Butalbital in the treatment of headache: history, pharmacology, and efficacy.
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.
Silberstein
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SD
Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
McCrory
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DC
D000208:Acute Disease; D000700:Analgesics / Q000627:therapeutic use; D001463:Barbiturates / Q000494:pharmacology / Q000627:therapeutic use*; D004338:Drug Combinations; D006261:Headache / Q000188:drug therapy*; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy; D018781:Tension-Type Headache / Q000188:drug therapy; D016896:Treatment Outcome
D000700:Analgesics; D001463:Barbiturates; D004338:Drug Combinations; C004470:butalbital