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Reducing the burden of headache
  1. R Peatfield

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    Edited by J Olesen, T J Steiner, R B Lipton. Published by Oxford University Press, Oxford, 2003, pp 409, £85.00. ISBN 0-19-851589-8

    It is now becoming clear that the physical effects of traditional neurological diseases, such as multiple sclerosis, Parkinson’s disease, and motor neurone disease, are the tip of an iceberg of neurological disability. Headache, with its meagre crop of hard physical signs and radiological abnormalities, accounts for a large proportion of, for example, the time lost from effective work in the community as a whole. In clinical practice it is becoming important to assess not only absenteeism from work, but also reduced efficiency of those patients who struggle to get to work. The disruption of family and social arrangements prompted by fear of the next attack may also be highly significant. A study of the medical staff in one Rome hospital found absenteeism to be low, but we must be careful not to assume everyone is so determined!

    The latest volume in Professor Olesen’s series, Frontiers in headache research, which is again based on his well established research seminars in Copenhagen, brings together most of the world authorities on the epidemiology of headache, with particular emphasis on the assessment of the disability headache can cause, and the extent to which we can measure amelioration following medication. The text is very thoroughly referenced, and gives good descriptions of, for example the Migraine Disability Assessment Questionnaire (MIDAS), the Headache Impact Test, and various quality of life scales. These are all validated ways of assessing disability in its own right, as well as the end points of trials, needless to say supporting the view that expensive drugs can often be justified in economic as well as human terms. There is a long section devoted to indirect costs of headache, and discussion of different ways of organising healthcare delivery for headache patients.

    Many readers of this journal looking at this book will be, I hope agreeably, surprised to find that, even in this somewhat socially orientated field, the science is easily the equal of that in other neurological diseases. Professor Olesen is to be congratulated in this book, and encouraged to continue the series.

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