Abstract
There have been so many textbooks and monographs on this topic in the last 25 years that it needs something different in quality, content or the sadly neglected skill of plain written language to make a new book worthwhile. The potential merit of this work is its attention to headaches of childhood, an area that has escaped many texts. The authors acknowledge previous books by Robert Mayer, Charles Barlow, Lanzi and Hockaday but they are not of the last decade.
Predictably, the text starts with basic neurophysiology, neurochemistry and pharmacology and a general assessment and diagnosis. Migraine gets 11 chapters, cluster headache one and tension headache one chapter. Further sections on chronic daily headache and psychogenic headache in quotation marks clearly show the confusion between these very arbitrary groupings, which is alas, not resolved here. Psychological and psychiatric issues are perhaps overdone, and riddled with contradictory views, sometimes expressed in an almost impenetrable psychobabble. I give one example:
‘The adoption of Feinstein's definition[of comorbidity]does not imply the assumption in itself of a hierarchy between the ‘index disorder’ and the ‘additional’ ones, if not in relation to our main focus, or consideration of a disease or disorder as the starting point of our analysis or in terms of a time sequence.’ (p. 181, Galli and Guidetti)
Curiously, treatment is neglected and relegated to 3 chapters headed ‘non-medical treatment’ (relaxation, biofeedback and psychotherapy). Almost as an afterthought is a section ‘symptomatic headaches’ (post-traumatic, intracranial infection and tropical infection) but no specific consideration of brain tumours, perhaps the most frequently expressed cause of worry amongst parents.
Individual chapters contain many formal classifications, often over-dependent on IHS criteria of 1988. There are far too many references to be of value when most readers have easy access to libraries and electronic data; and many classic relevant references are overlooked. There is however, a wealth of useful information from the literature, but a dearth of well-reasoned opinion and of detailed clinical description, which the modern scan-dependent trainee so badly needs. For example, there is inadequate description of the patient, the quality and effects of his headache in accounts of migraine, tension headache, cluster headache, and subdural haematoma. It is so important to paint a vivid and detailed clinical picture if over-zealous investigation and the attendant anxiety engendered is to be avoided. Similar shortcomings are evident in the only chapter about antiheadache drugs (pharmacology), where many drugs are summarized, but no therapeutic strategy is advised. Like many other chapters, this smacks of a literature summary rather than a seasoned, patient-orientated approach.
Although there are many features peculiar to childhood migraine and other headaches, many of the theoretical aspects of mechanisms and accompanying phenomena are common to adult headaches. For the reader trying to improve his understanding and clinical skills, the current books on adult headaches will prove more stimulating and informative.