Book Review

Headache and Migraine in Childhood and Adolescence

N Engl J Med 2002; 347:454August 8, 2002

Article

Headache and Migraine in Childhood and Adolescence
Edited by Vincenzo Guidetti, George Russell, Matti Sillanpaa, and Paul Winner. 304 pp., illustrated. London, Martin Dunitz, 2001. $125. ISBN: 1-85317-810-1

Headaches and migraines occur in a large proportion of children. Up to 10 percent of 5-to-15-year-olds have been reported to have migraines, and up to 28 percent of girls between the ages of 15 and 19 appear to have migraines. In addition, by the age of 5, 25 percent of children have had a notable headache, a proportion that increases to 75 percent by the age of 15. Given the common occurrence of these disorders, it is surprising how few detailed, complete books exist on the subject. Headache and Migraine in Childhood and Adolescence helps to fill this gap by providing in-depth information on childhood headache disorders.

Headache experts from 10 different countries are represented, with a substantial contribution from Italian workers in the field. The wide variety of topics includes the basic pathophysiology of childhood migraines and headache disorders and a description of assessment and diagnosis. A thorough discussion of childhood migraines makes up a large portion of the book, but space is also devoted to cluster headaches, tension-type headaches, chronic daily headaches, and so-called psychogenic headaches. There is also a discussion of secondary, or “symptomatic,” headaches. Treatment is discussed in specific chapters dispersed throughout the book; this scheme helps when a question on the treatment of a particular childhood headache arises. A special section covers biofeedback and relaxation treatments, highlighting the multidisciplinary, broad-based approach that may be necessary for the management of headache disorders in children. In addition to a thorough discussion of evaluation and management, the book has practical advice for headache specialists and for general practitioners.

The section on pathophysiology, though brief, is a broad-based review of the hypotheses underlying the pathophysiology of migraines. The chapters on neurochemistry and pharmacology complement each other quite well. The neurochemistry chapter outlines a broad variety of pathophysiologic considerations and discusses both the serotoninergic and the dopaminergic hypotheses. The complementary chapter on pharmacology discusses how treatments — including triptans for the serotoninergic model and dopamine antagonists for the dopaminergic model — can match the underlying pathophysiological processes. A brief but thorough discussion of a variety of prophylactic agents is also included.

The section on assessment and diagnosis will meet the needs of both primary care physicians and headache experts. Its topics range from the basic assessment of childhood headache disorders to the roles of neuroimaging and neuropsychological assessment. In these areas, research is lacking, and a consensus statement about the appropriate use of these diagnostic tools is not possible; however, these sections of the book are very helpful in the interpretation of current opinion and hypotheses.

The section on migraine headaches, which are the most frequent form of episodic headaches in children, makes up a large part of the book. In stepwise fashion, it covers diagnosis, pathophysiology, clinical presentation, variations in presentation, outcome, and management. Although the authors cover this topic well, they are limited by the deficiency of scientific data on childhood migraines. They overcome this limitation by providing personal expert opinions and by discussing experience gained from practice, complementing their coverage of the available studies.

In a unique section called “Special Issues,” a series of chapters goes beyond the typical discussion of headaches and migraines and considers why children's headaches may differ from those in adults and how they may provide clues for understanding adult headache disorders. It discusses the relation between sleep and headaches and raises the question of cause and effect with respect to recurrent headaches and sleep disturbances. This section also includes several chapters on the sociopsychological effects of migraines on children — on their pain perception and their quality of life, including the impact on their family and schoolwork.

Overall, Headache and Migraine in Childhood and Adolescence successfully joins the small library of books available on childhood headache disorders. Its breadth and depth of coverage will make it a useful tool for all practitioners who see children and adolescents. It will also be a useful reference for headache specialists and a foundation on which to build further studies.

Andrew D. Hershey, M.D., Ph.D.
Cincinnati Children's Headache Center, Cincinnati, OH 45229
andrew.hershey@chmcc.org