Book Review

Headache: Diagnosis and Treatment

N Engl J Med 1994; 331:1102October 20, 1994

Article

Headache: Diagnosis and Treatment
Edited By C. David Tollison and Robert S. Kunkel. 418 pp., illustrated. Baltimore, Williams and Wilkins, 1993. $50. ISBN: 0-683-08425-9

Headache is the subject of more than 50 books in print, ranging from self-help paperbacks to textbooks covering the entire spectrum of scientific literature on all the major subtypes of headache. Headache: Diagnosis and Treatment is yet another book on this topic. Its purpose is to provide health professionals with a practical textbook on the classification and treatment of head pain. It contains 47 chapters, primarily by American practitioners with expertise in the management of headache who represent a wide range of disciplines, such as neurology, internal medicine, otolaryngology, and psychology. Consequently, it comprehensively covers multiple approaches to the treatment of headache, from biofeedback to surgery.

An important advantage of this book is its broad coverage of all the major subtypes of headache, rather than an exclusive concern with migraine. Moreover it makes an important contribution because its organization is based on the nomenclature for head pain recommended by the International Headache Society, which is still relatively unfamiliar to many U.S. practitioners but in wide use elsewhere.

The quality of the chapters varies considerably. Some are particularly informative. These chapters describe the history and neurologic examination of patients with headache and the differential diagnosis, medical management, and nonpharmacologic management of particular subtypes of headache. Others, such as those that describe the role of psychological factors and sociocultural events in headache, are based on opinion rather than evidence.

The considerable inconsistency between chapters in recommendations for the treatment of the same kinds of headache may confuse the reader. However, this is also a strength of the book because it accurately portrays the lack of consensus regarding the efficacy of specific treatments. As Chekhov observed in The Cherry Orchard, “If a lot of cures are suggested for a disease, it means that the disease is incurable.”

The intended audience of the book is health professionals, but it will be of limited value for clinicians who require an authoritative reference. The recent multiauthored textbook The Headaches (J. Olesen, P. Tfelt-Hansen, and K.M.A. Welch, eds. New York: Raven Press, 1993) is a more comprehensive and scientific reference on all aspects of the subject. However, Headache: Diagnosis and Treatment will be quite useful for clinicians requiring information on the classification and differential diagnosis of occasional patients with migraine.

Kathleen R. Merikangas, M.D.
Yale University School of Medicine, New Haven, CT 06510