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Classification and diagnosis of headache disorders
  1. A Bahra

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    Edited by Jes Olsen. Published by Oxford University Press, Oxford, 2005, £85.00 (hardcover), pp 311. ISBN 0-19-856590-9

    This volume of Frontier’s in Headache Research focuses on the application in research and clinical practice of the International Classification of Headache Disorders II (2004).

    Section I presents epidemiological considerations, general principles in headache classification, and use of tools such as questionnaires, structured interviews, diaries, and diagnostic software programmes. Section II presents the sub-classification of migraines with and without aura and chronic migraine, probably the most well supported by epidemiological and genetic evidence.

    In section III fervent debate continues about the entity “Tension-type headache” and nuances in classification—infrequent, frequent, and chronic tension-type headache. The diagnostic and pathophysiological basis for the core trigeminal autonomic cephalalgias (cluster headache, paroxysmal hemicrania, and SUNCT) is followed by syndromes that occupy the fringe of accepted sub-classifications—for example, hypnic headache, haemicrania continua, and new persistent daily headache. There is elaboration on a more pragmatic and intuitive ordering of other primary headache disorders such as idiopathic stabbing, cough, exertional, and sexual headache.

    Sections IV and V provide the most interesting and thought provoking aspect of headache classification—the secondary headaches—undoubtedly the least evidence-based and consequently the most wanting in reclassification. The chapters discuss the literature and clinical characteristics of disorders such as post-traumatic headache, headache associated with substance (medication) use, infection, and vascular disorders. The chapter “Cranial Neuralgias and Central Causes of Pain” is superbly written. It dispels the myths of ophthalmoplegic “migraine”, Eagle’s syndrome, and Vidian neuralgia (was it all cluster headache?), while clarifying the phenotype of neuralgia associated with single nerves and their branches—for example, supraorbital neuralgia.

    Section VI elaborates upon the successes and difficulties of implementation of ICDH II in practice and research. As one author points out, if a classification is not user friendly, it won’t be used. Therefore, the call for a revised shortened classification for clinical practice, reserving the complexities of diagnostic hierarchy to the researcher, is required.

    The preface concludes with, “Hopefully it (the current volume) will be useful and interesting reading for all those caring for headache patients as well as for researchers in headache, and others with a general interest in disease classification”. It adeptly delivers as intended. It is easy to read, informative, provides helpful tools for the practising clinician, and provides further insights into the developing field of headache research.

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