We read with interest the article by Ziegler et al, entitled "Propranolol and Amitriptyline in Prophylaxis of Migraine: Pharmacokinetic and Therapeutic Effects," published in the August 1993 issue of the Archives,1 and we would like to add a couple of comments.
The authors report that the clinical effect of propranolol in migraine did not correlate with drug plasma levels or with measurements of the β-adrenergic blocking action. They state that the lack of correlation between propranolol plasma levels and clinical effects in migraine was previously reported only in one other study.2 We reported similar findings in an article published in the Archives3 in 1985, in which we showed that relief of migraine was not correlated with plasma concentrations of propranolol or its active metabolite, 4-hydroxy-propranolol. Also in that article, modifications of supine blood pressure and supine pulse rate induced by propranolol were not related to the antimigraine
Cortelli P, Albani F. Propranolol in Prophylaxis of Migraine. Arch Neurol. 1994;51(12):1181–1182. doi:10.1001/archneur.1994.00540240025008
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