Abstract
This book is directed at family physicians and paediatricians who care for children with headaches. The authors are two of the leading authorities on paediatric headache and are recognized as excellent teachers. The book takes advantage of their skills and experience in treating children with headaches and also uses the expertise of a group of co-authors who are leaders in the field of childhood and adolescent headache.
The book is divided into a series of well-organized chapters, which begin, with an overview of the epidemiology and classification of headache. The diagnostic criteria for migraine are reviewed with appropriate arguments forwarded on how alteration of each of the criteria would influence the sensitivity and specificity of the diagnosis. The IHS criteria are proposed as the best available ‘gold standard’ for epidemiological studies but the difficulties in interpreting such studies are reviewed.
Chapter 2 offers Dr Rothner's approach to the evaluation of paediatric headache. Dr Rothner has previously suggested a separation of headache into four groups (acute, acute recurrent, chronic progressive and chronic nonprogressive). This division is very valuable to those who treat headache and has been utilized by many of us over the years. The basics of what should be evaluated in the physical examination and neurological evaluation are reviewed. The value of investigations is dealt with in this chapter and also in the final chapter of the book.
The third chapter supplies a brief catalogue of conditions, which give rise to secondary headache. This is somewhat encyclopaedic and would be helped by a flow chart that gave the primary care physician a guide to when secondary headaches should be suspected.
Chapter 4 is written by Prof Peter Goadsby and provides an excellent overview of the current state of knowledge of migraine pathophysiology.
Chapter 5, by Drs Lewis and Winner, provides an excellent overview of the various migraine syndromes but could provide more references. The description of the ‘Alice in Wonderland’ phenomenon suggests that the distortions in visual perception occur before or as the migraine headache begins. This may mislead primary care physicians as many children report their episodes without associated headaches. Similarly the reference to benign paroxysmal vertigo (BPV) ignores the publication by Lindskog et al. (Headache 1999; 39:33–37) which suggested that BPV is not a general precursor of migraine.
Drs Winner, Lewis and Wasiewski provide an excellent summery of the lack of evidence for pharmacological intervention in paediatric headache. Similarly the chapter on nonpharmacological therapies is excellent.
The book is written by a group of expert clinicians and would greatly benefit from a discussion of their approach to the management of the typical paediatric migraine and tension-type headache patient. Most primary care physicians know that their patients have one of these two headache types. Similarly they know that medications do not work well. They usually seek referral to a paediatric neurologist because their success rates are much lower than the specialist's. Providing the reader with the clinical ‘magic’ which works for most children would be most valuable. What should a headache diary look like for children and how do you get them to keep the diary? If the diary does not work and the physician does not have access to a psychologist, what should be done?
The chapters on post-traumatic and miscellaneous headaches are helpful but I thought that the final chapter by Dr Lewis on headache in the paediatric emergency department would likely prove most helpful to the readers of this book. The chapter gives tables, which summarize the most common aetiologies in three studies. They also provide three observations, which will serve the practitioner well: (1) Occipital headache should be investigated. (2) An inability to describe the pain should suggest deterioration in verbal or mental abilities and should lead to investigations. (3) Patients with underlying pathological processes will have abnormalities on neurological evaluation. Tables offer key suggestions for the history and neurological exam and a flow chart leads the physician through a thoughtful approach to the emergency evaluation. The chapter, and book, ends with nine case histories which highlight some of the difficulties, which may be encountered when dealing with headaches in the paediatric population.
Overall this book is an excellent summary of paediatric headache. Specialists in the area will find little new information but family physicians, residents and paediatricians will benefit greatly from the book. Hopefully the next edition will include a chapter with specific directions and authors' biases on what has worked for them.