Management of Headache and Headache Medications, Second Edition

Logical Approach Helps Physicians Manage Headache Patients by Lawrence D. Robbins, M.D. ISBN: 0-387-98944-7 Springer-Verlag New York 2000 296 pages/softcover $50.00

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Management of Headache and Headache Medications provides physicians with a comprehensive reference which details cutting edge headache medicines and how to effectively manage headache patients through the use of medications--from first-line abortives and preventatives to narcotics.

Written by Dr. Larry Robbins, a well-known neurologist and director of the Robbins Headache Clinic in Northbrook, Illinois and an Assistant Professor of Neurology at Rush Medical College in Chicago, this book provides extensive discussions and interesting sample case histories for treatment of migraine, chronic daily (tension) headaches, cluster headaches, hormonal headaches, pediatric headaches and special headache topics.

Robbins does an excellent job at presenting the "delicate art" of managing headache medications. By treating headache as a medical condition which can be affected by stress or psychological factors, Robbins provides physicians with information on successfully managing the headache patient--which usually involves "changing and managing a complicated array of medications, being willing to switch medicines, and having the patience to stick with the headache sufferer."

Whether you're a family practitioner, medical student or a neurologist, you'll come to understand Robbins' goal of improving the quality of life for headache patients.

This 13-chapter, 296 page book includes:

• Introduction to Migraine - The working definition and characteristics of migraine; migraine workup; migraine triggers; and pathogenesis of migraine including genetic componencies, neurogenic inflammation and serotonin deficiencies.
  
  
• Migraine Abortive Medication - A quick reference guide and discussion of first and second-line migraine abortive therapy, with comprehensive sections on the use of triptans, anti-inflammatories, narcotics and sedatives and antiemetic medications.
  
  
• Migraine Preventive Medication - First, second, and third-line medications used to prevent migraine, with quick reference guides on antidepressants (an excellent table on sedation and weight gain), SSRIs, NSAIDs, calcium channel blockers, polypharmacy options, MAO inhibitors, and opioids.
  
  
• Hormones and Headache - An introduction to menstrual migraines with treatment options; special sections on headache during pregnancy and breastfeeding and headache during menopause and post-hysterectomy.
  
  
• Migraine Headache Sample Case Studies - Six sample case histories involving severe migraine with mild chronic daily headache; severe chronic daily headache; frequent migraine plus severe chronic daily headache and menstrual migraine; two migraines per month; severe refractive migraines plus chronic daily headache; and analgesic rebound headache with severe, frequent migraines and severe daily headaches.
  
  
• Introduction to Tension Headache and Tension Headache Abortive Medication - In-depth discussion of the clinical features and pathophysiology of tension headache including psychological comorbidities and the treatment of tension headache with first and second-line abortive medication. Tables of the criteria for chronic daily headaches, links between tension and migraine headaches, and the sources and strengths of caffeine make this a "must read" chapter.
  
  
• Tension Headache Preventive Medication - An introduction to tension, episodic tension and chronic tension headache with quick reference guides on prevention medications and criteria for the use of preventative medication. First, second and third-line prevention therapy for CDH is included. Robbins also discusses "last resort" treatments and what to do when nothing works including sedatives and long-acting daily opoids (with a frank discussion on prescription opiate addiction, dependence and tolerance; and the importance of monitoring opoids.
  
  
• Tension Headache Sample Case Studies - Two sample cases of severe chronic daily headache and occasional migraine and moderate to severe CDH, plus anxiety and depression.
  
  
• Introduction to Cluster Headache and Cluster Headache Abortive Medication - Includes a table on specific characteristics of cluster headaches and medications and nonmedication treatment of cluster headaches.
  
  
• Cluster Headache Preventive Medication - First, second and third-line preventives for episodic cluster headache; preventive meds for chronic cluster headache; and other therapies for prevention of episodic cluster headache.
  
  
• Cluster Headache Sample Case Studies - Three sample cases: a 40-year-old man with episodic cluster headache, a 58-year-old woman with episodic cluster headache, and a 34-year-old man with severe chronic cluster headache.
  
  
• Headache in Children and Adolescents - Practical guidelines for physicians to headache therapy for children and adolescents. Includes abortive and preventive medication discussion for children less than age 11 and adolescents 11 years and older who experience tension headache or migraine headache. First, second and third-line abortives and preventives discussed, together with handy quick reference guides. Emphasis on nonmedication techniques for adolescents.
  
  
• Special Headache Topics - Many headache areas including headache after age 50; post-traumatic headache; occipital nerve injections for neuralgia and unilateral headache syndromes; chronic paroxysmal hemicrania (CPH); hemicrania continua; SUNCT (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing); external and sexual headaches; organic pathology in exertional headaches and lumbar puncture headache.

Appendix A consists of reference citations on migraine headache, tension headache, cluster headache, headache in children and adolescents, and miscellaneous headache topics.

A useful drug identification guide and index can be found in Appendix B while Appendix C features a sample headache calendar for patients.

A list of foods to avoid for migraine patients is located in Appendix D and Relaxation Exercises for Headache Patients are detailed in Appendix E.

The most interesting appendix, entitled Clinical Pearls, can be found in Appendix F where Robbins shares 20 tips and clinical wisdom as he communicates the importance of trying and achieving for a balance between medication and headache.

Finally, Appendix G covers the use of herbs, vitamins, minerals and aromatherapy for headache.