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Does Fioricet Work for Migraine Headaches?

by Dr. Sharon Orrange on September 15, 2016 at 2:24 pm

Fioricet (butalbital/acetaminophen/caffeine) has been around forever and is used by many for the treatment of chronic migraine or tension headaches. It is a mixture of a barbiturate, Tylenol (acetaminophen) and caffeine.

Now, many formularies are no longer covering Fioricet capsules. For those of you who have relied on it for years, this (understandably) may make you nervous.

Well, it turns out it doesn’t really work that well—and there are much better options out there.

  • Fioricet and Fioricet with Codeine are not as effective for acute migraine as newer medications. There isn’t any evidence that shows that barbiturate-containing meds (the butalbital in Fioricet) help for migraine treatment. In fact, the use of Fioricet with Codeine often results in chronic migraine and a “medication overuse headache.”
  • NSAIDS. Start with these instead. There is good evidence that nonsteroidal anti-inflammatory drugs—ibuprofen, naproxen, and others—work well for the treatment of acute migraine.
  • Triptans. Imitrex (sumatriptan), Maxalt (rizatriptan), Relpax (eletriptan), and Frova (frovatriptan) are examples. Used alone or in combination with an NSAID, triptans work well for moderate to severe headaches that aren’t relieved by NSAIDs alone. Wondering which to choose? They generally work the same but you may notice fewer side effects with one over the other. Cost can also be an issue so you’ll want to pick a triptan that is covered by your insurance plan. It’s also a good idea to check GoodRx to see if the cash or discount price beats your co-pay.
  • Adding a nausea medication. For folks with moderate to severe migraine accompanied by nausea or vomiting, adding Reglan (metoclopramide) , Zofran (ondansetron) or Compazine (prochlorperazine) also helps.

Bottom line is . . . while your Fioricet capsules may no longer be covered, better options exist.

Dr O.


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