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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #139

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Have a patient with recurrent migraines? Have they tried multiple abortive medications without relief? Then consider using butalbital medications such as Fioricet without codeine.

If you have a patient who has tried their triptans and NSAIDs in hope that it would abort their migraine yet they continue to have the migraine, then seriously consider butalbital as it often will work in those naïve to the medication.

These medications are relatively safe, but patients can develop a medication overuse headache if they take it too often. Therefore, only prescribe them 4-6 pills as developing rebound headaches is not a good situation.

I have prescribed Fioricet for my migraine and recurrent headache suffers for years with no ill effect. Again, just be aware that patients can take it too often and develop a dependency to it as they will develop rebound headaches often. So, it should be used sparingly.

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