Abstract
This is a case-based book written by the neurology team in Boston and addressed to any physician who sees patients with headache. It presents common scenarios in the day-to-day practice where mistakes are often made. It will be a powerful training tool for neurology trainees and general practitioners with special interest in headache but it will also be useful for neurologists who would like to deepen their knowledge of headache management. After every case there is a discussion on the topic and a tip for the readers on how to manage similar situations. All the information offered in the book is based on strong scientific evidence and the references mentioned are relevant and up to date.
It starts by discussing the differential diagnosis in primary and secondary headaches and the use of different tests. Primary headaches can be confused between each other and with other secondary causes. The first two chapters offer tips on how to differentiate them.
The first case of the book presents a young woman with episodic headache accompanied by tension in the neck and triggered by stress. She had been told that it was tension-type headache. The authors explain that often a detailed history is enough to distinguish between tension-type headache and migraine and offer an extensive discussion about what features of this woman’s headache indicate that she actually suffers from migraine.
Of special interest is the reflection about the risks of requesting brain imaging in patients with typical migraine—the probability of finding a meaningful abnormality in someone who meets criteria for migraine with normal neurological examination is 0.1%, whereas the risk of an incidental finding is much higher than that.
There is a long discussion on acute and preventive treatment for common headaches. The side effects of triptans and possible causes for their failure are explained in detail. Medication-overuse headache is a frequent problem in headache clinics, and this book offers different ways of treating this problem. Special attention is given to acute and preventive treatment in pregnancy and breastfeeding. The chapter about non-pharmacological treatment comments on behavior modification to avoid triggers, alternative therapies, as well as occipital nerve blocks and the fact that patent foramen ovale closure or forehead muscle “migraine deactivation surgery” have not been proved to be effective for migraine.
The final chapter dedicated to medicolegal pitfalls in headache management is more relevant in the author’s country of origin, but it is useful for discussion and reflection.