Abstract
This is the second edition of Dr Robbins book, and once again he delivers a highly individualized approach to management of many common primary headache disorders and includes chapters on headache in children and adolescents, and special headache topics including patients over 50.
This book, like most single author books, has value in that clinicians usually find the presentation and discussion more uniform than in multiauthor texts. However this volume does not take an evidence based approach to the literature, particularly related to the medications, and although containing numerous and useful references at the end of the text, none are numerically cited in the text. Nevertheless, there is a lot of valuable information in this text.
The majority of the text deals with three primary headache disorders, including extensive discussions of migraine, tension-type headache, and cluster headache. There are clinical overviews on each disorder followed by overviews on potential abortive and preventative treatments for each. I particularly like the concept of denoting whether treatments are first, second or even third-line. The choices for these treatment and such categorizations are obviously those of the author but do generally fit what is observed in practice in North America. Some readers will agree with such an approach and others will have substantial disagreements, particularly with the choice of medications, but nevertheless there are approaches here that works for the author, who is recognized to be skilled headache specialist.
Each major section is followed by a series of case scenarios that incorporate variations on each primary headache disorder and their management particularly from the pharmacological point of view. There is an obvious amount of polypharmacy used in several of these case scenarios as it clear that Dr Robbins is daily managing these cases in his own clinic directly, which is a common occurrence in large American headache centres. I am sure most readers will be quite amazed by all the medications one patient is given, and how often they are changed, as the patients complain of side-effects and lack of efficacy.
The sections noted on children and adolescents are useful as are the sections on headache over 50 and post-traumatic headache, and the topic discussions in these sections follow a similar format to the other sections. The references are extensive and mostly up to date, and there are useful appendixes on drugs used in the USA, patient calendars, clinical pearls, foods to avoid for migraine patients, and alternative therapies, including herbs and vitamins. The ‘triptans’ are updated in this volume and there are many topics added, updated or revised.
In summary, Robbins has, once again, produced a very personal text, but one that is practical, detailed and loaded with lots of tips and ideas on how to manage headache patients. All headache physicians know that management is as much as an art as a science and it via such books as this one by Dr Robbins that one gets insight into the ‘art’. I would recommend this book as predominantly a reference and something to turn to when reflecting on a particularly difficult case. Residents in neurology and newly minted consultants and non-neurological specialists will find it useful, but I suspect it will be too much for most medical students and possibly too idiosyncratic for some headache specialists.