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Migraine and Headache Pathophysiology

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    Migraine and Headache Pathophysiology. Edited by lars edvinsson. (pp 184, £65.00). Published by Martin Dunitz Publishers, London, 1999. ISBN 1-85317-737-7.

    New information about how and why migraine happens continues to break on us in a dizzying succession of waves coming from various journals in different disciplines. We need an accessible, understandable, and unitary vehicle to collect, organise, and present this information. Journals, the Internet, and the abstracting services have their place, but for this purpose nothing beats the book. How well does Lars Edvinsson’s Migraine and Headache Pathophysiology meet this need?

    This book has several attractive features. Recognising that some of the world’s best science is now being done in the laboratories of industry, it has enlisted as authors several leading researchers from the major pharmaceutical manufacturing companies, in addition to “the usual suspects” from academe. Not only has this introduced some exciting writers to the “review book” audience, but it has provided a particular insight into the science of determining why drugs work, or don’t work, in migraine. The book is up to date, containing many 1998 references. Another strong point of the book it its comprehensiveness; though only 184 pages long, it covers every major aspect of the pathophysiology of migraine. There are chapters on innervation of cranial blood vessels, receptor physiology, neurotransmitters, 5-hydroxytrptamine receptor subtypes, cortical spreading, depression, neurogenic inflammation, arteriovenous shunts, cerebral haemodynamics, and animal modelling. This is achieved at the expense of some pretty terse prose at times, which can make it difficult for the non-expert to follow. It should be noted that, the title notwithstanding, this book deals almost exclusively with the pathophysiology of migraine, and the reader who buys it to get some insight into the mechanisms of tension-type headaches, or other kinds of headache, is going to be disappointed.

    Who should read this book? Certainly the migraine research should. Though much of it will be familiar to those who have kept up with the literature, it is nevertheless an attractive and handy compendium of current research information. Moreover, the first chapter (by Lars Edvinsson) and the last chapter (by Peter Goadsby) are very pretty syntheses of the field. What about clinicians? Some of it is heavy going for people like me, who are not basic scientists. But I got through it all in about 6 hours, and found I knew more about migraine coming out than I did going in—which makes reading it a very worthwhile exercise.