気象変化に伴う頭痛に対してツムラ五苓散エキス顆粒 (医療用) (TJ-17) を投与された患者を対象として，頭痛に対する有効性を後方視的に検討した．1週間あたりの頭痛の回数，NRSで評価した頭痛の程度，鎮痛薬の服用回数を評価した．安全性評価として有害事象を収集した．144例が解析対象となった．頭痛の回数は平均2.4回/週から1.6回/週に有意に低下した．NRSは平均10.0から5.2に有意に低下した．鎮痛薬の服用回数は平均1.6回/週から1.0回/週に有意に低下した．有害事象は発疹および便秘が各1例 (各0.7％) にみられた．気象病としての頭痛に対するTJ-17の有効性および安全性が示された．

  The purpose of our study is survey on actual conditions for social collaboration in headache.  An online survey was conducted among physician who are members of the Japanese Headache Society.  Responses were received from 308 headache specialists and 246 non-headache specialists. It became clear that in the future, it is necessary to collaborate not only with physicians but also with other professions that support headache treatment. For school-aged children, it is important to provide headache education from the early stage, and to collaborate with and raise awareness of the occupations involved in school-aged children (school physicians, school nurses, school nurse teachers, etc.) . For adults, it is desirable to establish a comprehensive support system by multidisciplinary professionals such as occupational health nurses and industrial physicians.

  The authors report a case of a patient with migraine that had improved after menopause but recurred after taking cilostazol. A 54-year-old woman visited our clinic complaining of weakness in her right upper and lower limbs and was admitted with a diagnosis of lacunar infarction. After taking cilostazol, she noticed a headache and nausea. Her headache disappeared after discontinuing cilostazol. Although it has been reported that cilostazol is involved in cAMP and induces migraine, the responsiveness of cilostazol to migraine after age-related migraine remission is unknown. Studying the long-term course of migraine patients and changes in responsiveness to cilostazol may lead to further elucidation of the pathophysiology of migraine.

  The patient was a 42-year-old man with no previous medical history. After taking a combination of finasteride and minoxidil for about 6 months to treat alopecia, he developed dull pain in the left side of his head. In addition, he started having more incoherent conversations, so he was admitted to the hospital for further inspection. At the time of admission, in addition to left temporal pain, he had sensory aphasia and gait disturbance. Blood tests showed high D-dimer levels. Head CT venography an examination did not visualize from the left transverse sinus to the sigmoid sinus. We diagnosed cerebral venous thrombosis (CVT) . Various tests did not detect any abnormal findings that could lead to cerebrovascular disease, so we diagnosed that the patient had drug-induced CVT due to the combined oral administration of finasteride and minoxidil.
  In order to diagnose juvenile cerebrovascular disease, it is necessary to inquire in detail about the patient's medication history, including non-approved drugs.

  The case was a 34-year-old man. After noticing sudden and slight frontal pain, motor aphasia and ideational apraxia occurred. MRI revealed a new infarction in the left transverse temporal gyrus～insular gyrus, and MRA revealed occlusion of the left M2. Suspected cerebral artery dissection was detected and blood vessel wall imaging showed that the T1 hyperintensity was high on the second day of illness, but the hyperintensity disappeared on the seventh day. Contrast-enhanced T1 vessel wall imaging showed a contrast-enhanced effect, and primary angiitis of the central nerve system was diagnosed. After 4 weeks of treatment with oral prednisolone, the contrast effect disappeared and the vascular occlusion gradually improved. Even after tapering off prednisolone, there is no recurrence and vascular stenosis continues to disappear. Even in cases where arterial dissection is suspected, it is necessary to follow the signal changes in the blood vessel wall imaging and consider primary angiitis of the central nerve system.