BOOK REVIEWS
Heal Your Headache: The
1 -2-3 Program for Taking
Charge of Your Pain
David Buchholz, MD,
Workman Publishing
Company, Inc., 2002.
246 pages. Paperback,
$13.95.
Migraine, the most common
disabling primary headache, af-
fects 12.6% ofAmerican adoles-
cents and adults with self-re-
ported severe headaches. This
represents more than 35 million
migraineurs, and it does not spare
any ethnic population. The de-
cade of the brain helped expand
our basic understanding of many
neurological disorders. Moreover,
this was accompanied by consid-
erable growth in our therapeutic
arsenal. Migraine benefited con-
siderably, as better understand-
ing of the epidemiology, burden,
impact, and acute treatment fol-
lowed pathophysiology.
Unfortunately, in the real
world, 52% of migraine suffer-
ers go undiagnosed and are not
allowed to enjoy the benefits of
modern treatment. Instead, they
are frequently misdiagnosed to
have sinus, tension, or stress with
or without the headache designa-
tion. Additionally, less than 5%
of migraine sufferers have ever
been started on preventive agents,
despite the fact that at least 25%
meet frequency criteria for pre-
vention (.4 migraine attacks/
month). Thus, there exists a par-
adox where what is known about
migraine has not translated into
improved headache care.
Heal Your Headache: The 1-
2-3 Program for Taking Charge
ofYour Pain, a wonderfully well-
written and instructive self-help
1229 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
book for headache sufferers,
smashes the migraine paradox.
Written by Dr. David Buchholz,
a professor of neurology at Johns
Hopkins University School of
Medicine and a self-described
"contrarian," "ornery instigator,"
and "troublemaker," the book is
insightful, practical, and dis-
plays therapeutic attitude.
This book empowers head-
ache sufferers by introducing a
simple plan for headache con-
trol. The 1-2-3 Program is repre-
sented by three steps which in-
volve: 1) avoiding "quick fixes"
in that major significance is put
on analgesic rebound headache
(also known as rebound or med-
ication overuse headache); 2) re-
ducing headache triggers, partic-
ularly such oral triggers as
caffeine, dietary items, and med-
ications; and 3) raising headache
threshold, principally obtained
by using preventive medications
appropriately.
Emphasis is placed on elimi-
nating or preventing the devel-
opment of rebound headache by
limiting the use of acute head-
ache medications. Migraine suf-
ferers are thoughtfully instructed
in how important rebound is,
and useful methods are de-
scribed that help them get and
keep better headache control.
Considerable importance is
placed on headache triggers. Two
important concepts are intro-
duced that will help sufferers un-
derstand why and how-usually
with their physicians' assis-
tance-they get into trouble with
rebound medications or quick
fixes and dietary triggers. First,
in terms of triggers, two major
categories are discussed: those
that cannot be changed-e.g.,
weather, menses, and stress-and
those that can be changed-oral
fnsnPROGRAMdm
ofi~Jins !aok" P
FORTI CHA4RGE V(0
inniiOWaM.). QN( OF RPIN.
triggers. Thus, for sufferers to
help themselves get better, they
must change the things they can,
stop caffeine, and eliminate all
potential dietary triggers. The
second concept has to do with
headache threshold, the level at
which headache control is main-
tained. If triggers escalate above
this level, headaches are generat-
ed, but when triggers remain be-
low this level, headaches are
controlled. The unchangeable trig-
gers are always present, some-
times better or less active, but at
other times worse and extremely
active. Reducing oral headache
triggers improves the chance that
headache threshold will not be
breached. Additionally, two other
features characterize headache
threshold: it is lowered by anal-
gesic rebound, and it is raised by
preventive medications.
The description of migraine
as a syndrome with multiple
manifestations and a wide spec-
trum allows headache sufferers
to recognize how they are im-
pacted by specific and nonspe-
cific migraine symptoms and
comorbidity. Many of these fea-
VOL. 95, NO. 12, DECEMBER 2003
 BOOK REVIEWS

tures are larval or not typical of
the research criteria formulated
by the International Headache
Society for headache diagnosis.
However, migraine symptoms
are legion and usually respond to
appropriate pharmacological and
nonpharmacological management.
These are the kinds of issues,
dilemmas, and features that are
described in Heal Your Headache.
Many vignettes accompany and
expand the material, as sufferers
are helped to understand that they
are not victims, and they are not
alone; headache control is within
their grasp.
The major problem with this sels, which result in pain.
book is that it relies too heavily on Despite the over indulgence
the vascular hypothesis of mi- in the vascular hypothesis, this is
graine pathophysiology. Almost a very good self-help book for
everything is explained in terms headache sufferers. I highly rec-
ofblood vessels constricting or di- ommend it.
lating. Unfortunately, this is not
representative of the current hy- Reviewed by:
pothesis that suggests that mi- Steve D. Wheeler, MD
graine is a neurobiologic event. Director and Cofounder
Migraine appears to be generated Ryan Wheeler Headache Treat-
in the brain with subsequent stim- ment Center
ulation of the trigeminal-vascular 20601 Old Cutler Road
system. Stimulation ofthis system Miami, FL 33189
results in release of potent vaso- Phone: (305) 235-2243
active substances and dilation of Fax: (305) 235-1178
capsular or meningeal blood ves- DrHeadache@aol.com

S* *..

The Cardiology Division at the University of

Maryland School of Medicine is recruiting a
non-invasive cardiologist at the Assistant/ As-
sociate Professor rank who will be based at
the Baltimore Veterans Administration Med-
ical Center. The individual should be board
certified/board eligible. Position involves full-
time participation in all aspects of general
and critical care cardiology. Participation in
teaching and research is expected. Appli-
cants for the above position will possess an
M.D. degree from an accredited medical
school. Salary is commensurate with experi-
ence. Interested individuals should submit a
current CV and list of three references to the
attention of C. William Balke, M.D., Professor
and Head, Cardiology Division, c/o Millie
Bileck, Department of Medicine, Division of
Cardiology, Room G3K18, University of Mary-
land Medical Center, 22 S. Greene St., Balti-
more, MD 21201. Communication by e-mail is
also acceptable (mbileck@medicine.umary-
land.edu). The UM,B encourages women
and members of minority groups to apply
and is an AA/ EEO/ADA Employer. Reference
Position 03-309-380.
HEALTH SYSTEM
University of Virginia School of Medicine, Department of
Urology, is seeking a senior level clinician with expertise
in infertility, and clinical trials experience. The applicant
will have completed a Urology residency and post
residency fellowship training. The applicant should also
have an interest in treating general urology patients.
Research interests should include clinical trials on sexual
function. This position is tenure eligible and the position
will remain open until filled. Send a CV and arrange for
three letters of recommendation to be forwarded to:
William D. Steers, M.D.
Professor and Chairman
Department of Urology
University of Virginia Health System
P.O. Box 800422
Charlottesville, VA 22908
The University of Virginia is an Equal
Opportunity/Affirmative Action employer. Women and
minorities are encouraged to apply.

JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 95, NO. 12, DECEMBER 2003 1230