Abstract
The authors of the 3rd edition of The Headaches have attempted to create a comprehensive source for headache medicine and have generally succeeded admirably. The second edition had 1026 pages with 132 chapters, and this new edition has 1169 pages with 139 chapters. A number of chapters have been placed or subdivided slightly differently, and most have been extensively revised in keeping with the advances in many basic science and clinical areas in the 6 years between editions.
The book is arranged into sections, beginning with (I) General Aspects of the Headaches and (II) Basic Science Aspects of the Headaches. These are followed by sections on headache types, essentially in the order presented in the International Classification of Headache Disorders, 2nd edition (ICHD II), beginning with sections on primary headaches (migraine, tension-type headache, cluster headache and other types) and followed by sections on the specific secondary headache types (post-traumatic, vascular, neoplastic, infectious, etc.) The cluster headache subsection actually covers paroxysmal hemicranias and SUNCT so might better have been titled cluster headache and the trigeminal autonomic cephalalgias. Following the secondary headache chapters, special sections are devoted to headaches in children and adolescents and to ‘special problems’ in headache, including issues concerning headaches and their management in pregnancy and lactation, elderly patients, and patients with other coexisting disorders. A chapter on ‘Headaches in the emergency room’ is the final topic, as it was in the previous edition.
In the first section, Chapter 6 ‘History and examination of headache patients’ (previously ‘Clinical approach to the headache patient’) has been expanded from two pages in the 2nd edition, to 10 pages. An interesting ‘Semistructured interview form’ is included in this essentially new chapter. The ‘Basic Science Aspects of Headache’ section has been reorganized with contributions from a number of new authors. Missing from this section is a chapter on psychiatric modulation of pain present in the previous edition. (Much of this information, however, is found in other chapters: ‘Imaging pain’ and in ‘Psychological treatment of migraine’).
The sections on migraine have been significantly expanded, by approximately 100 pages. Migraine mechanisms are discussed in a number of erudite chapters by leading researchers in genetics, neurophysiology, neurochemistry, neuroimaging and neuropsychology. This portion of the book is orientated towards the researcher and parts are quite technical, with some redundancy and alternative points of view regarding the nature of migraine pathophysiology. For example, chapters on nitric oxide and CGRP are present in both ‘Basic Science’ and ‘Migraine Mechanism’ sections. A terrific final chapter in this section by Olesen and Goadsby ‘A synthesis of migraine mechanisms’ places the reader at the cutting edge of knowledge about the pathogenesis of migraine, and might be a good place to start reading on the topic (albeit not the direction necessarily intended by the authors). Here the authors have summarized the genetic factors, environmental factors and physiological events leading to migraine, followed by a discussion of the proposed cascade of cortical spreading depression, trigeminal activation, vascular inflammation, and central nociceptive processing.
Chapters 43–46 ‘Clinical Features of Migraines’ are relatively unchanged and are again first-rate. Migraine treatment portions have changed somewhat, reflecting some advances since the previous versions were written. Unfortunately, missing from this edition is the chapter from the previous edition by the late, brilliant, John Edmeads ‘Unconventional treatments in migraine’.
The chapters covering acute and prophylactic therapy of tension type headache have been combined in this edition into one very useful and complete chapter on TTH treatment. The material in the previous edition's chapter ‘Oromandibular treatment of tension type headache’ is now rightly included in the secondary headaches portion in Graff-Radford's ‘Headache attributed to orofacial and temporomandibular pathology’. The cluster headache section now includes chapters on paroxysmal hemicrania and SUNCT. A new section ‘Other Primary Headaches’ is now present, in keeping with the ICHD II's section 4, which contains chapters on primary stabbing, cough and exertional headaches, sexual activity-associated headaches, hypnic headache, hemicrania continua, and new daily persistent headache.
In the ‘Secondary Headache’ section, a new chapter on whiplash-related headaches is included, again in keeping with this new specific category in the ICHD II. Headaches due to abnormal CSF pressure, neoplasms, substances, infections and metabolic disorders have been renamed and reorganized as well to follow ICHD definitions. There is a new chapter on headaches attributed to psychiatric disease. Chapters on headaches in childhood and adolescence, pregnancy and lactation, and elderly patients have been updated, Again included in the ‘Special Problems’ section are excellent chapters on headaches related to sleep disorders, coexisting psychiatric illness (although with some redundancy to the chapter on the headaches secondary to psychiatric disease), and coexisting medical illness. A new chapter on ‘Headache in patients with coexisting pain disorders’ will be of great interest to practitioners who see patients with multiple pain symptoms.
This text contains a number of truly outstanding chapters that are essentially masterful monographs on individual topics, written by leaders in their specific fields. Among them is the chapter by Burstein, Levy, Jakubowski and Woolf on ‘Peripheral and central sensitization related to headaches’, which is an amazingly concise summary of many years of study of these phenomena by the authors and others. ‘Psychological and behavioural treatments of migraine’ is a very thorough evidence-based assessment of relaxation training, biofeedback, cognitive-behavioural treatment, and related techniques. ‘Potential new drugs for acute and prophylactic treatment of migraine’ by Goadsby and Ramadan offers the reader a window on new data and ideas regarding potential pharmacological targets in migraine, including 5HT1D, 5HT1F, CGRP, Glutamate, and Adenosine receptors, nitric oxide metabolism, ion channels, cortical spreading depression, and the angiotensin system. The complex borderland topics of migrainous infarction and migraine-triggered epilepsy are discussed thoroughly in the chapter by Welch, Bousser and Boguslavsky. An anatomically orientated chapter on ‘Neurophysiology and autonomic dysfunction in cluster headaches’ is terrific and thought provoking. The chapters on secondary headaches are thorough and current. Vilming and Mokri's chapter on low CSF fluid pressure is particularly illuminating.
There was very little in The Headaches about anaesthetic management of head pain, and there was less discussion of intractable headache than would be expected, although this is covered to a degree in chapters 63 ‘Status migrainosus’, 65 ‘Chronic migraines’ and 118 ‘Medication overuse headache’. The chapters on headaches in the paediatric population, while useful and erudite, are brief and could be expanded. The chapter on differential diagnosis of migraine is also brief, with very little on spinal, otolaryngological, dental and other migraine masqueraders, but of course these are covered in detail in subsequent chapters on secondary causes of headaches, and other pertinent material is found in the chapter on the clinical approach to the headache patient.
The index is in places a bit inefficient and cumbersome to use. For example, the ‘Cluster headache’ heading includes the following subheadings concerning treatment: ‘Management of’, ‘Preventive and surgical management of’, ‘Preventive medications’, and ‘Acute treatment of’. As a result, searching for specific items can be a bit tricky.
The Headaches is a wonderfully comprehensive book every headache specialist must have on his or her shelf. The problems of multi-authored texts have not entirely been avoided by the editors, however, with some overlapping material, and some areas somewhat under-represented. There are some differences in opinion about classification, diagnosis and treatment, but this is, of course, unavoidable in this dynamic field, and not necessarily a bad thing. Different individuals will use The Headaches in different ways, and in fact it lends itself to different uses, including: 1) a source for a quick reference on a diagnostic or treatment question; 2) a compendium of review articles on particular topics; 3) a source of up-to-date bibliographies for further reading; or 4) a thorough reading of one chapter at a time. This last approach is quite practical as the editors wisely kept each chapter to a readable length.