From the Guidelines
Fioricet should not be prescribed daily for headaches. The medication contains butalbital, a barbiturate that can cause rebound headaches and physical dependence with frequent use 1. According to experts, acute therapy should be limited to no more than two times per week to guard against medication-overuse headache (or drug-induced headache) 1. Daily use of Fioricet can lead to several serious problems, including medication overuse headaches, physical dependence on the butalbital component, and tolerance requiring increasing doses for the same effect.
Some key considerations for headache management include:
- Identifying and avoiding triggers
- Maintaining regular sleep patterns
- Stress management
- Staying hydrated
- Considering preventive medications such as certain antihypertensives, antidepressants, or anticonvulsants for patients with frequent headaches 1.
It is essential for patients with frequent headaches to work with their healthcare provider to identify the specific type of headache they're experiencing and develop an appropriate treatment plan that minimizes risks of medication overuse and dependence 1.
From the FDA Drug Label
INDICATIONS AND USAGE Butalbital, Acetaminophen and Caffeine Capsules, USP are indicated for the relief of the symptom complex of tension (or muscle contraction) headache. Evidence supporting the efficacy and safety of this combination product in the treatment of multiple recurrent headaches is unavailable. Caution in this regard is required because butalbital is habit-forming and potentially abusable.
- Daily prescription is not recommended due to the potential for habit-forming and abuse of butalbital.
- The drug label lacks evidence to support the safety and efficacy of daily use for headaches 2.
- Caution is required when considering prescription of butalbital for multiple recurrent headaches.
From the Research
Medication Overuse Headache and Fioricet
Fioricet is a medication that contains butalbital, acetaminophen, and caffeine, commonly used to treat headaches. However, the daily use of Fioricet can lead to medication overuse headache (MOH), a subset of chronic daily headache [(3,4,5)].
Risk of Medication Overuse Headache
The risk of developing MOH is associated with the frequency of use of medication, and butalbital, a component of Fioricet, is one of the main classes of drugs implicated in the genesis of MOH [(3,4,5)]. The American Migraine Prevalence and Prevention Study demonstrated that transformation from episodic to chronic migraine is most likely to occur with 5 days of butalbital use per month 4.
Treatment and Prevention of MOH
Treatment of MOH consists of combining prophylaxis, 100% wean of overused acute medications, and provision of new acute medications, strictly limiting use to 2 or fewer days per week [(4,5)]. Patients with MOH can usually be effectively treated, but some cases may require referral for multidisciplinary day hospital or inpatient treatments [(4,5)].
Key Points to Consider
- Fioricet contains butalbital, which can lead to MOH [(3,4,5)]
- Daily use of Fioricet can increase the risk of developing MOH [(3,4,5)]
- Treatment of MOH requires a combination of prophylaxis, wean of overused medications, and provision of new acute medications [(4,5)]
- Limiting the use of Fioricet and other acute medications to 2 or fewer days per week can help prevent MOH 4