Butalbital Medications for Headaches and How to Safely Stop Them

Rebound Headache and Withdrawal from Butalbital-Containing Medications

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Butalbital-containing medications, like Fiorinal (butalbital/aspirin/caffeine) and Fioricet (butalbital/acetaminophen/caffeine), are commonly over-utilized in the treatment of headaches.

Let's explore the use of butalbital-containing medications for your headaches, and how a person can safely withdraw from them under a doctor's care.

What is Butalbital?

Butalbital is a short-acting barbiturate, often used in combination with Tylenol (acetaminophen), aspirin, and/or caffeine to treat headaches.

As a barbiturate, it depresses or slows down the central nervous system, causing a number of effects, depending on the dose. At lower doses, it relaxes muscles, providing headache relief for some. At higher doses, barbiturates are used as sedatives and even for anesthesia.

Why is Butalbital not an Ideal Headache Medication?

A person who takes butalbital for their headaches is at risk for developing chronic headaches and/or medication overuse headache, also known as a rebound headache.

With a rebound headache, a person feels an increase in their head pain intensity after abruptly stopping their medication. This increased pain makes it extra difficult to discontinue the medication, which perpetuates the headache cycle. Taking medications as few as two to three times a week can lead to a rebound headache. According to scientists, it's more the frequency than the actual dose that is a bigger risk factor in developing a rebound headache.

 

Breaking the Cycle of a Butalbital Rebound Headache

When a person stops butalbital, they are at risk for withdrawal symptoms, especially if they are taking frequent and/or high amounts. In this case, a gradual taper off butalbital is necessary to prevent seizures — a potential withdrawal symptom. 

Phenobarbital, a long-acting barbiturate, can help patients withdraw from large amounts of butalbital-containing medications.

The administration of phenobarbital is done gradually, in a tapered fashion. This means that the dose is slowly decreased every couple days and is done in a monitored setting under the care of a physician. On average, the withdrawal process can take 3 weeks. This is not a hard and fast rule though and may be longer or shorter based on the dose and frequency of butalbital the person had been taking. It also depends on the presence of distressing withdrawal symptoms while in the hospital. 

What Does This Mean for Me?

If you are concerned about your use of butalbital, please speak with your doctor before altering the dose or frequency on your own. It's also imperative you speak with your doctor during the withdrawal process about safer strategies to treat your headaches in the future. Your doctor may recommend a preventive headache medication or alternative therapies, like biofeedback or meditation, to supplement your headache medications.

Sources:

American Headache Society. (2015). Too Many Migraine Patients Are Getting Opiods and Barbiturates for Their Pain. Retrieved November 23rd 2015. 

American Headache Society. (2008). Chronic Daily Headache and Chronic Migraine. Retrieved November 23rd 2015.

Loder E & Biondi D. Oral phenobarbital loading: a safe and effective method of withdrawing patients with headache from butalbital compounds. Headache. 2003 Sep;43(8):904-9.

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