The Downsides of Taking Fiorinal and Fioricet for Your Headaches

Risks of Taking Fioricet and Fiorinal and When They May be Indicated

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Fioricet (butalbital/acetaminophen/caffeine) and Fiorinal (butalbital/aspirin/caffeine) are medications sometimes used to treat tension-type headaches. While effective in the short-term, there are a number of downsides to taking these medications, mostly because they contain butalbital. 

Let's understand butalbital in a bit more detail, and why its use should be limited for your headache health. 

What is Butalbital in Fioricet and Fiorinal?

Butalbital is a barbiturate, which means that is slows down the central nervous system.

It's one of the active ingredients in Fioricet and Fiorinal and helps relax the muscle tension believed to be associated with tension headaches. 

What is the Downside of Taking Fioricet and Fiorinal for Headache Relief?

One downside is that medications containing butalbital, like Fioricet and Fiorinal, can lead to medication overuse headaches. These are headaches that develop when a person overuses butalbital, typically taking Fioricet or Fiorinal 2 to 3 times a week or 10 or more days a month. When a person is experiencing medication overuse headaches, they are often not responsive to preventive headache medications, which can be a clue to the diagnosis.

The other downside is that withdrawal symptoms may occur with butalbital and may occur 8 to 36 hours after the last dose. Withdrawal symptoms can 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 withdrawal of butalbital, medical treatment in a monitored setting under the care of a physician is indicated.

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.


With butalbital, there is also a concern for intoxication. Symptoms of butalbital intoxication are similar to alcohol intoxication and include lack of coordination, problems with thinking and memory, slowness of speech, disinhibition, and emotional disturbances.

When Is It Okay to Take Fiorinal or Fioricet for Headache Relief?

Fiorinal and Fioricet may be reasonable medications once in awhile, like when other headache medications are not working or cannot be used. Regardless, though, their use should be limited and when used, should be monitored carefully under the guidance of a physician. 

If you have any questions or worries about taking butalbital-containing medications, please speak with your physician. Also, remember to not stop or change the dosage of a medication without first consulting your doctor. 


Ciraulo DA & Greenblatt DJ. Sedative-, hypnotic-, or anxiolytic-related disorders. In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry. 6th ed. Baltimore: Williams & Wilkins; 1995:872-887.

McLean W et al. Is there an indication for the use of barbiturate-containing analgesic agents int the treatment of pain? Guidelines for their safe use and withdrawal management. Can J Clin Pharmacol. 2000 Winter;7(4):191-7.

Sellers EM, Hoornweg K, Busto UE & Romach MK. Risks of drug dependence and abuse posed by barbiturate-containing analgesics. Can J Clin Pharmacol. 1999 Spring;6(1):18-25.

Silberstein SD & McCrory DC. Butalbital in the treatment of headache: history, pharmacology, and efficacy. Headache. 2001 Nov-Dec;41(10):953-67.

Sullivan JT & Sellers EM. Treatment of the barbiturate abstinence syndrome. Med J Aust. 1986; Nov 3;145(9):456-8.

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