If you suffer from migraine, then episodes can be completely incapacitating and last several days. This can impact work, school, personal relationships, and recreation activities.
Most people with migraine take medication to manage these symptoms, along with making lifestyle changes to avoid migraine triggers (which often include certain foods, stress, flashing lights, etc.). Even with proper care, however, migraine can remain disruptive in a person's life, resulting in time away from work and difficulty scheduling and attending planned events.
Some people treat their migraine with a medication called Fioricet, which is typically prescribed for tension headaches caused by muscle contractions. However, Fioricet is sometimes given as an off-label treatment for migraine or obtained directly over the internet.
We make it easy for you to participate in a clinical trial for Migraine, and get access to the latest treatments not yet widely available - and be a part of finding a cure.
Fioricet is known as a combination medicine in that it contains more than one medication. Specifically, Fioricet contains acetaminophen, butalbital, and caffeine.
Caffeine and acetaminophen work for pain relief, while butalbital induces relaxation, thus relaxing the muscle contractions that cause tension headaches. The drug is quite effective for occasional use to treat severe tension headaches that might be disrupting a person's life.
There are a number of other brands that have the same active ingredients, including:
These other brands may contain different inactive ingredients, however, which can potentially help avoid allergies or migraine triggers that might be included in the medication.
Fioricet is prescribed to treat both migraine and tension-type headaches, although it has not been approved to treat migraines specifically. Fioricet is not often used as an initial medication, but it can be prescribed off-label for migraine in some cases.
Only a subset of people¹ report benefits, and those people are typically non-responders to more mainstream medication. Butalbital can also reduce anxiety and thus help with migraines that are caused by stress. However, it can also present other issues, including physical addiction.
Because of this, some doctors prescribe Fioricet or similar medication only to people who do not respond to triptans, although it can have a solid benefit for those who need it. However, doctors have to be careful to avoid dependency. The approved use for tension headaches is typically far more occasional and thus less likely to lead to overuse of the medication.
Fioricet is taken orally, as a capsule or tablet, as a treatment for acute migraine. It plays no role in preventing migraine. You should take it only if you feel an attack or episode coming on. Typically, you take one tablet or capsule as needed every four hours, and no more than six tablets in a 24-hour period.
Never take more Fioricet than your doctor recommends, and do not take it because you are afraid you might be exposed to a trigger. It is very easy to overdose on this medication, and the overdose risks are high, including potentially fatal reactions.
Known side effects of Fioricet include:
People can also be allergic to one or more ingredients in Fioricet. Needless to say, you should not take Fioricet if you know you are allergic to caffeine. It should be taken with food or milk, which can be challenging for those whose migraine is accompanied by nausea.
Fioricet can interact with a number of medications.
It is contraindicated with doravirine, fostemsavir, isavuconazonium sulfate, isocarboxazid, linezolid, lonafarnib, lorlatinib, mavacamten, and phenelzine.
It interacts with several other medications, including ergotamine, fentanyl, heparin, statins, clonazepam, cortisone, conjugated estrogens, birth control, hydrocortisone, etc. You should not drink caffeine-containing beverages or alcohol when taking Fioricet.
The list of interactions is extremely long, which is another reason why Fioricet is not a first-line medication for migraine treatment.
In addition to hundreds of potential drug interactions, taking Fioricet does carry some other risks that you need to discuss with your doctor.
It is relatively easy to overdose on Fioricet. An overdose can cause caffeine toxicity, which seldom happens due to the normal consumption of food and caffeinated beverages. Overdosing can cause seizures, weakness, confusion, trouble breathing, and severe liver damage.
Other symptoms might include ringing in the ears, unusual heartbeat, trouble walking or sleeping, and slurred speech.
If you have taken too much of this medicine, call the poison control center at 800-222-1222. You may need to go to the emergency room. Fioricet overdose can be serious, and there have been instances of people intentionally overdosing.
Fioricet should be stored out of the reach of children and pets.
Allergy symptoms include itching, skin rash, and difficulty breathing. You should call your doctor immediately if you experience these symptoms. Rarely, acetaminophen can cause Stevens-Johnson Syndrome,² a serious allergic reaction that causes inflammation of the skin and detachment of the upper surface.
Because of this, any skin reaction to Fioricet needs to be taken seriously. Do not take any more of the medication and call your doctor right away. This reaction can happen even if you have taken acetaminophen before.
Barbiturates can also cause potentially fatal skin reactions so, again, make sure that you get any kind of skin reaction checked by a healthcare professional immediately. Conditions such as Stevens-Johnson Syndrome and similar toxic epidermal necrolysis are associated with significant morbidity and mortality.
These conditions require early detection and care, so check your skin regularly if you are taking this medication and pay attention to any rash or lesions.
Other allergic symptoms should also warrant a call to your doctor. Most likely, you will have to discontinue the medication and switch to an alternative. You should not take Fioricet if you have previously had any reaction to acetaminophen or to caffeine.
You should not take Fioricet if you are pregnant. Butalbital is potentially associated with certain congenital heart defects, namely:
Tetralogy of Fallot: This is a complex of four cardiac and pulmonary defects. Many infants with this condition require surgery soon after birth as it increases the risk of arrhythmia and endocarditis and causes developmental delays.
Pulmonary valve stenosis: This is a narrowing of the valve that controls blood flow to the lungs, causing the right ventricle to have to pump harder, which can cause damage to the heart over time.
Secundum-type atrial septal defect (ASD): This is a hole in the wall between the two atriums of the heart, allowing blood to flow between the two atriums, which can affect blood oxygen levels. Small defects generally go untreated and often close on their own, but larger ones may need a procedure to lower the risk of abnormal heart rhythms, heart failure, heart infection, stroke, and pulmonary hypertension.
The connection has not been formally proven due to the small sample sizes in available studies. However, given it is statistically significant, Fioricet should be avoided while pregnant and breastfeeding, as it does pass into breast milk.
If you get migraines and become pregnant, you should talk to your doctor. Other migraine medications can also carry risks during pregnancy and you may need your medications adjusted.
Both butalbital and caffeine can be physically addictive. It is very possible to become addicted to Fioricet, which is another reason it is not a front-line treatment. Because people with migraine get headaches fairly regularly, they have a higher risk of becoming addicted to Fioricet and/or its ingredients.
Barbiturates, in particular, can be a drug of abuse. This is important to note as Fioricet is sometimes taken to help people sleep, reduce stress, or self-medicate anxiety or depression.
People with mental health issues or a history of substance use disorder are more likely to abuse Fioricet. In fact, these factors are considered potential contraindications for prescribing Fioricet. This includes alcoholism, especially as mixing alcohol and Fioricet can cause extreme drowsiness and impaired judgment.
Regular use can cause rebound headaches, which are highly unpleasant and may not always respond to normal treatments. You should not use Fioricet on a daily basis in order to avoid this. Rebound headaches are caused by physical dependence on the drug to control pain and/or by physical addiction to caffeine, which results in headaches as a withdrawal symptom.
Caffeine withdrawal can also cause fatigue, low energy, depression, drowsiness, concentration issues, brain fog, and irritability. If you are prone to caffeine addiction, you need to be aware that Fioricet can cause or aggravate it due to a large amount of caffeine in the drug.
Barbiturates can cause a withdrawal state similar to alcohol, including seizures and delirium. Usually, people get addicted to Fioricet after ordering it online to self-medicate for chronic headaches, without realizing that it should not be taken daily. There are substantiated cases of people taking Fioricet for migraine and becoming addicted.
Additionally, much like alcohol, the more of the drug you take, the more you need to get the same effect, which can cause an overdose. You should talk to your doctor if Fioricet is no longer working as well as when you first started taking it. This can be a sign of physical dependence and may mean you need to stop taking the drug before you become tempted to take excessively large doses.
Common withdrawal symptoms of Fioricet include:
People who have become addicted to Fioricet may require detox and rehab to help them get through the withdrawal symptoms. It is very important not to take this medication other than when you truly need it. As you can get a little bit high from Fioricet, the temptation for recreational abuse is present.
The prescription of Fioricet for migraine is off-label. That is, it is not approved for treating migraine in the United States, but doctors may still prescribe it in some circumstances. Most doctors consider there to be better options.
Because of all the issues listed above, Fioricet is most often used as a medication of last resort to treat people who have not responded to other migraine medications. There is an array of other migraine medications available, and almost all of them are better and safer than Fioricet, although many are more expensive.
Fioricet should not be taken daily, so it is a poor choice for chronic migraine.
Mainstream medications used to treat migraines include:
Regular over-the-counter painkillers taken as needed
Triptans, specific to migraine
Antiemetics used to treat migraine that comes with nausea
A non-drug treatment sometimes used for migraine is transcranial magnetic stimulation³ (TMS). Studies show that TMS is significantly effective for acute migraine but has little to no effect on chronic migraine. More research is needed. However, TMS is generally safe and may be worth discussing with your doctor.
Combination drugs are also commonly used. These are called migraine cocktails and are prescribed especially for severe acute migraine.
Even better is to try and identify and avoid your migraine triggers so you don't have to take medication as often. This can be easier for some people than for others.
Consider the issues already mentioned. Never take more Fioricet than required, don't take it every day, and keep it away from children and pets.
Additionally, Fioricet is contraindicated during pregnancy and for:
People with porphyria
People with a history of depression and suicidal thoughts
People with a history of substance use disorder or alcoholism
People with asthma, emphysema, or other lung diseases
People with kidney, liver, or stomach problems
Older adults in general
People with sleep apne
People with a significant cardiovascular impairment such as congestive heart failure
People with high blood pressure
People with phenylketonuria
You should not drink alcohol when taking Fioricet as the combination can be extremely sedating and may potentially knock you out. It can also increase the risk of liver damage and toxicity.
Do not drive or operate heavy machinery after taking Fioricet as it can impact your ability to stay focused and alert for several hours after taking a dose. Avoid doing any tasks that require mental focus, and don't sign any binding legal documents due to the risk of impaired judgment.
Don't attempt to obtain Fioricet online without a prescription. Due to the large numbers of interactions, some severe, with other drugs as well as the potential for addiction, self-medicating with Fioricet is highly dangerous.
If you are taking Fioricet, you should seek medical help if:
Your headaches are worsening in frequency or intensity
You have any kind of skin reaction to the medication
The medication is no longer working as it once did
You have any kind of allergic reaction
You should call your doctor right away if you discover that you are pregnant, due to the potential risk of cardiac birth defects, to discuss whether you should continue taking Fioricet or switch to an alternative.
In general, your doctor will only prescribe Fioricet when other medications have not worked.
Fioricet is a medication approved for tension headaches that is sometimes prescribed for migraines. However, it is not an initial treatment migraine drug due to lower efficacy (except in people who don't respond to other medications), the risks of overdose and addiction, and the large number of drug interactions.
Typically, your doctor will only prescribe Fioricet if absolutely necessary, and you should not seek it out on your own. There are many better medication options for people with migraine that you and your doctor can explore.
Fioricet for migraines: A non-evidence-based intervention | Mental Health Daily
Questions and answers: FDA warns of rare but serious skin reactions with the pain reliever/fever reducer acetaminophen | U.S. Food and Drug Administration