Article Text

Headache in primary care.
  1. A J DOWSON

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    Headache in primary care. By sd silberstein, rb lipton, pj goadsby,and rt smith (Pp 192, £29.95). Published by Isis Medical Media, Oxford, 1999. ISBN 1-901865-66-5.

    A wide range of textbooks are now available on the topic of headache, ranging from short notes of 40 or 50 pages up to encyclopaedic tomes. This book falls into the middle of the range, being an easy read of 165 pages.

    The work is divided into three broad categories: (1) pathophysiology and epidemiology of headache, (2) primary headache disorders, and (3) secondary headache disorders.

    In the first section, the starting point is the International Headache Society (IHS) classification but the bridge to the clinical approach to patients is rapid and the use of disability assessment tools is discussed. The epidemiology of the various forms of headache is then examined, together with impact on the sufferer. An entire chapter is devoted to diagnostic testing, particularly to exclude ominous causes of headache, and finally the pathophysiology of primary headache is discussed, the focus being on migraine. Genetics, anatomy, and physiology are all investigated. This whole section is concise and informative, giving a very good overview of the subject.

    The rest of the book is divided into chapters dealing with specific types of headache, the first section looking at migraine, tension-type headache, chronic daily headache, cluster headache, and related symptoms, the final section covering secondary headache, including post-traumatic headache, headache associated with disease of the intracranial cavity, sinus headache, headache associated with CNS infection, headache associated with pregnancy and breast feeding, and geriatric headache. Within these chapters, all types of presentation and management are discussed, the emphasis being on the use and application of the IHS classification in a clinical setting.

    This book undoubtedly contains the full range of information necessary to deal with the treatment of headache. However, the clinical chapters are written from a predominantly American perspective and, therefore, the therapeutic approaches in particular do not necessarily correlate with those used in the United Kingdom. Because of the comprehensive nature of the work, there is a danger that the reader may not appreciate the relative importance of some of the various conditions discussed. For instance, my own experience has shown that the greatest clinic problem, even in a primary care setting, comprises patients with chronic daily headache and analgesic dependence. Important basic clinical issues such as this may be lost within the wealth of information set out here.

    My overall impression is that this is a very comprehensive book which would serve as a good reference. However, although it would be extremely useful for the primary care doctor in the United States where more specialisation exists, its value in the United Kingdom may be limited to the secondary care doctor or to the few primary care doctors who have a specific interest in headache.

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