Book review: Advanced Headache Therapy
Several months ago I purchased a Kindle version of Advanced Headache Therapy by Dr. Larry Robbins. It has taken me some time to finish reading it, mainly because it's not the kind of book that you read from cover-to-cover. It doesn't have a plot. It's a guidebook. So unless you're a healthcare professional or patient advocate, you probably wouldn't read it all at once. It's more likely that you would use it as a reference guide to generate new treatment ideas to discuss with your own doctor.
It is the overview of one doctor's clinical judgement. In this book, Dr. Robbins shares his approach to treating migraine and other headache disorders. His opinions are based on solid research, but he's not afraid to express his opinion when it differs from that of prevailing headache treatment practices. With the best interests of his patients in mind, he thinks for himself rather than following a cookie-cutter approach. In my opinion, that's the kind of doctor we all deserve.
He discusses pharmaceutical treatments at length. That's to be expected, considering the sheer number of options available for acute and preventive treatment. He also discussed his rationale for choosing migraine treatments partly based on the presence of comorbid conditions. For example, a tricyclic antidepressant might be prescribed for a patient with both migraine and depression while a patient with hypertension might be a better candidate for beta blockers or calcium channel blockers. One of his examples really impressed me because of his attention to quality of life and how that is impacted by pharmaceutical treatment. In this example he explains why he might not use Amitriptyline or Depakote for a patient already complaining of fatigue and weight gain as both of these medicines have weight gain and fatigue as potential side effects.
But the book doesn't stop with pharmaceutical treatments. He says that "it takes a village" to effectively treat headache disorders. He goes on to describe the reasons why he might recommend physical therapy, massage, acupuncture, biofeedback, psychotherapy, and much more. He doesn't shy away from admitting that medication alone is only one part of effective migraine management. He doesn't come out and say it, but what he is describing is multidisciplinary, complementary medicine with a mind-body approach.
He also discusses ways to engage patients in active coping such as exercise, sleep hygiene, mindfulness, and other non-medical strategies. His description of exercise was similar to that of my own headache doctor. Both encourage patients to strive for 20 minutes of physical activity 3-4 times a week. Dr. Robbins acknowledged that exercise can be a trigger and recommends migraineurs use exercise strategies that minimize the risk of overheating such a yoga or Pilates. He also suggests breaking up activity into 5-10 minute increments a few times each day. Those are the strategies that have helped me maintain the habit of regular exercise, so it was nice to get confirmation that I am using a good approach.
The book is comprehensive, but not full of scientific jargon that would confuse the average person. It's an easy read for patients. The down side is its cost. A hardback copy is over $100.00. Even my Kindle version cost about $70.00. If I didn't think I would use this information to improve my understanding of migraine treatment beyond my own health care, I'm not sure I would have purchased it. There is one exception though. Since the price of the book is less than the out-of-pocket costs to consult with a true headache specialist, I might consider buying a copy if I didn't have access to a specialist. There is so much information that it would likely generate new ideas for me and my doctor to consider. In that situation, I would view buying the book as an investment in my own health care education.
Not everything in the book is directed at patients. Reading some of it was like listening in on a conversation between an experienced headache specialist and a new doctor in training. If you have limited access to high quality experts, this book can become a helpful guide when looking for a good doctor because it demonstrates how good headache specialists think. Every doctor will have their own opinions about what works based on their own clinical experience. You might find a great doctor who doesn't agree with everything in Advanced Headache Therapy. That's typical and perfectly okay. As a patient, it has helped me understand how experts make treatment recommendations. It also helps me feel okay about terminating a relationship with doctors who aren't up to date on the most recent treatment recommendations.
Overall, it has been a good education. In the long term, it will be useful reference guide for my own healthcare and for educating others about treatment options.
When was your last migraine check-up?