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Headache.
  1. PHILIP BUTTERY

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    Headache.By egilius lh spierings. (Pp 236, £15.99). Published by Butterworth Heinemann, Oxford, 1998. ISBN 0750671289.

    This attractively attired palm sized handbook is one of several titles in a new series entitled The Most Common Complaints. Others so far include Confusion and Neck Complaints, and this one at least is aimed squarely, the publishers state, at a general market that will include general practioners and physicians and psychiatrists, as well as neurologists. The author is a headache specialist at Harvard and has written a small and engaging treatise that consideres the practicalities of managing patients with headaches of various aetiologies. Starting with a brief overview of headache, the book then divides itself into three main sections, splitting headaches into the acute, the subacute, and the chronic. The first two sections thus take on what might be termed organic causes of headache, with separate chapters on meningitis, subarachnoid haemorrhage, and hypertensive encephalopathy in the first section, and on tumour, pseudotumour, opthalmic zoster, temporal arteritis, and subdural haematoma in the second. This leaves the third section to cover the episodic and chronic headaches of conventional classification—tension type headache, migraine, and cluster headache among others. Each chapter has subsections on aetiology, presentation, and diagnosis and is individually and well referenced. The main differences between them comes in the extent to which they dwell on treatment. Thus, although acute headaches are logically divided into chapters by aetiology, with diagnosis and symptomatic treatment covered in some detail, treatment of the bacterial meningitis or subarachnoid haemorrhage itself is mentioned either barely ("with antibiotics”) or not at all. Clearly this approach flows naturally from the book's concept as a publication confined to headache, but in such a context the chapter divisions seem rather forced, and it also becomes difficult to see how the approach would satisfy any particular target audience. That said, the qualm becomes less relevant in the subacute section, where treatment of the conditions is at least covered (albeit succinctly), and completely irrelevant in the final section where the treatments are entirely symptomatic and discussed in detail.

    Throughout, there is an obvious attempt to keep the text digestible; the chapter subsections are clearly headed and keenly trimmed, usually to just one or two paragraphs. The text is also liberally sprinkled with illustrative case histories to guide your understanding (that you will find either entertaining and helpful or simply distracting), and one or two useful tables also summarise treatment regimes and efficacies. In keeping with this stylistic trend to brevity, the chapters themselves are kept very much “bite sized”, a strategy that results, for example, in no fewer than four chapters devoted to various aspects of migraine and its treatment. Overall though, the effect is a book that is both clear and succinct, and where there are frustrations they are almost inevitably a result of the constraints of size and scope placed on the book by its title and philosophy. Certainly the end result remains easily digestible, but if you are someone with a ravenous appetite for knowledge about headache, this minitome remains a mere tasty snack that, although it may take the edge off your hunger, certainly will not leave you satisfied for long.

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