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Monographs in Clinical Neuroscience. Volume 17
  1. R C PEATFIELD

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    Monographs in Clinical Neuroscience. Volume 17: Drug Treatment of Migraine and Other Headaches. Edited by h c diener (Pp 372, US$191.50). Published by Karger, Basel, 2000. ISBN 3 8055 6971 8.

    In the past decade, many new treatments for migrainous headache have been developed and marketed. The flow has slowed up in the past year or two, not least because several good theoretical ideas have not proved valuable in clinical practice, and the comprehensive review of current drugs is therefore timely. Professor Christopher Diener, who has published distinguished research on the pathophysiology of headache as well as its treatment, has assembled a panel of authorities to review all current treatments for migraine, both analgesic and prophylactic. At the end of the book there are individual chapters on cluster headache, tension headache, paroxysmal hemicranias, drug induced headache, and post-traumatic headache.

    In the main section of the book on migraine, all the triptans are covered, including almotriptan and frovotriptan, which have yet to reach the market, as well as opioids and the different drugs used in prophylaxis, including flunarizine, valproate, and gabapentin. The industry based pharmacologist who developed each drug gives an account of its theoretical properties, and then one of the principal clinicians responsible for the trials reviews its role in clinical practice. Each chapter is thoroughly referenced, and the book will prove to be an excellent source of references to classic trials. There is some duplication within the pairs of chapters, and occasionally commercial pride seems to inhibit a truly independent discussion of the merits of the drugs. Much of the clinical material, inevitably, amounts to a catalogue of trials that does not lend itself to easy consecutive reading. Some of the senior academic clinicians make valuable comments—notably Goadsby emphasising the 2 and not the 4 hour response data for naratriptan, Ferrari on the analysis of recurrence rates for different drugs, and Tfelt-Hansen and Saxena on the limited likely role of 5HT2 receptor inhibition on the mechanism of successful prophylaxis. Jim Lance distils a lifetime's experience of migraine prophylaxis into six pages. The reviews of simple analgesics in tension headache by Schoenen, and of post-traumatic headache by Keidel are excellent, providing material difficult to find elsewhere.

    In many respects this is an outstanding book. It provides an invaluable source of published evidence for the treatment of patients with headache—It needs some dedication to read it through, but it would be a useful addition to every departmental library.

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