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The Child with Headache: diagnosis and treatment
  1. I Abu-Arafeh

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Over the past 10–15 years there has been a large volume of research into headache, in general, and childhood headache in particular. Research interest and publications have covered vast areas of previously neglected aspects of childhood headache including epidemiology, pathogenesis, clinical features, classification, impact on child's life and education, management, psychological adjustment, and medical treatment. Two major developments have helped to drive research into childhood headache and migraine. Firstly, the publication of the classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain by the International Headache Society in 1988 triggered better understanding, research interest and debate into headache. Secondly, the introduction of a new generation of specific anti-migraine medications in the early 1990s has started a huge wave of research into migraine. Sumatriptan was the first of many 5HT1 agonists to show effective relief of migraine headache in adults associated with high expectation for a strong potential in children. The two factors drove the research into childhood migraine many steps forwards.

Unfortunately despite the huge amount of new knowledge on the subject and, possibly, the increased prevalence of headache and migraine in children, there is more need now than ever for an up to date publication on the subject. Until now, only two books on childhood headache and migraine are available on the paediatric bookshelf. The Classical books of Charles Barlow (Headache and migraine in childhood, Oxford: Blackwell Scientific, 1984) and that of Judith Hockaday (Migraine in childhood, London: Butterworth, 1988) remained the most recent sources of information and advice for practising paediatricians and general practitioners. Therefore, this book comes at an appropriate time to fill some of the gaps in the paediatric literature.

The book deals mainly with the diagnostic issues, differential diagnosis, and the management of childhood headache in a simple and practical way. Complex concepts and mechanisms were introduced and discussed with simplicity that made the reading of the book flow easily. Headache was introduced as a pain syndrome that has its own methods of measurement and management in the early parts of the book. The general direction of the book was determined, therefore, by the fact that 7 out of the 10 contributing authors been pain scientists, clinical psychologists, or child psychiatrists. Such an influence towards the psychology of pain has enhanced the quality of the book and enriched its value and contents. Therefore, the book provides the researcher on the subject of pain and headache a valuable reference to understand difficult issues in relation to pain measurement, impact of pain and headache on child's life and also the management of headache including behavioural modification.

From the point of view of the practising general paediatricians who deal with children with headache in busy medical paediatric clinics, the book provides a good brief overview of the causes of headache, diagnostic assessment, and treatment. The use of simple data collection sheet would be very useful to assist the attending physician in establishing the diagnosis of the type of headache and also in identifying both the trigger and relieving factors. The editors propose, in two appendices, lengthy interviews of the child and the parents that may defy the practicality of the consultation. It would be more appropriate to the clinician if those interviews were short and direct. Also, diaries would be a useful tool to help understand the child's headache by recording symptoms as they occur.

There is no doubt that this book will prove to be an important and useful resource for paediatricians treating children with headache. Other publications dealing with the practical issues and the organisation of headache services for children are also needed.

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