Downsides of Taking Fiorinal or Fioricet for Headaches

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. Although the drug causes intense relaxation and eases the pain of a tension headache, it is not without risks.

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.

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.1

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

Always take these medications as prescribed by your doctor. According to the manufacturer, the typical dose 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 50 milligrams (mg) butalbital, 300 mg acetaminophen, and 40 mg caffeine.2
  • Fiorinal contains 50 mg butalbital, 325 mg aspirin, and 40 mg caffeine.

     

Downsides of Taking Fioricet

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Dizziness, drowsiness, lightheadedness, sedation, shortness of breath, nausea, vomiting, abdominal pain, or an intoxicated feeling are the most commonly reported side effects.
  • Other side effects, such as constipation, excessive sweating, itch, serious skin reactions, and mental confusion are less common.
  • Butalbital is habit-forming and there is a high risk of dependence with extended and repeated use of Fioricet. Therefore it is not considered a first-choice medicine for headaches.
  • May cause medication-overuse headache with repeated use and a withdrawal syndrome upon discontinuation.
  • The potential for liver damage with the acetaminophen component exists, even at recommended dosages. The risk is increased with higher dosages, with chronic alcohol use, with some medications, and in patients with significant liver disease.
  • May not be suitable for some people, including the elderly and people with kidney or liver disease.
  • Although Fioricet may be prescribed for migraine headaches, it is not FDA approved for this and evidence does not support its use for migraine.
  • Should not be used during pregnancy or breastfeeding.
  • May interact with a number of other medications including those that also cause sedation such as opioids, benzodiazepines, and sedating antihistamines. Alcohol should be avoided.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

Side Effects of Taking Fioricet

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:4

      • Difficulty breathing
      • Itching
      • Rash

Risks of Taking Fioricet

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

A medication-overuse headache (MOH), once known as a rebound headache, drug-induced headache, or medication-misuse headache, is a chronic headache that develops as a result of prolonged and frequent use of certain medications for acute headaches. Such headaches are a common side effect of a number of classes of medications used to treat headaches.

According to the International Classification of Headache Disorders, MOH is diagnosed when a person has a headache 15 or more times a day and, in the case of combination pain relievers like Fioricet and Fiorinal, has been taking the drug for 10 days a month for more than three months.

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.

Withdrawal

When taking butalbital, you may experience withdrawal symptoms within eight to 36 hours after the last dose. Withdrawal symptoms may include anxiety, muscle twitching, tremor, weakness, dizziness, nausea and vomiting, insomnia, weight loss, and even seizures when the medication is discontinued.

Due to the risk of seizures with a withdrawal from butalbital, medical treatment in a monitored setting under the care of a physician is indicated.

Tolerance and Addiction

Tolerance and addiction may also occur with butalbital. Tolerance means that a person needs more of the medication to achieve headache relief. Addiction to butalbital is characterized by persistent behaviors, like compulsions, to take a butalbital-containing medication.

These behaviors impair their life in some way, negatively impacting relationships and/or everyday functioning.

Acetaminophen Overdose

Do not take Fioricet along with other medications that contain acetaminophen as it can be toxic to the liver.

 

Migraine Symptom

Fioricet is a combination medication composed of acetaminophen (Tylenol’s main ingredient), caffeine, and butalbital. It is used to relieve tension headaches and can also be prescribed to treat mild to moderate migraine.

Butalbital belongs to the barbiturate class of medication, which means it is a sedative, or relaxant. This makes Fioricet a barbiturate. Because it contains acetaminophen and caffeine, it is also a pain reliever and a stimulant.

Medications containing this combination of ingredients come in capsule and tablet forms, which can be taken by mouth. This combination of medications is also available in generics. Other brand names and formulations include:

What is Migraine ?

Migraine is a common neurological condition that affects millions of people from all ages, nationalities and gender. Like any other disease, its presence is manifested by symptoms felt by the sufferer and whose existence allows physicians to make a diagnosis.

Fioricet for Migraine
Fioricet for Migraine

The most common migraine symptom and the most recognizable as well, is the headache. Although it is not present in the rarer forms of the disease, it is one evident sign of migraine. The headache that accompanies a migraine is not the kind that gives a dull ache. The pain felt by migraines is the intense, throbbing kind which sometimes necessitates complete rest and disrupts normal daily functions. However, a headache is not the only indicator that signals a migraine.

Depending on the migraine attack, a host of other symptoms arise as well. Analyzing them helps the medical practitioner in determining what type of migraine the patient is suffering from and in prescribing the appropriate medications.

An inventory of migraine symptoms could be quite lengthy due to the various types of the disease. A generalized list of these include: severe headache on one or both sides of the head, nausea, vomiting, weakness, vision disturbance, sensitivity to light and sound, pain over one eye, aura, blurred vision and temporary blind spots. When the migraine comes with aura, this gives rise to a whole new set of symptoms that consists of: seeing flashing lights or zigzag lines, temporary blindness, speech difficulty, tingling and weakness in the limbs and face, confusion, giddiness and noise sensitivity.

This does not mean the sufferer undergoes all the symptoms during the attack. Most likely, he will experience only a few. Symptoms also vary from person to person. Further, a migraine symptom could be felt days before the attack, during the prodrome stage. In these times, the migraineur has unexplained feelings of elation or intense energy, cravings for sweets, thirst, drowsiness or irritability and depression.

Diagnosing migraine is not an easy task for the physician. In order to make an accurate evaluation, he will need to have as much information as possible, obtained from the patient and from medical tests conducted. Observation and analysis of symptoms is very helpful in arriving at a diagnosis. By knowing what symptoms are experienced by the patient, the specialist will be able to tell what type of migraine it is and what treatments are to be administered.

During consultation, the patient will be required to describe the duration and frequency of his All kinds of Headache and how intense they are, where pain is located, presence of associated symptoms and behavior during a headache.

Since other illnesses also exhibit similar sings to migraine, these have to be ruled out. A case in point is the fact that people with sever sinusitis also experience double vision and vision loss.

Experiencing migraine, however mild, is not a pleasant event. But the sufferer can put this to good use by being observant and recording what he is going through. The complexity of migraine and the difficulty in diagnosing it means that no detail is insignificant. Thus, if the patient is to take an active role in the management of his disease, he needs to be vigilant of every single migraine symptom.

Migraine Symptoms

Migraines, which often begin in childhood, adolescence or early adulthood, can progress through four stages: prodrome, aura, attack and post-drome. Not everyone who has migraines goes through all stages.

Prodrome

One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including:

  • Constipation
  • Mood changes, from depression to euphoria
  • Food cravings
  • Neck stiffness
  • Increased thirst and urination
  • Frequent yawning

Aura

For some people, aura might occur before or during migraines. Auras are reversible symptoms of the nervous system. They’re usually visual, but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes.

Examples of migraine aura include:

  • Visual phenomena, such as seeing various shapes, bright spots or flashes of light
  • Vision loss
  • Pins and needles sensations in an arm or leg
  • Weakness or numbness in the face or one side of the body
  • Difficulty speaking
  • Hearing noises or music
  • Uncontrollable jerking or other movements

Attack

A migraine usually lasts from four to 72 hours if untreated. How often migraines occur varies from person to person. Migraines might occur rarely or strike several times a month.

During a migraine, you might have:

  • Pain usually on one side of your head, but often on both sides
  • Pain that throbs or pulses
  • Sensitivity to light, sound, and sometimes smell and touch
  • Nausea and vomiting

Post-drome

After a migraine attack, you might feel drained, confused and washed out for up to a day. Some people report feeling elated. Sudden head movement might bring on the pain again briefly.

When to see a doctor

Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which could indicate a more serious medical problem:

  • An abrupt, severe headache like a thunderclap
  • Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
  • Headache after a head injury, especially if the headache worsens
  • A chronic headache that is worse after coughing, exertion, straining or a sudden movement
  • New headache pain after age 50

Migraine Causes

Though migraine causes aren’t fully understood, genetics and environmental factors appear to play a role.

Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. So might imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system.

Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).

Migraine triggers

There are a number of migraine triggers, including:

  • Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.Hormonal medications, such as oral contraceptives and hormone replacement therapy, also can worsen migraines. Some women, however, find their migraines occurring less often when taking these medications.
  • Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.
  • Stress. Stress at work or home can cause migraines.
  • Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — including perfume, paint thinner, secondhand smoke and others — trigger migraines in some people.
  • Sleep changes. Missing sleep, getting too much sleep or jet lag can trigger migraines in some people.
  • Physical factors. Intense physical exertion, including sexual activity, might provoke migraines.
  • Weather changes. A change of weather or barometric pressure can prompt a migraine.
  • Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
  • Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skipping meals or fasting.
  • Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods.

What should I do if i get a headache ?

So many North American people suffer headache and most of them can be treated by advil, asprin, or tylenol and other OTC medicines.

We encourage you to manage your headache by exercises, try to reduce stress,  sleep, exercise, and eat on a regular schedule and use OTC medicines to prevent headache.  Eat medicines before you feel you will get headache. In sometime, Headaches cannot be treated by OTC medicines and you have to use fioricet to cure your headaches.

Headaches are one of the most common forms of chronic pain (second only to back troubles). Anyone who’s suffered the splitting pain of a headache — especially a migraine — knows how difficult it can be to drive, work, and even carry on a conversation while your head is pounding.

But when a headache strikes, you can do more than just crawl into bed and wait for it to go away. There are effective headache treatments available and ways to find quick relief.

Headache Treatment: Medications

Just about any over-the-counter (OTC) pain reliever can offer relief for non-migraine headaches, also known as tension headaches, says Jack M. Rozental, MD, PhD, a migraine specialist at Northwestern Memorial Hospital in Chicago. Medications that contain only one drug (acetaminophen, ibuprofen, naproxen, or aspirin) are an effective headache treatment, he says, as are those that include a combination of aspirin, acetaminophen, and caffeine.

For those who suffer from frequent or recurring headaches, doctors sometimes recommend prescription-strength doses of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen.

Indomethacin, an NSAID that is available only by prescription, is “usually used for arthritis, but can also be very useful as a headache treatment,” Dr. Rozental says. “Indomethacin’s downside is that it is among the drugs most likely to cause gastric irritation,” including stomach ulcers and bleeding.

These prescription drugs are sometimes used to treat migraine headaches:

      • Butalbital, a barbiturate often used in combination with acetaminophen, caffeine, aspirin, and/or codeine
      • Narcotics, such as oxycodone, hydrocodone, hydromorphone, or codeine
      • Butorphanol, a narcotic nasal spray
      • Tramadol

Unfortunately, the risk with many of these prescription drugs is that they can lead to substance abuse and dependence, Rozental says. Butorphanol, in particular, “should be avoided because of its very high propensity to cause dependence after even minimal use,” he explains.

Frequent use of any pain reliever, including OTC drugs, can also cause what are known as rebound or medication-overuse headaches, says Rozental. To treat this type of headache, all pain-relieving medications must be stopped for at least three months. If you’re consistently taking large doses of OTC medications to treat recurrent headaches, talk to your doctor about your symptoms.

Headache Treatment: Tips to Cope

Fortunately, many headaches can be at least partially alleviated without medication, which will help minimize your need for pain relievers and reduce your risk of rebound headaches. Here are some tips for headache relief:

      • Close your eyes and rest. This is an effective headache treatment for a migraine headache, and can help ease a tension headache as well. Sit in a quiet, dark room with your eyes closed and just relax for a bit. “Patients with migraine instinctively seek out a dark, quiet environment in which they can go to sleep for at least a few hours,” Rozental says. “Sleep frequently diminishes or eliminates the pain.”
      • Massage your neck and temples. Rubbing your neck and temples can improve blood flow and soothe tension headaches.
      • Warm up your neck Try putting a heating pad or a warm cloth around your neck and the base of your skull to ease tension headaches. If that doesn’t help, you can apply an ice pack instead to see if that brings you headache relief.
      • Relax. Meditate, breathe deeply, and try to visualize a peaceful image. “Various relaxation techniques can significantly help patients who suffer from ‘muscle contraction’ headaches,” says Rozental.
      • Minimize stress. If you have a bad headache, try to step away from stress, literally. Avoid noisy environments, leave work a little early if you can, or ask your partner to take care of chores or the kids.
      • Watch what you eat and drink. What you put into your body can have a big impact on your headaches. Rozental advises limiting caffeine and alcohol and avoiding cigarettes. He also says regular meals are important, especially for people who get headaches from low blood sugar. “Do not skip meals, particularly breakfast,” he urges.

A headache can certainly put your activities on hold until you’re feeling better, but getting the right treatment can help you feel better, faster. Instead of trudging through your day with a headache, take time out to care for yourself.

Medications can get your head to stop pounding, but a little relaxation and time for yourself can also help.

Can coenzyme Q10 help with migraines?

Research on CoQ10 use for specific conditions and activities shows:

  • Heart conditions. CoQ10 has been shown to improve symptoms of congestive heart failure. Although findings are mixed, CoQ10 might help reduce blood pressure. Some research also suggests that when combined with other nutrients, CoQ10 might aid recovery in people who’ve had bypass and heart valve surgeries.  Only a few studies have looked at whether CoQ10 might help prevent heart disease, and their results are inconclusive. Research on the effects of CoQ10 in heart failure is also inconclusive. However, there is evidence that CoQ10 may reduce the risk of some complications of heart surgery.
  • Parkinson’s disease. Early research suggests that high doses of CoQ10 might be beneficial for people in the early stages of this progressive disorder of the nervous system that affects movement. A major National Institutes of Health-funded study showed that CoQ10, even in higher-than-usual doses, didn’t improve symptoms in patients with early Parkinson’s disease. A 2017 evaluation of this study and several other, smaller studies concluded that CoQ10 is not helpful for Parkinson’s symptoms.
  • Statin-induced myopathy. Some research suggests that CoQ10 might help ease muscle weakness sometimes associated with taking statins.
  • Migraines. Some research suggests that CoQ10 might decrease the frequency of these headaches.The Canadian Headache Society guideline for migraine prophylaxis recommends, based on low-quality evidence, that 300 mg of CoQ10 be offered as a choice for prophylaxis. Guidelines from the American Academy of Neurology and the American Headache Society say that CoQ10 is “possibly effective” in preventing migraines.
  • Physical performance. Because CoQ10 is involved in energy production, it’s believed that this supplement might improve your physical performance. Research in this area has produced mixed results, however.
  • CoQ10 has not been shown to be of value in treating cancer, but it may reduce the risk of heart damage caused by one type of cancer chemotherapy drug.
  • CoQ10 can reduce muscle pain  – Although results of individual studies have varied, the overall scientific evidence does not support the idea that CoQ10 can reduce muscle pain caused by the cholesterol-lowering drugs known as statins.
  • Blood pressure – The small amount of evidence currently available suggests that CoQ10 probably doesn’t have a meaningful effect on blood pressure.
  • Other Health Conditions – CoQ10 has also been studied for a variety of other conditions, including amyotrophic lateral sclerosis (Lou Gehrig’s disease), Down syndrome, Huntington’s disease, and male infertility, but the research is too limited for any conclusions to be drawn.

Generally safe

CoQ10 supplements might be beneficial for treating conditions such as congestive heart failure and Parkinson’s disease. CoQ10 is considered safe, with few side effects. However, be sure to take this supplement under your doctor’s supervision.