Ziegler D K, Hurwitz A, Preskorn S, Hassanein R, Seim J
Department of Neurology, University of Kansas Medical Center, Kansas City, 66160-7314.
Arch Neurol. 1993 Aug;50(8):825-30. doi: 10.1001/archneur.1993.00540080036010.
To determine if the effectiveness of propranolol hydrochloride and amitriptyline hydrochloride are correlated with blood levels and/or with standardized test of pharmacologic effect and to determine which clinical variables are predictors of response to one or the other medication.
Three-month modules of treatment with each drug and placebo in a randomized crossover design. Headache scores from daily diaries were calculated at monthly intervals, as were simultaneous blood levels of drug, supine and standing blood pressure, pulse rise with exercise, and salivary flow.
Outpatient headache clinic at the University of Kansas Medical Center, Kansas City.
Thirty consecutive patients with a history of frequent migraine.
From headache scores, patients were classified as either propranolol responders, amitriptyline responders, or nonspecific responders. Clinical variables as predictors of response to medications were studied, as were effects on frequency, duration, and/or severity of headache.
No significant correlations were found between changes in headache score and blood level of drug or change in any of the physiologic measurements. Amitriptyline significantly reduced the severity, frequency, and duration of headache attacks; propranolol reduced the severity of attacks only. Amitriptyline response was correlated with female gender and baseline headaches of shortest duration and of highest frequency. Propranolol response was associated with attacks of greatest duration at baseline and with low pulse rise with exercise at baseline. Nonspecific response was associated with male gender and most frequent headaches by history.
确定盐酸普萘洛尔和盐酸阿米替林的疗效是否与血药浓度和/或药理学效应的标准化测试相关，并确定哪些临床变量可预测对这两种药物中任一种的反应。
采用随机交叉设计，每种药物和安慰剂进行为期三个月的治疗模块。每月计算每日日记中的头痛评分，同时测定药物血药浓度、仰卧位和站立位血压、运动时脉搏上升幅度以及唾液流量。
堪萨斯城堪萨斯大学医学中心门诊头痛诊所。
30例连续的有频繁偏头痛病史的患者。
根据头痛评分，将患者分为普萘洛尔反应者、阿米替林反应者或非特异性反应者。研究了作为药物反应预测指标的临床变量，以及对头痛频率、持续时间和/或严重程度的影响。
头痛评分变化与药物血药浓度变化或任何生理测量指标的变化之间均未发现显著相关性。阿米替林显著降低了头痛发作的严重程度、频率和持续时间；普萘洛尔仅降低了发作的严重程度。阿米替林的反应与女性性别以及最短持续时间和最高频率的基线头痛相关。普萘洛尔的反应与基线时最长持续时间的发作以及基线时运动时低脉搏上升幅度相关。非特异性反应与男性性别以及有记录的最频繁头痛相关。
