Mechanism and management of headache, 5th ed

Mechanism and management of headache, 5th ed Lam c J.W. Butterworth/Heinemann, 1993 ISBN 0750605758 289pp RRP $95.00 Mechanism and management of headache has been a major resource reference for both clinical and research aspects of headache for the past 24 years. The current 5th edition constitutes a substantial amplification of previous editions, but it is worth noting that there has been little change in the descriptive chapters of history recording, diagnosis based on history, physical examination and descriptions of clinical aspects of headache. The accuracy and detail of Professor Lance’s original descriptions warranted little expansion. The author has expanded considerably the chapters related to mechanism of headache, and provides a lucid and readily readable description of the physiology of head and facial pain and a detailed description of current knowledge of the neuro-transmitter biochemistry involved in pain pathways. The controversy over neurogenic and vasogenic mechanisms of migraine is considered, with neither mechanism discounted. While the contribution of intracranial infection, subarachnoid haemorrhage and intracranial tumour as causes of headache are well acknowledged, the evaluation of data related to the pathophysiology of headache in these circumstances is not exhaustive. Post lumbar puncture headache is well discussed, but separate mention of post myelogram headache is not made; this is a deficiency, particularly in the light of potential litigations with this investigation. It is a little disappointing that psychogenic mechanisms of headache are not given more than a paragraph of discussion, even though two appendices relate to hyperventilation and relaxation exercises. The list of drugs which can produce headache is interesting, with simvastatill and gemfibrozil added to the list of more familiar agents. Notable omissions are sections on headache in HIV positive patients, and consideration of headache patients in whom extreme management difficulty corresponds with suspicion of opiate habituation. The chapters related to management are precise and quite current. The results of two multi-centre trials of nimodipine are discussed, indicating that 40 mg three times dailv for 12 weeks is no more effective than placebo. Other studies in which nimodipine was significantly more effectivr than placebo are ignored and the pro-

posed pharmacological action of nimodipine on cerebral vasculature is not summarised. The use of pharmacological agents for trigeminal neuralgia and atypical facial pain, including mexiletine and pimozide and the use of baclofen in chronic facial pain is not discussed. Similarly, the problems with management of post herpetic neuralgia involving trigeminal or upper cervical dermatomes is not discussed in an exhaustive fashion. In considering the mechanism of migraine, evidence is provided that magnesium concentration is lower during migraine headache. The author does not discuss the use of magnesium supplementation in migraine management. The use of aspirin is mentioned in separate paragraphs related to acute and interval therapy, but discussion omits important reference to the restricted value of aspirin in reducing the frequency and intensity of migraine in patients with severe migraine, as well as in subjects with minor migraine. It is regrettable that there is no mention of the potential side effects of NSAID therapy, except for reference to significant gastrointestinal symptoms with flufenamic acid. The potential for complications with prolonged use of these agents is sufficiently significant for a mention of caution with the use of all anti-inflammatory agents. Despite these observations of minor omissions, Professor Lance’s book remains a leading resource and has a satisfactory select reference list for each chapter. There are a number of useful tips, e.g. the reminder to consider sphenoidal sinusitis as a cause of headache. The 5th edition of Mechanism and management ofheadache is recommended to all practitioners with an interest in headache and should be a necessarv addition to medical libraries. In summary, it is a great little book, full of useful information and readable at all levels. It should be appreciated even more than earlier editions, provided the reader does not expect an exhaustive review. RWUONDG,URICK Sydney

Neurological and neurosurgical intensivecare, 3rd ed Ropper A.H. (ed) Raven Press, 1993 ISBN 088167981-X RRP $327.50 This multi-author book outlines the management of problems encountered by neurological and neurosurgical emergencies and is primarily concerned with the

1. Clin. Neuroscience

treatment and monitoring of raised intracranial pressure, the care and examination of comatosed patients, the treatment of mechanical respiratory failure, specific therapies for subarachnoid haemorrhage, stroke and cerebral haemorrhage, head trauma and status epilepticus and general medical problems tat are encountered in this population. This is the 3rd edition of Neurological and ne-uroxqical intensive care by Allan Roper and is an up to date version of the well received previous editions. There is mention of MR angiography trends in electrophysiological monitoring and new treatment areas such as the use of plasma exchange treatment of GuillainBarre syndrome and current trials for acute ischaemic stroke. The book is divided into two sections: general principles, followed by specific problems in neurological intensive care. Part one of the book has some excellent chapters related to the physiology, clinical aspects and treatment of raised intracranial pressure. The chapter by Roper and Rockoff on physiology and clinical aspects of raised intracranial pressure provides a concise summary of the fundamentals of intracranial pressure and indications for monitoring. Similarly, the chapter on airway management and respiratory support provides an excellent precis on the fundamentals of ventilation and its effects on intracranial pressure. It provides a good discussion on methods of intubation. trdcheostomy and ventilatory parameters. The section on nosocomial infections. however, is short and rather superficial in its scope. The second part of the book deals with specific neurological and neurosurgical conditions and their management. The chapters on the management of head injury, subardchnoid haemorrhage and cerebral tumour are concise outlines of the various theldpics u
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