Brain, Vol. 122, No. 7, 1392-1393,
July 1999
© 1999 Oxford University Press
Book Reviews |
MECHANISM AND MANAGEMENT OF HEADACHE.
By James W. Lance and Peter J. Goadsby 1998. Pp. 317. Oxford: Butterworth Heinemann.Price £50. ISBN 0-7506-3728-5..
The Princess Margaret Migraine Clinic, Department of Neurology, Charing Cross Hospital, London, UK
That headache is becoming a respected subspecialty within neurology owes much to Jim Lance. He has been working in the field for 35 years, combining clinical assessment and care with relevant basic science studies, and he shows no real signs of flagging, even after his official retirement. His textbook, intended for entrants to the field as well as neurologists in more general practice, was first published in 1969 and has now reached its sixth edition; on this occasion co-authored with his heir apparent, Professor Peter Goadsby, who has more recently carried the flag to London.
As befits the authors' vast experience and authority, the paramount importance of a good history is emphasized, and in particular the need for a detailed account of previous and current drug treatment. There is a superb comprehensive chapter on the many types of non-migrainous headache without structural abnormalities, and the authors are firmly in favour of spreading depression as the mechanism of the migrainous aura. They provide an even-handed discussion of the more obscure alternative therapies without losing probity, and are particularly good and topical on the different roles of the various triptans that have now been marketed. There is a very useful table of trade names used in different countries.
A lot of older references are woven skilfully into the argument, one of the many benefits of a symbiosis between the distilled wisdom of Lance and the dynamism of Goadsby. The clinical features of each headache syndrome are described in appropriate detail, followed by discussion of pathophysiology and treatment, with full references. That many of their more anecdotal practices so often coincide with my own must reflect the unobtrusive influence that Lance has had on neurology world-wide over the years.
One can offer few material criticisms. Lance is, perhaps, not dogmatic enough about the limited role of 5HT3 antagonists, and the extensive literature on the very low productivity of routine scanning of long-standing headache patients could be reviewed in more detail, as could the pharmacology of the mechanism and treatment of atypical facial pain.
Professor Goadsby's literary productivity in the last year has exceeded even that of his mentor—three books of which two are co-authored and one edited. All are excellent; perhaps the Silberstein book is better for undergraduates and general practitioners, the Lance book for neurologists, and the Blue Book for cognoscenti requiring comprehensively referenced reviews of growing topics. All tastes are, therefore, catered for and competing books must be either much shorter or much longer.
References
Peter J Goadsby and Stephen J Silberstein, editors. Headache. Blue books of practical neurology, Vol. 17. Oxford: Butterworth Heinemann; 1997.
Silberstein SD, Lipton RB, Goadsby PJ. Headache in clinical practice. Oxford: ISIS Medical Media; 1998.
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