Pfaffenrath V, Kellhammer U, Pöllmann W
Cephalalgia. 1986;6 Suppl 5:25-32. doi: 10.1177/03331024860060S503.
In the prophylaxis of migraine beta-blockers are commonly used. In the therapy of tension headache (TH) the use of tricyclic antidepressives is widespread. Therefore, from a rational point of view, one should combine an antidepressive and a beta-blocker in the treatment of combination headache (CH), in which patients have both migraine and TH. In an open uncontrolled study, 61 patients with CH received a combination of an antidepressive (amitriptyline) or amitriptyline-N-oxide and a beta-blocker (propranolol or metoprolol) for at least 3 months. The 61 patients kept a diary in which they recorded frequency and duration of migraine attacks and tension headaches. The median migraine attack frequency decreased in the 3 months from four to two and the mean attack duration per month from 2 to 0.7 days. TH frequency was reduced from a median of 21 days to 6 days; TH duration fell from a median of 21 days to 2.7 days. At first sight, this treatment appears to be highly effective, at least when judged by the results at the group level. Nevertheless, in an open uncontrolled study like this, one must be aware of many problems, which are discussed in detail.
在偏头痛的预防中，β受体阻滞剂被广泛使用。在紧张性头痛（TH）的治疗中，三环类抗抑郁药的使用很普遍。因此，从合理的角度来看，在治疗既有偏头痛又有紧张性头痛的混合性头痛（CH）时，应该将一种抗抑郁药和一种β受体阻滞剂联合使用。在一项开放的非对照研究中，61例混合性头痛患者接受了一种抗抑郁药（阿米替林）或氧化阿米替林与一种β受体阻滞剂（普萘洛尔或美托洛尔）的联合治疗，为期至少3个月。这61例患者记录日记，在日记中记录偏头痛发作和紧张性头痛的频率及持续时间。在3个月内，偏头痛发作的中位数频率从4次降至2次，每月发作的平均持续时间从2天降至0.7天。紧张性头痛的频率从中位数21天降至6天；紧张性头痛的持续时间从中位数21天降至2.7天。乍一看，这种治疗似乎非常有效，至少从组水平的结果判断是这样。然而，在这样一项开放的非对照研究中，必须意识到许多问题，本文将详细讨论这些问题。
