Abstract
This 181 page paperback by three of the world's leading headache specialists and a family physician colleague has as one of its goals, as stated in the preface, ‘to provide the primary care provider with a rigourous, accurate, practical approach to headache. It achieves this goal to an admirable degree.
It starts off with a section on the importance of headache in primary care practice. This chapter emphasizes that ‘the main clinical burden of dealing with headaches will continue to be carried… by primary care physicians’. It points out that ‘much can be done at the primary care level to prevent’ chronic daily headache.
Three sections then follow, one on the pathophysiology and epidemiology of headache, one on primary headache disorders, and one on secondary headache disorders. The page edges for each section are cleverly colour coded, so that each can be found quickly.
The section on primary headache disorders contains chapters on the diagnosis and treatment of migraine, tension-type headache, chronic daily headache and cluster headache. These chapters are comprehensive, superbly illustrated and are clearly the loving work of physicians who have ‘devoted their careers to studying headache and improving patient care’. This is no cookbook for headache management. No disorder is too rare to be included, and there is for example a section on Familial Hemiplegic Migraine. The molecular structures of ergotamine and dihydroergotamine are shown, as is that of sumatriptan. Some statements could be argued with. For example, it is stated that ‘the definition of CADASIL is migraine with aura and some hemiparesis, where the patient has at least one first degree relative with identical attacks’. Patients with CADASIL do not necessarily have to have migraine, but to be fair the CADASIL syndrome is explained fairly fully in the book. In fact the attention given to rare syndromes in this book may be more than many primary physicians want. Some figures could do with more careful explanations. One for example tries to convince us that vomiting is more common than photophobia in migraine attacks, and another that all migraineurs have more than one attack per month. In a book directed at primary care physicians, it should be made clear that these figures are dealing with selected populations, or are otherwise influenced by research design.
The section on secondary headaches includes chapters on post-traumatic headache, sinus headache and geriatric headache among others. Once again the book tries very hard to promote understanding of basic mechanisms, in addition to providing diagnosis and treatment information. In keeping with the superb informative tables and illustrations throughout the book, the chapter on post-traumatic headache has a table showing the Glasgow Coma Scale and a figure showing brain motion during head trauma.
In summary, this book is crafted by true headache experts who have a deep affection for basic science and the understanding of headache. Readers familiar with the headache literature will recognize many figures from classic papers including graphs on migraine prevalence, illustrations of Lashley's migraine aura, positron emission tomograms of the brainstem ‘migraine generator’ and of posterior hypothalamic activity in cluster headache. All this may be a bit much for some primary care physicians, but the book is well organized and will be useful to all of them in their diagnosis and treatment of headache. Those who love medicine will love this book. It will be useful for neurologists and even the headache specialists, as it has enough up to date detail that all will learn something from it. For example, it has a fine illustration of the neural innervation of the carotid circulation and has informative tables on the use of headache drugs during pregnancy and breast feeding.
This book is highly recommended for physicians at all levels who see headache patients. The tables and illustrations alone are worth the price.