People who suffer from tension-type headaches that do not respond to over-the-counter (OTC) medications may find relief with combination drugs that include butalbital.
Commonly prescribed as Fioricet (butalbital/acetaminophen/caffeine) or Fiorinal (butalbital/aspirin/caffeine), butalbital is a sedative in the barbiturate class of medicines. While the drug causes intense relaxation and eases the pain of a tension headache, it is not without risks.
Tension Headaches
The most common type of headache disorder, a tension headache occurs when neck and scalp muscles become tense, or contract, meaning they squeeze down. This causes pain, often described as a rubber-band-around-the-head feeling or a pressure sensation, on both sides of the head.
Tension headaches can be triggered by a number of factors including stress, hunger, lack of sleep, anxiety, and temperature changes. They may occur at any age but are most common in adults and older teens. Some people are more prone or vulnerable to developing tension headaches than others, although the reason behind this is not very clear.
The good news is that most tension headaches are mild in pain and can be easily alleviated with rest, fluids, removal of the trigger, and/or an over-the-counter medication like Motrin (ibuprofen) or Tylenol (acetaminophen). Behavioral therapies too can be effective like physical therapy or cognitive-behavioral therapy.
Butalbital
When recurring tension headaches do not respond to other treatments, your doctor may prescribe Fiorinal or Fioricet. Codeine may also be added to this combination of medicine. While this medication is very effective in the short-term, there are some things to watch out for.
Butalbital is a barbiturate, which means that it helps to slow down the central nervous system and relax the muscle tension believed to be associated with tension headaches.
Before taking medication containing butalbital, tell your doctor if you:
- are allergic to any ingredients in the medication, such as acetaminophen or aspirin.
- are currently taking blood thinners, antidepressants, antihistamines, or other sedatives such as sleeping pills or tranquilizers
- have or previously had liver disease, porphyria, or depression
- are pregnant, plan to become pregnant, or are currently breastfeeding
Dosing
Always take these medications as prescribed by your doctor. The typical dosing for Fioricet or Fiorinal is one to two tablets, every four to six hours as needed, not to exceed six tablets per day. These drugs should not be taken more than twice a week, as extended and repeated use of butalbital can lead to physical dependence.
- Fioricet contains 300 mg of acetaminophen, 50 mg of butalbital, and 40 mg of caffeine.
- Fiorinal contains 325 mg of aspirin, 50 mg of butalbital, and 40 mg of caffeine.
Side Effects
Fioricet and Fiorinal should be taken with food or milk to prevent gastric problems. The following side effects have been reported in people taking medications containing butalbital:
- Confusion
- Depression
- Drowsiness
- Lightheadedness
- Stomach pain
- Upset stomach
- Vomiting
More serious side effects may occur and could be signs of an allergy or serious complications. See your doctor immediately if you experience any of the following:
- Difficulty breathing
- Itching
- Rash
Risks
Butalbital-containing medications can be habit-forming and may lead to addiction and other problems. Risks of taking Fioricet and Fiorinal include:
Intoxication
Butalbital slows the central nervous system, leading to lack of coordination, problems with thinking and memory, slowness of speech, disinhibition, and emotional disturbances. Do not drive or operate heavy machinery while taking medicines containing butalbital.
Medication Overuse Headache
Medication overuse headaches, a type of headache disorder that occurs when a person takes medication too frequently to treat their headaches, are common in patients who take butalbital medications.
With Fioricet or Fiorinal, a medication overuse headache or rebound headache can occur from taking it three times a week or 10 or more days a month.
In addition, medication overuse headaches are often not responsive to preventive headache medications. This lack of response to other medications is often a clue to doctors that a medication overuse headache has developed.
Medications containing butalbital should be limited to two days per week to avoid this rebound effect.
