Brain, Vol. 123, No. 9, 1971-1972,
September 2000
© 2000 Oxford University Press
Book reviews |
THE HEADACHES.
.
Service of Neurology, University Hospital Marqués de Valdecilla, Santander, Spain
The first edition of this headache encyclopedia was a `successful experiment', to use the Editors' words. The previous edition of this volume justifiably appeared in 1993, after a few years of crucial advances in the headache field, basic science, e.g. discovery of 5-HT receptor subtypes, the clinical arena, with the publication of the headache classification and operational criteria of the International Society in 1988, and in the therapeutic area, with the development of sumatriptan. With the inevitable defects of a big book of multiple authorship, mainly repetition and heterogeneous style, the first edition of this book brilliantly covered the large headache world, impossible for a single author to handle nowadays.
As the Editors point out in their Preface to this second edition, headache research has progressed at an ever-accelerating pace over the last 7 years, which again justifies this newborn volume. The discovery of the first migraine gene, coding for a voltage-gated calcium channel, the description of migraine and cluster headache `generators' in brainstem and hypothalamus, using modern PET techniques, and the explosion of the triptan market are only a few, though relevant, examples of the recent advances in head pain extensively reviewed in this book.
The format of the book is of numerous, usually short, chapters. Preserving the same physical aspect, the number of chapters (125 versus 132), pages (894 versus 1026) and authors (121 versus 131) has increased in this edition. The Editors' wise desire to keep a wide international representation and a shared North American and non-North American authorship has been only partially achieved, with a clear relative predominance of Scandinavian authors. The book is divided into six big sections. The first 55 pages (eight chapters) are devoted to `General aspects of headaches'. After an irreproachable, but very conventional, historical chapter, the book repeats the necessary and excellent section on how to use the IHS classification by its mentor, Jes Olesen. My only criticism here is regarding the `Critique of the IHS classification'. The space dedicated to this fashionable topic is too small and his comment on `something' called chronic daily headache `being a step backward' and giving no place, and even no reference, to the number of authors defending conditions such as transformed or chronic migraine should be included in the IHS classification. This is not understandable in a book which attempts to cover extensively every aspect of headaches. The main improvement in epidemiological chapters of this section is found in Chapter 4, in which headache-related quality of life is carefully reviewed. After a misplaced and too brief chapter on `Clinical approach to headache patient', we find two useful new chapters on clinical trials and ethical issues containing some repetitions, which could have been avoided by putting them together.
The second section of this book (Chapters 9–26) deals with `Basic science aspects of the headaches'. Chapters 9 and 10 are devoted to anatomy. Illustrations in Chapter 9 taken from Netter's book lose all their attractiveness when in black and white, and are not schematic enough. Some aspects in Chapters 11–15 on basic aspects of nociception are actually difficult to follow for a clinical neurologist. In future editions the authors of these chapters should try to make these basic data easier to understand and avoid going into excessive depth in their personal areas of interest. After one new chapter on serotonin receptors, in which I find the place given to 5-HT2B and 5-HT7 receptors exaggerated and some comment on the possible role of 5-HT1A and 5-HT2A receptors in headache pathophysiology lacking, there is an excellent review on the trigeminal system by Margarita Sánchez del Río and Michael Moskowitz. The following chapters on ion channels are a good decision and will be welcomed by many clinicians eager for this kind of information. This section ends with pertinent reviews on spreading depression, experimental headache and on psychological pain modulation.
The most important section of the book, comprising 40 chapters, is devoted to `The migraines'. This core part of the book is very well organized and, compared with the previous edition, adequately reflects the dramatic advances that have occurred in migraine pathophysiology and treatment in the last decade. My main criticism is in the title on the section `The migraines': why not simply `Migraine'? Following the same reasoning, why not use `Tension-type headaches' in the following section? It is clear that the title in the plural reflects the very respectable view of the Copenhagen group separating migraine with and without aura as different entities, as stated on the last page of Chapter 27, the first of this section. This tight conceptual separation, for which, in my opinion, there is still no definite proof for or against, gives rise to confessed opposite views within the same chapter (see Chapter 30 on migraine genetics). The two chapters on migraine epidemiology and co-morbidity are clear and complete. The recent advances in migraine genetics are now comprehensively explained by Ferrari and Russell, while in Chapter 31 the biochemistry of jugular venous blood has been added. Except for two new chapters on 5-HT in migraine and nitric oxide in migraine, the remaining ones aere up-to-date versions of the previous edition. The chapters on platelets and on immunology will hardly be justified in future editions and I would have seen it more logical to move Chapters 16, `Serotonin receptors: relevance to migraine pathogenesis and treatment', and 22, `Cortical spreading depression', to this part of the book. All of this section is admirably summarized by Jes Olesen and Peter Goadsby in Chapter 41. The next four chapters deal with clinical features, differential diagnosis and prognosis of migraine. I miss, in the long list of differential diagnosis, a mention of pseudomigraine with pleocytosis. Chapters 46–49 are devoted to non-pharmacological management of migraine. Homeopathic treatment, a very popular migraine therapy in many countries for which there are recent negative serious scientific data, should have been discussed within unconventional treatments. The following 11 chapters on pharmacological treatment of migraine are among my favourites in this book. Each acute or preventative pharmacological group is homogeneously analysed in depth, while a general view of how to prescribe acute and preventative medications can be found in Chapters 55 and 61. The secret of the success of this crucial area of the book is that most of its chapters are written by two experienced and complementary authors, Peer Tfelt-Hansen and Pramod Saxena, which gives the necessary thread. The last six chapters in the `The migraines' section cover special migraine types, such as familial hemiplegic migraine, basilar artery migraine or ophthalmoplegic and retinal migraine. In this chapter I would have shown an MRI picture of the recently described enhancement of the cisternal portion of the oculomotor nerves in ophthalmoplegic migraine.
The fourth section of this book is devoted to other primary headaches. Twenty-one chapters are dedicated to tension-type headache. After an excellent epidemiological review, there is one more chapter on `Anatomy and pathology of tension-type headache', which I find reiterative of Chapters 9 and 10. The following nine chapters give the right idea of the poor and speculative knowledge we still have on tension-type headache pathophysiology. Clinical features of tension-type headache are well reviewed in Chapters 80–82, and there are six chapters on tension-type headache treatment. Oromandibular dysfunction occupies too much space in this section, with two complete chapters, one on the pathophysiology and one on treatment, and multiple references in other chapters, for instance in the anatomical chapter. This excessive citation could give the reader the wrong idea of the role of temporomandibular dysfunction in tension-type headache, which is far from being demonstrated in the majority of cases, and oromandibular disorders are also reviewed in Chapter 121.
Cluster headache deserves 10 chapters. In this case, the information is too fragmented, sometimes making it difficult to get a clear, global idea of the problem. For instance, Chapter 91 on `Anatomy and pathology of cluster headache' focuses on the cavernous sinus area, while we know now that the most important anatomical structure in cluster headache is the hypothalamus, as May and Goadsby review nicely in Chapter 94, where I miss a PET image of the hypothalamic activation. Chapters devoted to diagnosis and management of this condition are remarkable. Two comprehensive chapters on chronic paroxysmal hemicranea and other primary headaches, such as stabbing, provoked hemicrania continua and SUNCT, close the primary headaches part of this book.
Secondary headaches and cranial neuralgias, following the rules of the IHS classification, are reviewed in the following 23 chapters. The general scheme of this section is maintained from the previous edition, as are the majority of the authors. The most important chapters for clinicians, such as headache associated with arteritis, high and low CSF pressure, intracranial neoplasms or with single or chronic use of substances, are well written and comprehensive.
The last section of this book is dedicated to `Special problems in the headaches and their management', and occupies eight chapters. Half of them have basically the same authors and content as the first edition, whereas the remaining four either have different authors or are new, such as an appropriate chapter on `Headache and sleep'.
So far, this reviewer has mostly given his (constructive) criticism to this volume. I would not like readers of this review to get a negative impression of this book. In spite of these minor criticisms, this book is in general superb, and remarkable improvements in this new edition are patent in more than 90% of its chapters. This book fills a need in a field in which there is no competition. I can testify that it is an absolutely obligatory book for anyone who is devoted to headache, both in clinical and in the basic fields; my personal copy disappears every day from my office, taken by my collaborators: this is the best praise which can be given to a book. In addition, this book should be in every Neurological Unit, and many of its chapters should be read by every neurologist. It should be remembered here that headache is the most common symptom with which patients present to neurologists, but that, in spite of this, many headache patients are mismanaged by neurologists who are more interested in very rare disorders. After the appearance of this book, in which we can easily find answers to most questions on clinical and basic headache aspects, our excuses for headache misunderstanding and mismanagement are definely a thing of the past.
Notes
Second edition. Edited by Jes Olesen, Peer Tfelt-Hansen and K. Michael A. Welch. 1999. Philadelphia: Lippincott Williams & Wilkins. Price $199. Pp. 1056. ISBN 0-7817-1597-0.
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