Butalbital in the Treatment of Headache: History, Pharmacology, and Efficacy

Authors: Silberstein S.D.¹; McCrory D.C.²

Source: Headache: The Journal of Head and Face Pain, Volume 41, Number 10, November/December 2001 , pp. 953-967(15)

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Abstract:

Analgesics containing butalbital compounded with aspirin, acetaminophen, and/or caffeine are widely used for the treatment of migraine and tension-type headache. The butalbital-containing compounds are efficacious in placebo-controlled trials among patients with episodic tension-type headaches. Despite their frequent clinical use for migraine, they have not been studied in placebo-controlled trials among patients with migraine. Barbiturates can produce intoxication, hangover, tolerance, dependence, and toxicity. Butalbital can result in intoxication that is clinically indistinguishable from that produced by alcohol. Butalbital-containing analgesics can produce drug-induced headache in addition to tolerance and dependence. Higher doses can produce withdrawal syndromes after discontinuation. Butalbital-containing analgesics may be effective as backup medications or when other medications are ineffective or cannot be used. Because of concerns about overuse, medication-overuse headache, and withdrawal, their use should be limited and carefully monitored.

Keywords: migraine; acute medication; butalbital; drug overuse; daily headache

Document Type: Research article

DOI: http://dx.doi.org/10.1046/j.1526-4610.2001.01189.x

Affiliations: 1: From the Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, Pa 2: Center for Clinical Health Policy Research, Duke University, Durham, NC

Publication date: 2001-11-01