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There exists a wide discrepancy between the excitement of recent advances in the pathophysiology of headache, including the neurovascular hypothesis of migraine, serotinergic receptor pharmacology, and knowledge of the involvement of brainstem structures in head pain, and the often low level of enthusiasm for headache management in the United Kingdom. In this volume Mongini presents a personal view of headache and facial pain aetiology and management which complements other researchers in the field.
The first section concentrates on the importance of facial, cervical, and masticatory muscles in the aetiology of headache with some excellent anatomical illustrations. Reference is also made to serotinergic mechanisms in migraine but this could have been expanded to include a more current view of the neurovascular hypothesis of migraine and also a discussion of calcium channelopathies in the pathogenesis of migraine.
The second clinical section describes in detail the examination of the muscles of mastication including palpation of trigger points and recognition of bite abnormalities. This section would have benefited from more discussion of the features of secondary headaches, altered intacranial pressure syndromes, the importance of vascular risk factors in migraine assessment, and unusual variants of migraine such as familial hemiplegic migraine. Mongini includes many clear photographs of patients with abnormalities of masticatory muscles and tension related symptoms to illustrate his points.
The chapters on management of headache are based around case discussions, with an emphasis on physical therapy for the cervical and masticatory muscles and on treatment of comorbidity of depression as being paramount to successful therapy. Whereas the recognition of concurrent depression cannot be over emphasised in its importance it would have been useful to include a comments on the stepwise approach to migraine therapy and a guide to the use of triptans. Perhaps the most obvious omission in this section is a discussion of chronic daily headaches with analgesic misuse, probably the most common problem seen in headache clinics.
This book should be used as an adjunct to other headache texts on the market to give the reader an insight into a management strategy for those patients with challenging and unusual headache problems.
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