Downsides of Taking Fiorinal or Fioricet for Headaches

A drug with a high risk of addiction

Sick man taking medicine
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Fioricet (butalbital/acetaminophen/caffeine) and Fiorinal (butalbital/aspirin/caffeine) are medications sometimes used to treat tension-type headaches, the most common type of headache disorder. 

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 "why" 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). Behavioral therapies too can be effective like physical therapy or cognitive-behavioral therapy.

But one worry with treating tension headaches is the risk that some people are prescribed Fiorinal or Fioricet. While this medication is very effective in the short-term, there are some things to watch out for.

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

Downsides of Taking Fioricet and Fiorinal for Headache Relief

Butalbital is a barbiturate, which means that it helps to slow 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.

Here are some of the downsides of taking a butalbital-containing medication:

Medication Overuse Headache

One downside is that medications containing butalbital, such as Fioricet and Fiorinal, can lead to medication overuse headaches—a type of headache disorder that occurs when a person takes medication too frequently to treat their headaches. This then leads to a withdrawal headache, also called a rebound headache. 

With Fioricet or Fiorinal, a medication overuse headache can occur from taking it three times a week or 10 or more days a month. In addition, when a person is experiencing medication overuse headaches, they are often not responsive to preventive headache medications. In fact, the lack of response to preventive headache medications is often a clue to doctors that a medication overuse headache has developed.

In the end, Fioricet or Fiorinal should be limited to 2 days per week to avoid this rebound effect. 

Withdrawal Symptoms

The other downside is that withdrawal symptoms may occur with butalbital, often 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. 

Intoxication

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, such as 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. 

A Word From Verywell

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. 

Sources:

Monteith TS, Oshinsky ML. Tension-type headache with medication overuse: Pathophysiology and clinical implications. Curr Pain Headache Rep. 2009 Dec;13(6):463-69.

National Headache Foundation.(2007).  Fiorinal and Fioricet

U.S. National Library of Medicine: Medline. (2016) . Tension headaches.

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