Answers for headache

Andrew Dowson is a general practitioner and Director of Headache Service at King's College Hospital, London. This puts him in a good position to write a book that answers questions about headaches that patients present with in the course of a busy practice. His pocket-sized book is part of a Churchill Livingstone series called Questions answered.

The emphasis is naturally on migraine, which can be a burden for doctors as well as for their patients. A key question posed is “How well is migraine managed in primary care today?” and the answer given is “less than 50% of migraine sufferers receive effective treatment from their healthcare provider”. This deplorable situation probably applies in Australia as well as in the United Kingdom.

The author intends this book to be delved into when required, rather than read from cover to cover. Most answers are not supported by references to original sources, and this makes one apprehensive at times, but in general they reflect current opinion. Some answers are deceptively simple. For example, “thunderclap headache” at orgasm is not always benign, or an occasion for “a certain amount of amusement”, but may signal a subarachnoid haemorrhage and requires immediate investigation when it happens for the first time.

I found a particularly helpful table in the Appendix summarising the many medications used in the treatment of headache with their trade names, dosages and side-effects. On the other hand, I found some illustrations unnecessarily complex: for example, the multiple diagrams included in Figure 2.7 do not clarify the mechanism of migraine. However, my overall impression is that it will prove interesting and useful in the care of headache patients.

The price is higher than one might wish, but, if every doctor had the answers to these questions at his or her fingertips, there would be far fewer disgruntled patients in the community.

James W LanceNeurologist Woollahra, NSW