Butalbital Headache - Is Your Fiorcet Causing Your Headaches?

Butalbital headache occurs when patients are taking medications such as Esgic, Esgic Plus or Fiorcet for treatment of headaches. Some of these also contain caffeine. Each of these brand name medications contain butalbital which is the generic form of the drug. For many years before the introduction of triptans such as Imitrex, Maxalt and others, most physicians handed out this medication to treat migraine.

Unfortunately, butalbital is a form of opiod and as a result can become addicting if used for a long period of time. Now when I say a long period of time, I mean using it for over six months and taking it more than three times per week.

Although not used as commonly as in previous years, generally when many people with migraine in their sixties present to a doctor for headache evaluation, about 75% of them come to doctor butalbital too frequently.

Butalbital Headache Symptoms

Butalbital can actually cause migraines to get worse. This happens when the drug is used more and more frequently, which results in transformational migraine. The migraines become more and more frequent and eventually run together to form daily headache.

With daily use, the headache becomes constant and is usually a lower level headache, perhaps rated a 3 or 4 out of 10 on a pain scale.(This is where 10 is severe disabling pain and you are in bed and perhaps crying.) The headache may be all over your head and have a throbbing quality.

Treatment of Butalbital Headache

If you have been on this medication for years, treatment depends on how much you are taking daily or weekly. Treated as a form of analgesic rebound headache in most clinics, doctors tend to use IV infusions of steroids for one or two days to break the cycle of pain. The patient is then on a lower dose of steroid for about a week.

Rarely, headache specialists use phenobarbital as a medication for a week or two with the steroids. This is used only when someone is taking multiple daily doses of butalbital. If patients are only using butalbital twice a week or so, Naprosyn 500mg might be substituted for this with success.

Caution: Stopping butalbital should NOT be done suddenly, as rarely a seizure might result. This type of treatment should be monitored by your physician.

Treatment should also include lifestyle changes and use of alternative therapies such as herbal headache remedies.

References:

Silberstein, Stephen D. McCrory, Douglas C. (2001) in the Treatment of Headache: History, Pharmacology, and Efficacy. Headache: The Journal of Head and Face Pain 41 (10), 953-967.

Loder, Elizabeth Biondi, David (2003) Phenobarbital Loading: A Safe and Effective Method of Withdrawing Patients With Headache From Butalbital Compounds. Headache: The Journal of Head and Face Pain43(8), 904-909.