Book Review: Advanced Headache Therapy
Lawrence Robbins, MD
Although headache is one of the most common medical complaints, the majority of evidence-based treatments are limited to the episodic form of the condition that is more responsive to care. In the absence of evidence, we are left to observations. Concerning observations, Louis Pasteur noted, “chance favors the prepared mind.” A lifetime of observations has been complied in Advanced Headache Therapy by Lawrence Robbins, MD.
This book joins an increasing number of texts from Springer dedicated to headache management, but it stands out as it discusses many non-pharmacological approaches, such as resilience and acceptance. Dr. Robbins also delves into the reason why certain individuals fail the usual therapies. The strength of this book is its focus on what to do when “everything” has failed.
Advanced Headache Therapy is written out of experiences encountered when the “usual” fixes didn’t fix. It is understandable that headache physicians become discouraged over time when they are seeing patients in follow up whom they have not been able to help much. These patients are often labeled “failures.” However, it is not helpful simply to know that someone failed a therapy; we must know why he or she failed. Dr. Robbins highlights many of the reasons why patients do not respond well to treatment—from undiagnosed or undertreated mood disorders, to personality disorders or additional medical comorbidities.
Where available, evidence is applied but more importantly years of “Clinical Pearls” are highlighted, allowing us to learn from a real-world clinician.
Covered topics include: refractory headaches, pediatric headaches (including return to school issues), cluster headaches, and psychological comorbidities, with case studies that reinforce the importance of taking care of the whole person. Significant attention is paid to the “end of the line” patient with an honest discussion of opioids and butalbital. Significant attention is paid to refractory migraine treatment options, including sphenopalatine ganglion blocks, monoamine oxidase inhibitors, frequent triptans, Botox, opiates, and stimulants.
This book principally represents Dr. Robbins’ opinion, which is both its strength and weakness. While a section covering secondary headaches in geriatric patients would have been a welcome addition, overall, the entire book is full of practical outpatient clinical advice. The greatest lesson I have learned from Dr. Robbins is not to punish people for their brain chemistry. Now, whenever I don’t know what to do for someone, I approach the situation as if there is something new I need to learn. Advanced Headache Therapy provides all of us with a tremendous learning resource.
Readers of Practical Pain Management are already familiar with Dr. Robbins as a frequent contributor and Editorial Board member. Now with Advanced Headache Therapy, the rest of the pain management community will have the opportunity to benefit from his clinical expertise and wisdom.