is a common disease, but our study revealed unmet needs concerning education on this topic among undergraduates in Japan．

　Sudden onset of neck pain is necessary to distinguish serious conditions such as vertebral artery dissection, acute aortic dissection, and cervical epidural hematoma. We report an extremely rare case of isolated unilateral alar ligament injury (ALI ) that clinically presented with the aforementioned symptom. A 14-year-old adolescent female was asymptomatic the day prior to the episode but awoke one morning with severe neck pain and was unable to sit upright. On physical examination, her head was tilted to the left, although she was able to flex and extend her cervical spine. She could not perform lateral bending movements and left-to-right rotation owing to severe neck pain. Cervical spine magnetic resonance imaging confirmed an isolated left ALI. The patient’s neck was stabilized using a soft collar, and her neck pain gradually improved. Only 12 cases of isolated unilateral ALI are reported in the literature, and this condition is rarely diagnosed. Clinicians should consider craniocervical junction lesions in the differential diagnosis in patients who develop sudden posterior neck pain．

　The patient is a 16-year-old male who had generalized tonic-clonic seizures after visual symptoms and was admitted to the hospital. MRI showed bilateral occipital lobe ulegyria. The patient had been experiencing occipital pain followed by a pattern of dots appearing on the left side of the visual field for 6 years, which had increased in frequency. The pattern of visual symptoms was thought to be elemental visual hallucinations of occipital lobe epilepsy rather than an aura of migraine. Elemental visual hallucinations in migraine have zigzagging patterns that move slowly to the periphery of the visual field, whereas in occipital lobe epilepsy, they are circular or point-like and move rapidly to the center of the visual field or contralateral to the site of its appearance. Administration of levetiracetam reduced the posterior headache with visual aura, and it passed without recurrence of seizures. A detailed history of visual symptoms and head MRI images may be useful in differentiating occipital lobe epilepsy from migraine with aura．