Butalbital in the treatment of headache: history, pharmacology, and efficacy

Headache. 2001 Nov-Dec;41(10):953-67. doi: 10.1046/j.1526-4610.2001.01189.x.

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.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Analgesics / therapeutic use
  • Barbiturates / pharmacology
  • Barbiturates / therapeutic use*
  • Drug Combinations
  • Headache / drug therapy*
  • Humans
  • Migraine Disorders / drug therapy
  • Tension-Type Headache / drug therapy
  • Treatment Outcome

Substances

  • Analgesics
  • Barbiturates
  • Drug Combinations
  • butalbital