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Understanding Fioricet’s Efficacy in Migraine Treatment : A Comprehensive Guide

What is Fioricet?

Fioricet is a prescription medication used to treat tension headaches and migraines. It is a combination medication that contains three active ingredients: (1)

  • Acetaminophen: This is a common pain reliever and fever reducer found in many over-the-counter medications. It works by reducing the production of prostaglandins in the brain, which are chemicals that cause pain and fever.
  • Butalbital: This is a barbiturate, which is a type of central nervous system depressant. It helps to relax muscle contractions involved in tension headaches.
  • Caffeine: This is a stimulant that can enhance the effects of pain relievers like acetaminophen. In Fioricet, it is included in a relatively small amount.

The combination of these three ingredients is believed to be more effective for certain types of headaches than any of the individual components alone. While Fioricet is FDA-approved for treating symptoms of tension headaches, it is also occasionally prescribed off-label for migraine relief.(2)

However, it is important to note that Fioricet contains a barbiturate, which can be habit-forming and should be used with caution. It is typically prescribed for short-term use and is not recommended for long-term, chronic pain management.

Can Floricet Help in Migraine?

A migraine is a type of recurring headache characterized by intense, throbbing pain typically on one side of the head. It is often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. Migraines are a neurological disorder that can be debilitating and can significantly impact a person’s daily life. They can last anywhere from a few hours to several days, and the severity of the pain can vary widely. Some individuals may experience warning signs, known as an “aura,” which can include visual disturbances or other sensory changes before the headache begins.(3,4)

Migraines are believed to result from a combination of genetic, environmental, and hormonal factors, and they can be triggered by various factors such as certain foods, stress, hormonal changes, and sensory stimuli. Managing migraines often involves a combination of lifestyle modifications, identifying triggers, and sometimes medication prescribed by a healthcare professional.

Fioricet is sometimes prescribed to help with migraines. Fioricet is a combination medication that contains acetaminophen (a pain reliever), butalbital (a barbiturate that helps relax muscle contractions), and caffeine (which can enhance the effects of pain relievers). This combination is believed to be effective in relieving certain types of migraines, particularly those associated with muscle tension or contractions.(5)

However, it is important to note that Fioricet contains a barbiturate (butalbital), which can be habit-forming. It should be used with caution and as directed by a healthcare provider. Fioricet may not be effective for all types of migraines, and its use should be determined by a healthcare professional based on an individual’s specific symptoms and medical history. (6,7)

There is a lack of substantial evidence to firmly establish its efficacy in treating migraine attacks, especially when compared to safer alternatives. Fioricet might be considered if other migraine treatments have proven ineffective, but close monitoring by a healthcare provider is crucial to mitigate potential side effects.

How Does Fioricet Help in Migraine?

As mentioned above, Fioricet contains three active ingredients that work together to address different aspects of migraine symptoms:

  1. Acetaminophen: This component is a pain reliever and fever reducer. It works by inhibiting the production of prostaglandins in the brain, which are chemicals that promote pain and inflammation.
  2. Butalbital: This is a barbiturate, a type of central nervous system depressant. It helps to relax muscle contractions involved in tension headaches, which can be a contributing factor in migraines.
  3. Caffeine: Fioricet includes a small amount of caffeine, which is a stimulant. Caffeine can enhance the effects of pain relievers like acetaminophen, potentially providing additional relief.

Together, these ingredients aim to address the various components of a migraine attack. Acetaminophen targets the pain and fever associated with migraines, butalbital helps to relax muscle tension, and caffeine enhances the effectiveness of acetaminophen. This combination is believed to be particularly effective for certain types of migraines, especially those with a significant tension component.

Are There Any Side Effects To Taking Fioricet?

Just like any other medication, Fioricet can also cause certain side effects. Common side effects may include:

  • Drowsiness or Sedation: Fioricet contains butalbital, which is a central nervous system depressant. This can lead to drowsiness or a feeling of sedation.
  • Dizziness or Lightheadedness: Some people may experience dizziness or a feeling of lightheadedness, especially when standing up quickly.
  • Nausea or Upset Stomach: This can be a common side effect, particularly if taken on an empty stomach.
  • Vomiting: Some individuals may experience vomiting, especially if they are sensitive to medications.
  • Stomach Pain: Abdominal discomfort or pain may occur.
  • Feeling of Intoxication: Due to the presence of a barbiturate (butalbital), some people may feel a mild sense of intoxication or “high.”
  • Shortness of Breath: This is a less common but potentially serious side effect.
  • Allergic Reactions: While rare, some individuals may be allergic to components of Fioricet and may experience symptoms like rash, itching, swelling, severe dizziness, or difficulty breathing.
  • Liver Damage (with excessive use): High doses of acetaminophen in Fioricet can potentially lead to liver damage.
  • Dependence or Addiction: Due to the presence of butalbital, Fioricet has the potential for dependence and should be used with caution.

If you experience severe or persistent side effects, or if you have any concerns about taking Fioricet, you should contact your healthcare provider promptly. They can provide guidance on the best course of action based on your specific situation.

Apart from side effects, Fioricet also has the potential to interact with various medications, including:

  • MAO inhibitors
  • Opioid pain relievers
  • Alcohol
  • Sleep or anxiety medications like benzodiazepines
  • Other medications that induce sedation
  • Multi-symptom cough/cold medications containing acetaminophen

It is important to remember that this is not an exhaustive list of all possible interactions and side effects.

Potential Concerns Associated with Fioricet for Migraine Treatment

Taking Fioricet for migraine comes with several potential risks and may not be suitable for everyone. One key concern is the presence of the habit-forming ingredient, butalbital. Prolonged and high-dose use can lead to dependence, and abruptly discontinuing the medication after regular use may result in withdrawal symptoms. Combining Fioricet with alcohol or other sedative medications can be dangerous, as butalbital has a lengthy clearance time from the body.

Using Fioricet in conjunction with other products containing the same active ingredients is strongly discouraged. Doing so can heighten the risk of overdose, potentially causing harm to the liver, kidneys, and in severe cases, may be life-threatening. It is vital to communicate with your doctor about all medications, including over-the-counter products, vitamins, herbs, and natural supplements you are taking.

Moreover, regular use of Fioricet can elevate the likelihood of rebound headaches or medication overuse headaches. Research has indicated that using butalbital for extended periods, even just five days per month, may escalate the risk of a migraine transitioning from an acute to a chronic condition.(8) Lastly, Fioricet has the potential to raise blood pressure and heart rate. If you have a history of high blood pressure or heart-related conditions, it is crucial to consult with your doctor regarding the associated risks of using Fioricet.

It is also very important to strictly adhere to your doctor’s prescribed dosage of Fioricet, as an overdose can have serious and potentially life-threatening consequences. If you suspect that you have taken an excessive amount of Fioricet, do not hesitate to call 911 (or your local emergency number) or seek immediate assistance at an emergency room.

Some of the common symptoms of overdose may include: (9)

  • Profound drowsiness and dizziness
  • Nausea and vomiting
  • Slowed breathing
  • Severe lethargy
  • Marked drop in body temperature
  • Impaired coordination and balance


Fioricet can be a viable option for the treatment of migraines, particularly for individuals experiencing tension-related headaches. However, it is imperative to approach its use with caution due to potential risks and side effects. Fioricet should only be taken as prescribed by a healthcare professional, and close monitoring is essential to mitigate any adverse effects. Additionally, considering alternative migraine treatments and discussing them with your doctor is advisable, especially for those with specific medical conditions or concerns. Open communication with your healthcare provider will ensure that the benefits and risks of using Fioricet are carefully weighed to find the most suitable migraine management approach.


  1. Breitmeyer, J.B., 2010. Fiorinal and Fioricet. The Essence of Analgesia and Analgesics, p.262.
  2. DailyMed – fioricet- butalbital, acetaminophen, and caffeine capsule (no date) U.S. National Library of Medicine. Available at: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c018be7d-f7b8-45e2-97b8-8e7a71740657 (Accessed: 07 September 2023).
  3. Goadsby, P.J., Lipton, R.B. and Ferrari, M.D., 2002. Migraine—current understanding and treatment. New England journal of medicine, 346(4), pp.257-270.
  4. Baloh, R.W., 1997. Neurotology of migraine. Headache: The Journal of Head and Face Pain, 37(10), pp.615-621.
  5. Marmura, M.J., Silberstein, S.D. and Schwedt, T.J., 2015. The acute treatment of migraine in adults: the a merican H eadache S ociety evidence assessment of migraine pharmacotherapies. Headache: The Journal of Head and Face Pain, 55(1), pp.3-20.
  6. Tfelt‐Hansen, P.C. and Diener, H.C., 2012. Why should American headache and migraine patients still be treated with butalbital‐containing medicine?. Headache: The Journal of Head and Face Pain, 52(4), pp.672-674.
  7. Bryczkowski, C. and Geib, A.J., 2012. Combined butalbital/acetaminophen/caffeine overdose: case files of the Robert Wood Johnson Medical School Toxicology Service. Journal of Medical Toxicology, 8, pp.424-431.
  8. Tepper, S.J., 2012. Medication-overuse headache. COnTInUUM: Lifelong Learning in neurology, 18(4), pp.807-822.
  9. Bryczkowski, C., 2013. Butalbital/paracetamol/caffeine overdose. Reactions, 1441, p.2.
Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 20, 2023

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