Artigo Acesso aberto Revisado por pares

The Woman's Guide to Managing Migraine: Understanding the Hormone Connection to Find Hope and Wellness

2013; Elsevier BV; Volume: 111; Issue: 3 Linguagem: Inglês

10.1093/bja/aet263

ISSN

1471-6771

Autores

Marian O’Connor,

Tópico(s)

Migraine and Headache Studies

Resumo

This is a book for patients, written by a Californian Family Practitioner and Associate Clinical Professor. It was obvious from first glance that it is packed with anecdotes. I am afraid I started with a Marvin the Android view that I really was not going to enjoy this at all. In fact, and to my surprise, I did enjoy reading it greatly, although not necessarily for the obvious reasons. There are many good things to say. The writing style is clear, lucid, and engaging. Key points are summarized in boxes. The explanation of the pathophysiology of migraine makes sense of a confusing condition. The classification of headaches, and the importance of diagnosis would be comfortingly familiar to any UK reader acquainted with the current NICE guidelines. Medication overuse (probably the most common form of headache I see) is given the prominence it deserves. Non-medical treatments (including homeopathy) are discussed sensibly. The collaborative approach between patient and practitioner is praiseworthy and brought out in the author's comment that understanding of the condition can ‘help you be a better advocate for yourself’. It is well referenced, and given that this is a book directed at patients, it is impressive that the author expects them to have the potential to visit source material. However, my particular enjoyment in reading the book is inextricably entwined with its problems for a UK audience. George Bernard Shaw reportedly remarked that we and our American cousins are ‘two countries divided by a common language’. This book demonstrates splendidly that in fact we are separated by a vast range of cultural differences, both in general terms and particularly in the practice of medicine. I was fascinated to see among the anecdotes that patients’ husbands (remember this is a ‘Woman's Guide’) might deal with their spouse's headache by going off to play beach volleyball on their own. I can reliably report that this is a coping strategy that has absolutely never come up in my own clinic in Swindon (perhaps in Truro or Weston-super-Mare…). Similarly, husbands can go to a tee party; no not Lapsang-Souchong and cakes, rather golf with your mates. Some of the differences around medical context are equally fun; I doubt that many British gynaecologists routinely call their patients, ‘Honey’; at least not those wishing to stay in practice for any length of time. Other differences are more problematic. Drug names of course are different; however, even when I thought I had caught the gist; Fioricet (butalbital–acetaminophen–caffeine)—surely that is going to be one of those odd over the counter combinations related to co-codamol?—it turns out I was hopelessly wrong. Yes I knew acetaminophen was paracetamol (although a patient might not), but I was shocked to discover that butalbital is not a weak opioid, it is an addictive barbiturate. In all fairness, the author is not advocating Fioricet, she is pointing out its dangers. However, I was taken aback at the recommendation that a home supply of injectable strong opioids is worth considering. Of course, context is all, and my point is less that these ideas are absolutely wrong; they may be reasonable in the context of Californian healthcare (although I would need to be convinced about the availability of an addictive barbiturate), they are not translatable to the UK. So in conclusion, I really did enjoy this book. It is an excellent overview of migraine, particularly in the context of fluctuating hormonal levels. It is also a fascinating text about cultural differences. But it is not really a book that is going to appeal to a UK doctor. It might be a book for the already well-informed patient wanting to extend her knowledge; it would be utterly perfect if she already had a background in cross-cultural studies and a degree in pharmacology.

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