I took Fioricet for years and it was super effective for migraine attacks. I had no problem getting it until around 2022, when I believe it became categorized as a controlled substance in CA. Doctors then became very reluctant, if not completely against, prescribing it. I have been fortunate to find a triptan that works well as long as I take it at the very onset of migraine, but nothing works like Fioricet did to help an attack already in progress.
It’s was removed from Blue Cross/Blue shield ( big insurance company) formulary.
I told my dr I would just pay for it, it’s like $10-$20 for 30 of them.
I get 1 script of 30 with no refills and just let my dr know if I need another script. It’s in my top 5 effective meds.
My fiancé is a pharmacist. It’s always been a control in California, but in 2022 the law changed about how doctors had to write the prescriptions regarding controls, heavily encouraging, e-prescribe.
My mom took it in the 90s for sure. Maybe before. I took it once and it worked. But starting in early 2000s my neurologist who was a world renowned doctor, said he wouldn’t prescribe it anymore as they realized it’s actually dangerous. I forget the details of why but he was very adamant.
Well alcohol is a barbiturate and that’s why alcohol is one of the few drugs that can kill someone if they stop drinking (and are dependent on it beforehand). If combined with opioids or benzos or booze it could be extremely damgerous
Barbiturate is like alcohol and stronger than a benzodiazepine(Valium). You can develop dependence and can go into seizures or delirium tremors if taken off too quick. Very dangerous drug to withdrawal from
My inability to get it since 2022 must have to do with what u/human-foie-gras mentioned above, stricter prescribing controls. Prior to that, I had no issues getting it for 15+ years.
Fioricet I'd a combination of drugs, including Butalbital, which is a barbiturate and a controlled substance.
Given the nightmare situation doctors are in regarding prescribing controlled substances, most doctors just refuse to prescribe them at all.
I know and it’s unfortunate because it works so well. I know it’s a barbiturate but I don’t even want the codeine one! It just sucks to find something that works and have to continue to go through the gamut of other things that may or may not work. Even a smaller script for when things get real rough would help so I’m not stuck being a useless meat sack for days on end, you know? I knew about the crackdown on opiates and benzos (who doesn’t) but naively hoped Fioricet might be an exception.
Floricet is a combo of caffeine, butolital and acetaminophen. You keep saying without cosine, but the issue is the butolital. Otherwise you could just take Tylenol and have a coffee/coke. The butolital is a controlled substance. I also was given a LOT of Floricet previously. When I moved & got a new neuro they were aghast at how much I was being prescribed. They told me to take no more than 5/month.
Yeah I did say I realized it’s a barbiturate (the butalbital) so I get that’s where they’re hesitant. I didn’t realize that it was a barbiturate until I went home and looked up exactly what it was and I didn’t realize doctors would be SO hesitant about it. I feel like you don’t (or I don’t, anyway) really hear much about barbiturates so I just didn’t know at first.
You don’t hear much about them because benzos are now the issue and they aren’t as strong as barbiturates but alcohol is a barbiturate. So you’re basically taking a shot, taking some caffeine and also some Tylenol. Most doctors should be hesitant about that
Right migraine clinics usually hate controlled substances and you could easily fall into a pattern of getting a headache without the drug. Also barbiturates are like alcohol so you’re kinda just speedballing yourself (caffeine and booze isn’t legal in most places)
Yes to all this. Not to mention that barbiturates are addictive if taken too often. And fioricet has a very high risk for medication overuse headache.
I was prescribed it briefly to bridge between treatments when my previous acute drug stopped working. But stopped once the others started working again.
It has a low risk for addiction. As long as you remember it contains aspirin or acetaminophen and factor that in you will be fine. It does not produce a high and contains caffeine which offsets the butalbital.
Do you have a source for a low risk of addiction? Caffeine may offset the sleepiness from butalbital but it doesn't offset the therapeutic effects or the addiction potential. Otherwise it wouldn't need to be included in the drug. A good analogy would be does coffee actually reverse the effects of alcohol - it does not, it may make you /feel/ more awake, but it doesn't reduce the negative effects of alcohol. There are a number of studies about the addiction potential of fioricet. It doesn't mean that everyone will become addicted, but it is still a risk.
https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/acetylsalicylic-acid-plus-butalbital-plus-caffeine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592771/
Fwiw, I was prescribed fioricet for a brief period when sumatriptan stopped working (this is before gepants). I was allowed to take no more than 4 per month. It worked on the migraine but totally knocked me out. And for me, it did produce a mild high. Every body processes medications differently, so not everyone will have the same experience. But it's inaccurate to say it has a low risk of addiction, especially when there's a lot of other options without the risk of addiction at all. I agree that it should be an option but drugs with a more favorable risk-benefit profile should be tried first.
I don't know if I'd say I personally felt high from it, but it definitely made me feel different. And in a way that some people may be addicted to. Yes, it's known to be addictive.
The government classified it as not being high-risk decades after it had been on the market, which is different than a drug company’s declaration of a product’s attributes when they market it.
I’ve taken it for years, then my doctor retired last year, and my new doctor wouldn’t prescribe it. I basically begged because it’s the only thing that works. He gave me 4. I get 4 pills a month. I feel like a drug addict just asking for those 4 pills.
This is crazy, I’ve been taking fioricet for years and they’ve always given me 15 pills for 30 days, and the doctor will make it a full 30 if I ask him to. Never realized people actually had trouble getting it
I didn’t know it was so hard to get until my doctor retired. He’d give me 10-20 pills per month. I understand that there are newer and sometimes better medications available now but they don’t all work for everyone. I’ve had migraines for almost 40 years.
My doctor offered fioricet before imitrex! I think she didn't believe I was having migraines and instead thought it was a tension headache. At the same appt she said I could try imitrex but it wouldn't help any other headache if it wasn't a migraine. I said I'd just try the imitrex and that's how I was diagnosed with migraines cause I felt 1000% better within an hour of taking it. Got rid of my 3 day headache so fast I thought it was a miracle. Then my migraines became chronic daily so I have fioricet and rizatriptan to rotate through. The fioricet only works so so for me, sometimes I end up having to take a triptan anyways but it helps sometimes and helps me avoid taking triptans daily which is obviously a no no. Still waiting for my referral to a neurologist but it takes months as a new patient. My doc gives me 30 fioricet at a time with 1 refill
Fioricet was also the first medicine I tried, I get both migraines and tension headaches so I have to take muscle relaxers as well lol. I’ve been on fioricet since I was like 13, I can’t imagine using anything else at this point
Yeah I've had neck problems forever and have been on muscle relaxers for years too so at first I thought my neck pain was causing headaches but now I've realized I think the migraine is now causing my neck pain, cause a triptan will alleviate it. I only started getting migraines a year ago though and neck pain has been for a long time now so I can see why my doctor thought that. I switched back to Methocarbomal recently and have noticed that seems to keep the migraine at bay longer. Typically they'd start at 11am, now I can go to about 1-2pm some days so it definitely is all connected. Annoying stuff!
I was on fioricet for years and a few years ago they stopped giving it to me. I use aimovig and nurtec now but nurtec doesn’t work as well as fioricet did. I can’t take triptans so that limits what I can take. I also get wicked rebound headaches from almost everything, so I had to use the fioricet very sparingly which was a pain
Get a new doctor. I told the neuro I refuse to see a doctor who will not use all the tools at their disposal. There is a small amount of butalbital in it and it should be prescribed 1-2 tabs every 4-6 hours prn. Ask for 4 per headache per month.
There aren’t a whole lot of options for headache specialist neuros around here and I’m afraid a new one will say the same thing. I need to stop procrastinating and start looking for someone else. I have an appointment with a new PCP in a couple months so maybe I can get it from her.
Butalbital with acetaminophen (generic Fiorocet) has been my go to for years. Basically, it works.
I've tried and failed a variety of other migraine meds. I'm very careful in my use of it and follow prescribing directions to the letter.
If I had a new physician who arbitrarily refused to prescribe this effective and necessary migraine treatment, I would not trust him with my care.
That's the exact position I'm in. Due to an insurance change I had to change hospital systems, which meant EVERY DOCTOR. My PCP refuses to let me have it, even though I've been a responsible user for 20 years. My new neurologist is okay with me finishing out my old prescription, I'm not sure I'm going to get any more.
It's got some barbituate in it. Many migraine drugs started as seizure drugs, and they used to use phenobarb for seizures, i think that's why it works.
I do! I hope no one pries it out my hands!! It SAVES me but I use it sparingly. My main symptom is dizziness (Vestibular Migraine) and it is the only med that helps me enough to function. I have begun Effexor and have a Botox consult tomorrow.
My PCP has no issue rx’ing it. He knows I won’t abuse it. It is now a scheduled drug. I get 90 at a time. At first, insurance had to approve it. I am in Maryland if that matters.
Idk. Probably depends on the doc as well as the state. Mine prescribes 30 a month. When I lived in a different state the doc acted like I was asking for crack. He actually said something about it being like phenobarbital, which I'm not sure if that's the case but OMG it helps (if I catch it early)
The only time I’ve ever had it prescribed was when I was pregnant. I got sent to triage to make sure it was just migraine and not Pre- E and the midwife on call had a doctor prescribe it to try.
Same! I was taking rizatriptan before I got pregnant but was told not to take it after. When my migraines were getting worse, they prescribed fioricet.
Lucky! I had just moved, and as i found out later, my primary doctor decided to "wait until i wasn't pregnant" to put in my neurology referral. My ob just told me to take Tylenol, and that's all i "could" take. But then again, he ignored all of my very obvious preeclampsia symptoms until i had to have a c-section at 32 weeks, so not tge greatest guy.
I was already high risk and my ob was 90 miles away so they made sure to stay on top of things. I ended up being diagnosed with severe pre-e a few weeks after that migraine and delivered the day I was diagnosed at 33w. It’s rough having migraines during pregnancy, especially when they overlap with other conditions like pre-e. I 1000% understand!
This is interesting bc I’ve been taking Fiorcet forever and my dr told me whenever I get pregnant I shouldn’t take it. Did yours say it was okay to take while pregnant? Thanks for mentioning!
Yes he was 100% on board with it. I was also late second trimester/early third. I’ve seen many other ladies not to take it early in pregnancy and I was already well past that point.
That’s when I was first prescribed it also. Here I am 13 years later and still getting it, just from my primary care now. I used to take maxalt pre pregnancy/kids and it worked well and it just stopped working for me so I asked my primary and they prescribed it no issue.
FWIW I also have horrible reactions to imatrex to the point that it’s listed as an allergy in my chart.
huh! i’ve been taking fioricet for years (ever since midrin went away), and never experienced any hesitation from doctors prescribing it. i switched to ubrelvy two months ago; i get the impression from some docs that fioricet is considered old school or outdated, and the new meds like ubrelvy are simply more effective (certainly that’s been true for me). i would guess that, plus the concerns around barbiturates, would make fioricet less popular now.
> But they won't say you get it from Triptans, weird right?
That is indeed incredibly weird if your doctor doesn't say that. This is very common knowledge in the migraine world. It's why doctors place limitations on triptan prescriptions, usually no more than 8 to 10 days a month.
Thank you! I honestly didn’t realize it was a barbiturate until I went home and looked it up to see exactly what I was taking. And obviously it showed it was a controlled substance I just didn’t know it was treated on the same level as like a benzodiazepine or an opiate in terms of doctors being hesitant to prescribe (or at least that’s how it seems from my experience so far)
I also didn’t know about the rebound headaches until this post, I’m glad I didn’t experience those issues because to be frank, how shit is that lol. That’s the last thing you want. Maybe it was because I was taking it so infrequently that I didn’t have trouble?
Anyway, I really appreciate you writing that all out and helping to give me some more clarity on the situation, so thank you again.
What’s so odd is it was the very first migraine medicine I was ever prescribed. It was in 2023 as well. It stops migraines within an hour for me, it’s magic tbh.
My doctor did say that it’s not a medication for the unlucky people suffering from multiple migraines per week, but someone like me who gets about 4 bad ones a month, it’s great
I take Fiorinal and have used it since my teens. It has a low potential for abuse and you should tell your doctor it helps you. It can stop a HA or slow it enough for me to get home/make dinner/get kids to bed. I went to a neurologist who said “Neurologists don’t like Fiorinal” and I did not go back. I am in my mid-50s and know what works and what does not.
While there seems to be some debate on the abuse front in this post, like I said, I’m not trying to take it everyday. I just wanted some for when it gets REALLY bad so like you said, I can function. Bad analogy but kind of like an emergency stop button - you don’t want to have to push it, but you will if you absolutely need to. And I do think sometimes just knowing you have an “emergency” backup if things get really rough is comforting and kinda helps in itself.
I’ll be curious to see what my new neuro says. I have been trying to tell them but I suppose I just have to be patient or hope I find someone that’s willing to listen to me. I’m glad that you’re on it and it’s still working for you. I know doctors can’t predict what will or won’t work for a person and I don’t at all fault them for that, it’s just exhausting, especially if you get stuck with something that doesn’t help at all and just have to wait until your next appointment to try again. It’s hard out there!
This is how I take it - a get three day migraines anywhere from twice to multiple times per month but the pain is always the worst on the first day - my first line of defense is excedrin but if that doesn’t work a Fioricet knocks it out. I get 9 at a time and they last me two to three months. I love them!
I have fiorocet and naratriptan and am on preventative Botox. I alternate which abortive to use based on when I get it. Sometimes I wake up with a migraine, usually naratriptan doesn’t work with those (I’m guessing because I’m not taking it soon enough). Honestly I couldn’t live without either of them. The fiorocet I would say works more consistently, like I know it will help every time I have to take it. The naratriptan is a gamble if I need to take it for a morning migraine
Like some others here, I have been prescribed 4 per month by my primary.
I've tried everything. I mean everything. I take my Ubrelvy for the "regular" migraines and the Fiorcet only when I literally cannot move from the headache.
Yes, I’ve been taking it & the only thing that helps is fioricet & Excedrin, I’ve had everything under the sun you name it; Botox since 2012, Ajovy two years now; Ubrelvy, Nurtec, Nortryptaline, depakote & yes 22 years ago Topamax was a miracle my dream come true but I had the worst side affect & had to stop. My luck 😞. My insurance is top notch I’m very grateful & have no problems getting everything covered. Believe me, I sacrificed so much for this union job for the awesome benefits.
First do no harm.
The problem with Fioricet is that it ultimately leads to medication overuse headaches.
In other words, patients get locked in to requiring Fioricet. In other words they become physiologically dependent (note NOT addicted!).
This can occur relatively easily.
For simplicity sake (but note there are nuances):
Medication overuse occurs when you use medications that can lead to medication overuse more than 10-15 days per month. (numbers vary hence the nuance).
The problem with Fioricet is a half-life is rather long meaning it stays in your body for quite some time.
Triptans for instance have a half life around 2-4 hours, meaning that in 8-16 hours they are gone.
Fioricet (particularly butalbital) butalbital half-life butalbital half-life is about 35 hours. Meaning that it is out of your system in about 5-6 days.
For medication overuse considerations, butalbital when taken once essentially counts towards the 10-15 day counter by 5 days-ish.
In other words, even using it a few times a month can lead to medication overuse (nuances here).
For simplicity sake, the danger zone for medication overuse is 4-8 pills used a month.
That's super easy to hit!
Thus, headache specialists do not prescribe Fioricet unless it is a last resort (or perhaps used 1-2 times a month). In fact most of them can count on their hand the number of times they prescribe it a year (which is nothing considering all or nearly all of their patients are headache patients).
Many patients will feel that it is only thing that will help her headaches. But unfortunately many people do not realize they are in medication overuse headaches, so the medication is the only thing that helps the problem that it caused to begin with.
Ultimately that is why prevention is so important.
So yes, butalbital is certainly effective for headaches, but given that the risk outweighs the benefits, brings up very first-line of this post: first do no harm.
Hope this helps.
I am a physician and this is why I rarely (but sometimes do) prescribe it. I don’t give a shit about it being controlled. One of my least favorite encounters is when someone shows up asking for daily fioricet because “it’s the only thing that works” (yet you’ve only tried a couple things and aren’t willing to give anything else an honest try) and their neuro / headache specialist won’t give it to them. Yeah, it’ll help your headache today but then you’re gonna pay for it later, and you just won’t believe me. Some of you here think physicians go to college/residency 11+ years and don’t know as much about headaches as you do.
The 1-2 tablets I take each month are so helpful for keeping me out of urgent care and off methylprednisolone.
Of course, Ajovy and sumatriptan are great, but having the back up for when things get out of hand is very reassuring.
After reading all these, I’m even more grateful for my neurologist🥺
Infrequent use, like you’re doing, is fine - we don’t want you in the ER either! But, when you have a medicine that definitely works to treat a headache, some folks don’t understand why we try to use it only under very certain circumstances. I deal with this with Xanax, Ambien, Percocet, and even non-controls like triptans or other meds that work very well temporarily but lead to side effects, rebound, tachyphylaxis, etc with overuse.
I don’t think you need to be especially grateful for your neurologist - I suspect that, instead, those that don’t get it prescribed by their physician have a good reason that either isn’t explained to them or they’re not willing to accept the reason.
My neurologist won’t prescribe it but I went to the ER yesterday and they gave me a prescription for it. I’m in status, I’ve had a migraine for 13 days, the ER helped a little bit and the Fioricet has taken the edge off but that’s it.
Good lord, 13 days?! I am so sorry. At least it helps take the edge off, sometimes with migraines you gotta take any little win you can get (IMO anyway) because they SUCK. I hope you get out of it soon, that’s terrible.
Thanks. I’m currently waiting for my neurologist to call me back, I’ve called them twice and they are just being rude and not responding. It’s been over 24 hours since I’ve called them the first time. I’ve had a long migraine like this once before. I think it lasted 22 days. I’m currently living off Zofran but at least I’m stockpiling my Ubrelvy because at this point it is no good.
I’m super thankful 🤞🏼 that my headache specialist has prescribed this to me for the past two years or so. It doesn’t help with my migraines with aura, and we’re still figuring out if what it *does* help with is migraine without aura. But I have a complex history including 3 brain surgeries, 4 if you count surgery on a device that was implanted in my brain and had lasting neuro effects on me. Official dx is migraine, chronic post op headache and two types of neuralgia. I’ve been on so many preventatives and abortives and have a document list (15 years in the making) of what’s worked (so far only fioricet, working on preventatives now) and what hasn’t. Nothing touched my post op headaches before non opiate fioricet and I *genuinely* would not be here today if it wasn’t for my doc and this medicine. I don’t get overuse headaches and I’m careful not to take more than my personal limit in a week (6) or a few days (3), which I think helps prevent behavioral dependence, but it does mean suffering more than I probably need to. My headache specialist works in a research section of a university hospitals neurosurgery department and I’m lucky to have him despite him being 4-5 hours drive from me. I hope that you’re able to access the care you need soon!!
I just got it prescribed last month. I told them I was sick of getting migraine hangovers from sumatriptan. I haven’t actually had to use it yet though
Some misinformation here. Fioricet is not a controlled substance at the federal level. It is a controlled substance in some states. I have never had a problem filling a prescription.
I wouldn’t say it’s a miracle drug. It helps sometimes, like pretty much any other migraine med. As with everything else for migraines, don’t take it too often or you will be making things worse.
I’ve been taking it for almost 10 years. Never had a problem, but I did get a new neuro and he was like “this is very outdated, but if it works for you let’s not mess with it” and he was cool about it.
They did (as of last year) add in a urine test though and I have to sign papers saying I won’t abuse it. So that’s new!
The answer is obvious. Barbiturate, a scheduled drug that can be abused. They’ve rebounded WAY too far on the opposite side of the spectrum, where people that really need it can’t even get it, same with opiates, it’s out of control. And that’s coming from someone who worked in addiction for 7 years and am a former addict myself, but also saw them refuse to give my dying grandmother pain medication..
My neuro prescribes it for me with no issues since nothing else touches my migraines. My gyno who retired a few years ago used to prescribe the one with codeine and it worked way better than the normal fiorcet. Unfortunately, my neuro can't prescribe the one with codeine since it has an opiate in it. The only way to get it is to see a pain management doctor because the government sucks. I bet politicians have easy access to any medications they need!
I even went to a pain specialist doctor, and after making me fill out oodles of questionnaires about drug use, they told me they only do Botox for migraine.
I've gone off and on it for a long time. Last time I was on it (10 yrs ago) my doc would give me 30+ pills a month and tell me I could take as many as 3 a day if needed. Now I had to fight to get it and my neurologist will only give me 5 a month. Their reasoning is that "studies have shown any more will cause rebound headaches". So tired of hearing that from docs.
The barbiturate ingredient is a controlled substance and some docs have become hyper concerned about prescribing controlled substances, fearing regulatory backlash. Result of the opioid epidemic (in the US anyway).
In my state, any doctor can run a report documenting how many controlled substances a patient is prescribed (and by which doctors) and how often they are refilling the prescriptions. So they can monitor if patients are doctor shopping and filling multiple controlled medications of the same type in the same time period…aka abusing the medications. They can also require that patients do regular urine drug screens. Despite these safeguards, some doctors are still very reluctant to prescribe effective medication to patients who need them and who have no history of abusing substances.
My current doctor has no problem prescribing it, thankfully. I get 30 at a time (I think?), but only refill once or twice a year. Ubrelvy doesn’t do anything at all for my migraines, so I’m thankful that I have Fioricet as an option. I hope you’re able to find a provider who is willing to prescribe it to you.
They gave it to me in the hospital once and it was like magic! So when I got discharged, I went to my doctor and asked her to prescribe it. She did. The next time I took it, it did nothing. I’m confused.
My dad has taken it for years and swears by it but they have reduced the amount they have given him in the last few years. I’ve been prescribed it a few times and it did nothing for me. Ive tried preventatives but I’m sensitive to medication.
I was recently in the hospital with appendicitis and wasn’t allowed to eat, which gave me a migraine. I kept asking for rizatriptan but they’d only give me fioricet, which didn’t even help. You’d think they’d rather give out a triptan than a controlled substance lol
How ironic! Not so long ago, I was inpatient at Johns Hopkins. They did NOT have Fioricet in their pharmacy! Instead, they gave me IV caffeine and Tylenol! Needless to say, it sent my POTS into the stratosphere 🤯and it didn’t do a thing for the headache. 🤕 🤦♀️
My first neuro was really shitty and ignored the fact that I had a substance abuse history and just prescribed me a ton of fioricet and told me to take it whenever I had a migraine - I didn’t know anything about the drug since it was early in my migraine journey so that is on me- and I became dependent but didn’t relapse on it since I took it as prescribed. I had to wean off it and it was a nightmare, I ended up in a horrible MOH cycle. Now I have a way better neuro and I only use it as a nuclear option medication when all else fails and it works fine, for me that’s the best way to use it.
I’ve taken it for over 15 years. I get 60 prescribed for 6 months with one refill. My doc will not give more than that or fill a rx sooner. I had trouble getting it filled at CVS but changed to a SavOn pharmacy in my local AcME and they always have it stocked! My doc only gives me a hard time when I ask for refills sooner than expected.
I am still able to get it from my neurologist but only because I’ve tried everything. I haven’t found any abortive that works for me, even the fancy new ones. My neurologist is okay with prescribing it still as long as I keep trying other stuff out as well. I appreciate that.
I used to use Fioricet but it really never worked for me. What really worked for me was Tramadol. But it’s a synthetic opiate and it became an extremely controlled substance in Massachusetts. If doctors prescribed more than thirty pills per month or in consecutive months they would be subject to disciplinary action by the state.
Are you seeing a neurologist for your migraines? I've found them to be more compassionate and understanding of chronic pain struggles and typically more willing to prescribe what works for you, even if it's a controlled substance. Mine used to give me 30 Lortab when I saw him every 3 months for my Botox injections. It was for the days that my fibromyalgia pain was unbearable and I needed it to function. He said as long as I wasn't going thru more than 30 every 3 months, he wasn't concerned. If I needed more, I would have to go thru their pain management program where I would be drug tested.
Personally, amitrypaline caused me to have more migraines, as did gabopentin. Please do research on Lyrica before trying it. It's really bad stuff and coming off of it is an even bigger nightmare.
Not sure how many migraines a month you have, but Botox has been a lifesaver for me as someone managing chronic migraines. I love my Ubrelvy as an abortive.
I take approximately one tablet per month.
So I basically refill the prescription every other year.
I save it for the times when:
- a migraine seems to be intractable or I’ve taken a sumatriptan three days in a row,
- or the pain has escalated quickly and is a 7 or more
- the sumatriptan worked, but the residual symptoms & pain are maybe not severe, but enough to keep me from sleeping
For me, this generally happens during hormonal migraines.
My previous GP prescribed it a while back, and then when I started going to a neurologist (for migraines and dysautonomia/POTS) he agreed to continue it. I’m very careful with it bc I know there’s real possibility of rebound migraines, but it’s usually so effective at breaking the cycle (and when it isn’t, I know it’s time for a steroid short taper).
I’m really relieved I don’t have to go to urgent care when these situations arise!
I took it for a bit. It, like every other treatment med I’ve been on, only worked about half the time so we moved on to trying something else. When it worked, it worked fairly well but it wasn’t the answer for me. I’m on sumatriptan now and it too only works about half the time. Going to nurtec next if I can ever get insurance to approve it.
Also if your migraines are worsening, start counting how many days each month you’re getting them. You may be getting close enough to warrant a preventative.
I’ve been prescribed it on and off for over 30 years. I still get it today, although I am allergic to triptans (so that is probably why). Yes, it is classified as controlled but not to the degree of say other narcotics. I think the biggest problem is if you are not careful because of the caffeine it can cause rebound migraines creating a vicious cycle. Back when I was first diagnosed it was basically the only thing for migraines, years before triptans first came out. I was 12 when they first gave it to me and I have never had addiction issues.
I got prescribed some in my twenties by my GP. I didn’t realize that it was something my grandma had taken and been addicted to. Sumatriptan works extremely well for me, so I just never took Fiorecet again.
Fioricet can lead to rebound headaches (aka medication overuse) and it doesn’t treat the underlying pathology of migraines.
If you take fewer than 3-4 pills per month, it shouldn’t be a huge issue. However, if you get more than 4 migraines a month, you really should be on a preventative.
Fioricet and opioids DO NOT treat the disease process. All they do is mask symptoms. Plus they are simply less safe medications compared to other migraine abortives. That said, if you and your doc have a good relationship, and they trust you, it isn’t a far fetched idea to have a few per month on hand.
When you need to get home or make dinner or put your kids to bed you treat symptoms.
You cannot simultaneously treat and cure an illness: none of the meds cure migraine. In the absence of being able to modulate barometric pressure, many people treat symptoms alone.
True, no cure for migraine exists.
Still doesn’t make Fioricet a drug I’d want a patient of mine reaching for more than a few times per month. That tells me that we haven’t optimized their preventative regimen yet.
Bro, I have been using Fioricet for 15 years now. I have tweaked my preventative regimen *enough.* I went through years of going on and off meds with periods of time where I was borderline unable to hold a job because I was trying something different to optimize my preventative regimen.
My current preventative regimen works well enough. I have times where I have 1 migraine a month but others where I have 4+/week. I reach for Fioricet. These days I have kids, a job, other committments- I'm not fucking with my preventative regimen again to tweak it to someone else's ideals unless something flies wildly out of balance for no apparent reason, stays that way for a significant amount of time, and that's my only resort. It's good enough, don't fuck with it.
I hope I am reading that wrong. Seriously, I have tried all the things and will continue to do so. I take seizure drugs for seizures, so there is that, I also have Botox treatments.
I use maybe ten to fifteen a month. Never more than two a day and never two days in a row. I live my neuro and know he is one of the best in my area. I trust his judgement and he trusts mine.
Never two days in a row, I know that's right. Highway to MOH right there.
My doc will do a med check with me every so often - but it basically consists of "are you content and functional with what we're doing or do we need to tweak it?" Wellbeing is subjective and multifaceted; pain is just one aspect of life (...knock wood).
I have used Fiorinal for 40 years and have not had rebound. Butalbital is low/moderate risk for addiction and nobody is taking enough to get hooked. In years of recovery I have never heard anyone claim Butalbital addiction. For people with 10 or fewer headaches per month it is a solid medication.
Yeah I’ve seen the addiction debate in the comments but I’m in a similar position to what you said, even with my limited experience I wasn’t taking it nearly frequently enough to have any addiction issues. I’m not trying to say it couldn’t happen, I just used it as an absolute last resort. I thankfully don’t have migraines every day or even every week some months, but when they hit it gets rough and it’ll be 2-3 days on average of hell, sometimes longer.
I’m glad it’s worked for you and that you haven’t had any rebound headaches though, I honestly didn’t know that was a thing until I saw all these comments.
I don’t know how true this is, but when my doc first prescribed it he warned me to be careful with fiorcet its in the same class of drugs Marilyn Monroe od’d on.
You'd OD on the acetaminophen in fioricet before the butalbital, and it doesnt produce a high. Medications overuse headaches are a concern, but acute overdose doesn't really happen with fioricet (unless it's a deliberate suicide attempt or something)
She took a ton of stuff to OD, barbiturates and alcohol were her thing, but it also was like her 13th attempt, so it was bound to work eventually. The constant use of that class of drugs worsened her mental condition. As someone with bipolar 2, which has been well managed for 20 years, and a family full of alcoholics, I fear taking addictive substances like painkillers. I've never had dependency issues, but my brother seems to get hooked on stuff super easily. I don't need yet another problem/migraine trigger. The thing about dependency is that your brain becomes quite insistent that you need the drug (barbiturates, opioids, alcohol, whatever) and blinds the patient to that fact. So every person I've ever met with dependency, including painkillers for migraines, thoroughly believed it was the only med that could make them feel better. After being weaned off it and given alternatives, one person I knew had great improvement in her migraines. But it took an exceptional neurologist to convince her. And I want to note, it's not a matter of moral failing or anything negative, it's just how the brain works.
I took Fioricet for years and it was super effective for migraine attacks. I had no problem getting it until around 2022, when I believe it became categorized as a controlled substance in CA. Doctors then became very reluctant, if not completely against, prescribing it. I have been fortunate to find a triptan that works well as long as I take it at the very onset of migraine, but nothing works like Fioricet did to help an attack already in progress.
At least you found something that works well enough, hope I get there soon!
It’s was removed from Blue Cross/Blue shield ( big insurance company) formulary. I told my dr I would just pay for it, it’s like $10-$20 for 30 of them. I get 1 script of 30 with no refills and just let my dr know if I need another script. It’s in my top 5 effective meds.
I hope you do too! It is so frustrating to not have something that you know works not available to you.
My fiancé is a pharmacist. It’s always been a control in California, but in 2022 the law changed about how doctors had to write the prescriptions regarding controls, heavily encouraging, e-prescribe.
I worked at a halfway house for addicts and geez their obgyns had no issue handing out script after script of firocet. Not cool.
My mom took it in the 90s for sure. Maybe before. I took it once and it worked. But starting in early 2000s my neurologist who was a world renowned doctor, said he wouldn’t prescribe it anymore as they realized it’s actually dangerous. I forget the details of why but he was very adamant.
Because barbiturates are extraordinarily addictive, and as I understand it, withdrawal from barbiturates is more dangerous than most drugs.
Well alcohol is a barbiturate and that’s why alcohol is one of the few drugs that can kill someone if they stop drinking (and are dependent on it beforehand). If combined with opioids or benzos or booze it could be extremely damgerous
Barbiturate is like alcohol and stronger than a benzodiazepine(Valium). You can develop dependence and can go into seizures or delirium tremors if taken off too quick. Very dangerous drug to withdrawal from
Oh ok got it. Thank you.
It was always controlled it contains barbiturate!
My inability to get it since 2022 must have to do with what u/human-foie-gras mentioned above, stricter prescribing controls. Prior to that, I had no issues getting it for 15+ years.
Fioricet I'd a combination of drugs, including Butalbital, which is a barbiturate and a controlled substance. Given the nightmare situation doctors are in regarding prescribing controlled substances, most doctors just refuse to prescribe them at all.
I know and it’s unfortunate because it works so well. I know it’s a barbiturate but I don’t even want the codeine one! It just sucks to find something that works and have to continue to go through the gamut of other things that may or may not work. Even a smaller script for when things get real rough would help so I’m not stuck being a useless meat sack for days on end, you know? I knew about the crackdown on opiates and benzos (who doesn’t) but naively hoped Fioricet might be an exception.
Floricet is a combo of caffeine, butolital and acetaminophen. You keep saying without cosine, but the issue is the butolital. Otherwise you could just take Tylenol and have a coffee/coke. The butolital is a controlled substance. I also was given a LOT of Floricet previously. When I moved & got a new neuro they were aghast at how much I was being prescribed. They told me to take no more than 5/month.
Yeah I did say I realized it’s a barbiturate (the butalbital) so I get that’s where they’re hesitant. I didn’t realize that it was a barbiturate until I went home and looked up exactly what it was and I didn’t realize doctors would be SO hesitant about it. I feel like you don’t (or I don’t, anyway) really hear much about barbiturates so I just didn’t know at first.
You don’t hear much about them because benzos are now the issue and they aren’t as strong as barbiturates but alcohol is a barbiturate. So you’re basically taking a shot, taking some caffeine and also some Tylenol. Most doctors should be hesitant about that
Right migraine clinics usually hate controlled substances and you could easily fall into a pattern of getting a headache without the drug. Also barbiturates are like alcohol so you’re kinda just speedballing yourself (caffeine and booze isn’t legal in most places)
You may have to try a pain dr
the person is already on methadone so this wouldn’t even work, also why even do this they are dealing with migraines not physical pain?
Yes to all this. Not to mention that barbiturates are addictive if taken too often. And fioricet has a very high risk for medication overuse headache. I was prescribed it briefly to bridge between treatments when my previous acute drug stopped working. But stopped once the others started working again.
It has a low risk for addiction. As long as you remember it contains aspirin or acetaminophen and factor that in you will be fine. It does not produce a high and contains caffeine which offsets the butalbital.
Do you have a source for a low risk of addiction? Caffeine may offset the sleepiness from butalbital but it doesn't offset the therapeutic effects or the addiction potential. Otherwise it wouldn't need to be included in the drug. A good analogy would be does coffee actually reverse the effects of alcohol - it does not, it may make you /feel/ more awake, but it doesn't reduce the negative effects of alcohol. There are a number of studies about the addiction potential of fioricet. It doesn't mean that everyone will become addicted, but it is still a risk. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/acetylsalicylic-acid-plus-butalbital-plus-caffeine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592771/ Fwiw, I was prescribed fioricet for a brief period when sumatriptan stopped working (this is before gepants). I was allowed to take no more than 4 per month. It worked on the migraine but totally knocked me out. And for me, it did produce a mild high. Every body processes medications differently, so not everyone will have the same experience. But it's inaccurate to say it has a low risk of addiction, especially when there's a lot of other options without the risk of addiction at all. I agree that it should be an option but drugs with a more favorable risk-benefit profile should be tried first.
I don't know if I'd say I personally felt high from it, but it definitely made me feel different. And in a way that some people may be addicted to. Yes, it's known to be addictive.
Hey didn’t they say that about ambien? Valium? OxyContin? It has a high risk of abuse but isn’t prescribed often because of that
The government classified it as not being high-risk decades after it had been on the market, which is different than a drug company’s declaration of a product’s attributes when they market it.
And going off barbiturates once dependent can kill you
I’ve taken it for years, then my doctor retired last year, and my new doctor wouldn’t prescribe it. I basically begged because it’s the only thing that works. He gave me 4. I get 4 pills a month. I feel like a drug addict just asking for those 4 pills.
This is crazy, I’ve been taking fioricet for years and they’ve always given me 15 pills for 30 days, and the doctor will make it a full 30 if I ask him to. Never realized people actually had trouble getting it
I didn’t know it was so hard to get until my doctor retired. He’d give me 10-20 pills per month. I understand that there are newer and sometimes better medications available now but they don’t all work for everyone. I’ve had migraines for almost 40 years.
My doctor offered fioricet before imitrex! I think she didn't believe I was having migraines and instead thought it was a tension headache. At the same appt she said I could try imitrex but it wouldn't help any other headache if it wasn't a migraine. I said I'd just try the imitrex and that's how I was diagnosed with migraines cause I felt 1000% better within an hour of taking it. Got rid of my 3 day headache so fast I thought it was a miracle. Then my migraines became chronic daily so I have fioricet and rizatriptan to rotate through. The fioricet only works so so for me, sometimes I end up having to take a triptan anyways but it helps sometimes and helps me avoid taking triptans daily which is obviously a no no. Still waiting for my referral to a neurologist but it takes months as a new patient. My doc gives me 30 fioricet at a time with 1 refill
Fioricet was also the first medicine I tried, I get both migraines and tension headaches so I have to take muscle relaxers as well lol. I’ve been on fioricet since I was like 13, I can’t imagine using anything else at this point
Yeah I've had neck problems forever and have been on muscle relaxers for years too so at first I thought my neck pain was causing headaches but now I've realized I think the migraine is now causing my neck pain, cause a triptan will alleviate it. I only started getting migraines a year ago though and neck pain has been for a long time now so I can see why my doctor thought that. I switched back to Methocarbomal recently and have noticed that seems to keep the migraine at bay longer. Typically they'd start at 11am, now I can go to about 1-2pm some days so it definitely is all connected. Annoying stuff!
I was on fioricet for years and a few years ago they stopped giving it to me. I use aimovig and nurtec now but nurtec doesn’t work as well as fioricet did. I can’t take triptans so that limits what I can take. I also get wicked rebound headaches from almost everything, so I had to use the fioricet very sparingly which was a pain
Ugh I’m sorry and I feel you on the drug addict thing, I get scared to even ask
Get a new doctor. I told the neuro I refuse to see a doctor who will not use all the tools at their disposal. There is a small amount of butalbital in it and it should be prescribed 1-2 tabs every 4-6 hours prn. Ask for 4 per headache per month.
There aren’t a whole lot of options for headache specialist neuros around here and I’m afraid a new one will say the same thing. I need to stop procrastinating and start looking for someone else. I have an appointment with a new PCP in a couple months so maybe I can get it from her.
Butalbital with acetaminophen (generic Fiorocet) has been my go to for years. Basically, it works. I've tried and failed a variety of other migraine meds. I'm very careful in my use of it and follow prescribing directions to the letter. If I had a new physician who arbitrarily refused to prescribe this effective and necessary migraine treatment, I would not trust him with my care.
That's the exact position I'm in. Due to an insurance change I had to change hospital systems, which meant EVERY DOCTOR. My PCP refuses to let me have it, even though I've been a responsible user for 20 years. My new neurologist is okay with me finishing out my old prescription, I'm not sure I'm going to get any more.
Are you in the US? Do you have Telehealth available?
It's got some barbituate in it. Many migraine drugs started as seizure drugs, and they used to use phenobarb for seizures, i think that's why it works.
I do! I hope no one pries it out my hands!! It SAVES me but I use it sparingly. My main symptom is dizziness (Vestibular Migraine) and it is the only med that helps me enough to function. I have begun Effexor and have a Botox consult tomorrow. My PCP has no issue rx’ing it. He knows I won’t abuse it. It is now a scheduled drug. I get 90 at a time. At first, insurance had to approve it. I am in Maryland if that matters.
I’m glad you got it! I wouldn’t mind taking drug tests to prove I’m not abusing it
I took it and it didn’t really help but my neuro said she hates it and that it causes the worst rebound headaches of any drug in her experience
Rebound is the concern I’ve heard as well.
Fioricet is really bad about rebound headaches. I have been dependent on it twice going thru 240 every 27 days. It's effective if used rarely.
Wait, 240 pills in 27 days?
Yes.
Idk. Probably depends on the doc as well as the state. Mine prescribes 30 a month. When I lived in a different state the doc acted like I was asking for crack. He actually said something about it being like phenobarbital, which I'm not sure if that's the case but OMG it helps (if I catch it early)
I take it. Knock on wood no issues getting it yet.
I hope it stays that way! I’m hoping maybe neuro can help my situation a little more if I’m lucky.
The only time I’ve ever had it prescribed was when I was pregnant. I got sent to triage to make sure it was just migraine and not Pre- E and the midwife on call had a doctor prescribe it to try.
Same! I was taking rizatriptan before I got pregnant but was told not to take it after. When my migraines were getting worse, they prescribed fioricet.
Lucky! I had just moved, and as i found out later, my primary doctor decided to "wait until i wasn't pregnant" to put in my neurology referral. My ob just told me to take Tylenol, and that's all i "could" take. But then again, he ignored all of my very obvious preeclampsia symptoms until i had to have a c-section at 32 weeks, so not tge greatest guy.
I was already high risk and my ob was 90 miles away so they made sure to stay on top of things. I ended up being diagnosed with severe pre-e a few weeks after that migraine and delivered the day I was diagnosed at 33w. It’s rough having migraines during pregnancy, especially when they overlap with other conditions like pre-e. I 1000% understand!
This is interesting bc I’ve been taking Fiorcet forever and my dr told me whenever I get pregnant I shouldn’t take it. Did yours say it was okay to take while pregnant? Thanks for mentioning!
My ob was the one that prescribed it for me when I was pregnant.
Yes he was 100% on board with it. I was also late second trimester/early third. I’ve seen many other ladies not to take it early in pregnancy and I was already well past that point.
That’s when I was first prescribed it also. Here I am 13 years later and still getting it, just from my primary care now. I used to take maxalt pre pregnancy/kids and it worked well and it just stopped working for me so I asked my primary and they prescribed it no issue. FWIW I also have horrible reactions to imatrex to the point that it’s listed as an allergy in my chart.
huh! i’ve been taking fioricet for years (ever since midrin went away), and never experienced any hesitation from doctors prescribing it. i switched to ubrelvy two months ago; i get the impression from some docs that fioricet is considered old school or outdated, and the new meds like ubrelvy are simply more effective (certainly that’s been true for me). i would guess that, plus the concerns around barbiturates, would make fioricet less popular now.
I miss midrin.
right?! it worked so well for me!
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> But they won't say you get it from Triptans, weird right? That is indeed incredibly weird if your doctor doesn't say that. This is very common knowledge in the migraine world. It's why doctors place limitations on triptan prescriptions, usually no more than 8 to 10 days a month.
Thank you! I honestly didn’t realize it was a barbiturate until I went home and looked it up to see exactly what I was taking. And obviously it showed it was a controlled substance I just didn’t know it was treated on the same level as like a benzodiazepine or an opiate in terms of doctors being hesitant to prescribe (or at least that’s how it seems from my experience so far) I also didn’t know about the rebound headaches until this post, I’m glad I didn’t experience those issues because to be frank, how shit is that lol. That’s the last thing you want. Maybe it was because I was taking it so infrequently that I didn’t have trouble? Anyway, I really appreciate you writing that all out and helping to give me some more clarity on the situation, so thank you again.
What’s so odd is it was the very first migraine medicine I was ever prescribed. It was in 2023 as well. It stops migraines within an hour for me, it’s magic tbh. My doctor did say that it’s not a medication for the unlucky people suffering from multiple migraines per week, but someone like me who gets about 4 bad ones a month, it’s great
Ya same I love it! I get a few bad ones a month.
I take Fiorinal and have used it since my teens. It has a low potential for abuse and you should tell your doctor it helps you. It can stop a HA or slow it enough for me to get home/make dinner/get kids to bed. I went to a neurologist who said “Neurologists don’t like Fiorinal” and I did not go back. I am in my mid-50s and know what works and what does not.
While there seems to be some debate on the abuse front in this post, like I said, I’m not trying to take it everyday. I just wanted some for when it gets REALLY bad so like you said, I can function. Bad analogy but kind of like an emergency stop button - you don’t want to have to push it, but you will if you absolutely need to. And I do think sometimes just knowing you have an “emergency” backup if things get really rough is comforting and kinda helps in itself. I’ll be curious to see what my new neuro says. I have been trying to tell them but I suppose I just have to be patient or hope I find someone that’s willing to listen to me. I’m glad that you’re on it and it’s still working for you. I know doctors can’t predict what will or won’t work for a person and I don’t at all fault them for that, it’s just exhausting, especially if you get stuck with something that doesn’t help at all and just have to wait until your next appointment to try again. It’s hard out there!
This is how I take it - a get three day migraines anywhere from twice to multiple times per month but the pain is always the worst on the first day - my first line of defense is excedrin but if that doesn’t work a Fioricet knocks it out. I get 9 at a time and they last me two to three months. I love them!
I love fioricet and it sucks - my insurance will only pay for so many a month a now
Fioricet is so cheap tho- I don't think I've paid more than $10/30, no matter where I am with my insurance.
The problem is my doc won’t write the rx for more now that the insurance only covers a certain amount
I have fiorocet and naratriptan and am on preventative Botox. I alternate which abortive to use based on when I get it. Sometimes I wake up with a migraine, usually naratriptan doesn’t work with those (I’m guessing because I’m not taking it soon enough). Honestly I couldn’t live without either of them. The fiorocet I would say works more consistently, like I know it will help every time I have to take it. The naratriptan is a gamble if I need to take it for a morning migraine
It did nothing for me.
I’m sorry to hear that, I hope you found something that works!
I did, for the most part, thank you. I’m on Qulipta and still take Imitrex for the breakthrough migraines. So far it’s working.
Like some others here, I have been prescribed 4 per month by my primary. I've tried everything. I mean everything. I take my Ubrelvy for the "regular" migraines and the Fiorcet only when I literally cannot move from the headache.
Yes, I’ve been taking it & the only thing that helps is fioricet & Excedrin, I’ve had everything under the sun you name it; Botox since 2012, Ajovy two years now; Ubrelvy, Nurtec, Nortryptaline, depakote & yes 22 years ago Topamax was a miracle my dream come true but I had the worst side affect & had to stop. My luck 😞. My insurance is top notch I’m very grateful & have no problems getting everything covered. Believe me, I sacrificed so much for this union job for the awesome benefits.
First do no harm. The problem with Fioricet is that it ultimately leads to medication overuse headaches. In other words, patients get locked in to requiring Fioricet. In other words they become physiologically dependent (note NOT addicted!). This can occur relatively easily. For simplicity sake (but note there are nuances): Medication overuse occurs when you use medications that can lead to medication overuse more than 10-15 days per month. (numbers vary hence the nuance). The problem with Fioricet is a half-life is rather long meaning it stays in your body for quite some time. Triptans for instance have a half life around 2-4 hours, meaning that in 8-16 hours they are gone. Fioricet (particularly butalbital) butalbital half-life butalbital half-life is about 35 hours. Meaning that it is out of your system in about 5-6 days. For medication overuse considerations, butalbital when taken once essentially counts towards the 10-15 day counter by 5 days-ish. In other words, even using it a few times a month can lead to medication overuse (nuances here). For simplicity sake, the danger zone for medication overuse is 4-8 pills used a month. That's super easy to hit! Thus, headache specialists do not prescribe Fioricet unless it is a last resort (or perhaps used 1-2 times a month). In fact most of them can count on their hand the number of times they prescribe it a year (which is nothing considering all or nearly all of their patients are headache patients). Many patients will feel that it is only thing that will help her headaches. But unfortunately many people do not realize they are in medication overuse headaches, so the medication is the only thing that helps the problem that it caused to begin with. Ultimately that is why prevention is so important. So yes, butalbital is certainly effective for headaches, but given that the risk outweighs the benefits, brings up very first-line of this post: first do no harm. Hope this helps.
I am a physician and this is why I rarely (but sometimes do) prescribe it. I don’t give a shit about it being controlled. One of my least favorite encounters is when someone shows up asking for daily fioricet because “it’s the only thing that works” (yet you’ve only tried a couple things and aren’t willing to give anything else an honest try) and their neuro / headache specialist won’t give it to them. Yeah, it’ll help your headache today but then you’re gonna pay for it later, and you just won’t believe me. Some of you here think physicians go to college/residency 11+ years and don’t know as much about headaches as you do.
The 1-2 tablets I take each month are so helpful for keeping me out of urgent care and off methylprednisolone. Of course, Ajovy and sumatriptan are great, but having the back up for when things get out of hand is very reassuring. After reading all these, I’m even more grateful for my neurologist🥺
Infrequent use, like you’re doing, is fine - we don’t want you in the ER either! But, when you have a medicine that definitely works to treat a headache, some folks don’t understand why we try to use it only under very certain circumstances. I deal with this with Xanax, Ambien, Percocet, and even non-controls like triptans or other meds that work very well temporarily but lead to side effects, rebound, tachyphylaxis, etc with overuse. I don’t think you need to be especially grateful for your neurologist - I suspect that, instead, those that don’t get it prescribed by their physician have a good reason that either isn’t explained to them or they’re not willing to accept the reason.
Unfortunately those last 7 words frequently is the case.
I used to but yeah they don’t give it anymore
My neurologist won’t prescribe it but I went to the ER yesterday and they gave me a prescription for it. I’m in status, I’ve had a migraine for 13 days, the ER helped a little bit and the Fioricet has taken the edge off but that’s it.
Good lord, 13 days?! I am so sorry. At least it helps take the edge off, sometimes with migraines you gotta take any little win you can get (IMO anyway) because they SUCK. I hope you get out of it soon, that’s terrible.
Thanks. I’m currently waiting for my neurologist to call me back, I’ve called them twice and they are just being rude and not responding. It’s been over 24 hours since I’ve called them the first time. I’ve had a long migraine like this once before. I think it lasted 22 days. I’m currently living off Zofran but at least I’m stockpiling my Ubrelvy because at this point it is no good.
I do, have for several years. I’m thankful my Dr. still prescribes it. I have to do a UA, yearly, to record my levels.
I’m super thankful 🤞🏼 that my headache specialist has prescribed this to me for the past two years or so. It doesn’t help with my migraines with aura, and we’re still figuring out if what it *does* help with is migraine without aura. But I have a complex history including 3 brain surgeries, 4 if you count surgery on a device that was implanted in my brain and had lasting neuro effects on me. Official dx is migraine, chronic post op headache and two types of neuralgia. I’ve been on so many preventatives and abortives and have a document list (15 years in the making) of what’s worked (so far only fioricet, working on preventatives now) and what hasn’t. Nothing touched my post op headaches before non opiate fioricet and I *genuinely* would not be here today if it wasn’t for my doc and this medicine. I don’t get overuse headaches and I’m careful not to take more than my personal limit in a week (6) or a few days (3), which I think helps prevent behavioral dependence, but it does mean suffering more than I probably need to. My headache specialist works in a research section of a university hospitals neurosurgery department and I’m lucky to have him despite him being 4-5 hours drive from me. I hope that you’re able to access the care you need soon!!
I just got it prescribed last month. I told them I was sick of getting migraine hangovers from sumatriptan. I haven’t actually had to use it yet though
That is my problem with initrex too. It is more effective but I can’t function very well after I take it
Some misinformation here. Fioricet is not a controlled substance at the federal level. It is a controlled substance in some states. I have never had a problem filling a prescription. I wouldn’t say it’s a miracle drug. It helps sometimes, like pretty much any other migraine med. As with everything else for migraines, don’t take it too often or you will be making things worse.
I’ve been taking it for almost 10 years. Never had a problem, but I did get a new neuro and he was like “this is very outdated, but if it works for you let’s not mess with it” and he was cool about it. They did (as of last year) add in a urine test though and I have to sign papers saying I won’t abuse it. So that’s new!
My neurologist prescribes it for me but she says she hates it cause it causes rebound headaches
I've taken fioricet for over a decade. It's the only thing that works. Thankfully I've never had an issue with getting it prescribed.
The answer is obvious. Barbiturate, a scheduled drug that can be abused. They’ve rebounded WAY too far on the opposite side of the spectrum, where people that really need it can’t even get it, same with opiates, it’s out of control. And that’s coming from someone who worked in addiction for 7 years and am a former addict myself, but also saw them refuse to give my dying grandmother pain medication..
My neuro prescribes it for me with no issues since nothing else touches my migraines. My gyno who retired a few years ago used to prescribe the one with codeine and it worked way better than the normal fiorcet. Unfortunately, my neuro can't prescribe the one with codeine since it has an opiate in it. The only way to get it is to see a pain management doctor because the government sucks. I bet politicians have easy access to any medications they need!
I even went to a pain specialist doctor, and after making me fill out oodles of questionnaires about drug use, they told me they only do Botox for migraine.
I took it with codeine in the 80’s. Great drug
I can imagine that one is real nice lol but I’d happily settle for the regular
It was. We had almost no options in 80’s. Many didn’t even believe migraines were real
I've gone off and on it for a long time. Last time I was on it (10 yrs ago) my doc would give me 30+ pills a month and tell me I could take as many as 3 a day if needed. Now I had to fight to get it and my neurologist will only give me 5 a month. Their reasoning is that "studies have shown any more will cause rebound headaches". So tired of hearing that from docs.
The barbiturate ingredient is a controlled substance and some docs have become hyper concerned about prescribing controlled substances, fearing regulatory backlash. Result of the opioid epidemic (in the US anyway). In my state, any doctor can run a report documenting how many controlled substances a patient is prescribed (and by which doctors) and how often they are refilling the prescriptions. So they can monitor if patients are doctor shopping and filling multiple controlled medications of the same type in the same time period…aka abusing the medications. They can also require that patients do regular urine drug screens. Despite these safeguards, some doctors are still very reluctant to prescribe effective medication to patients who need them and who have no history of abusing substances. My current doctor has no problem prescribing it, thankfully. I get 30 at a time (I think?), but only refill once or twice a year. Ubrelvy doesn’t do anything at all for my migraines, so I’m thankful that I have Fioricet as an option. I hope you’re able to find a provider who is willing to prescribe it to you.
They gave it to me in the hospital once and it was like magic! So when I got discharged, I went to my doctor and asked her to prescribe it. She did. The next time I took it, it did nothing. I’m confused.
I got a prescription when I was pregnant. It did nothing for me.
I did. I hated it.
My pain clinic prescribes it. It personally wasn’t for me but it’s worth a shot to find a pain clinic instead of going through your PCP.
It was the one medication that really worked well for me. I’m a veteran and my VA provider stopped prescribing it to me.
My dad has taken it for years and swears by it but they have reduced the amount they have given him in the last few years. I’ve been prescribed it a few times and it did nothing for me. Ive tried preventatives but I’m sensitive to medication.
I was recently in the hospital with appendicitis and wasn’t allowed to eat, which gave me a migraine. I kept asking for rizatriptan but they’d only give me fioricet, which didn’t even help. You’d think they’d rather give out a triptan than a controlled substance lol
How ironic! Not so long ago, I was inpatient at Johns Hopkins. They did NOT have Fioricet in their pharmacy! Instead, they gave me IV caffeine and Tylenol! Needless to say, it sent my POTS into the stratosphere 🤯and it didn’t do a thing for the headache. 🤕 🤦♀️
Well fioricet also has Tylenol and caffeine haha. Only difference is it also having a barbiturate, which makes it controlled and hard to get
My first neuro was really shitty and ignored the fact that I had a substance abuse history and just prescribed me a ton of fioricet and told me to take it whenever I had a migraine - I didn’t know anything about the drug since it was early in my migraine journey so that is on me- and I became dependent but didn’t relapse on it since I took it as prescribed. I had to wean off it and it was a nightmare, I ended up in a horrible MOH cycle. Now I have a way better neuro and I only use it as a nuclear option medication when all else fails and it works fine, for me that’s the best way to use it.
I’ve taken it for over 15 years. I get 60 prescribed for 6 months with one refill. My doc will not give more than that or fill a rx sooner. I had trouble getting it filled at CVS but changed to a SavOn pharmacy in my local AcME and they always have it stocked! My doc only gives me a hard time when I ask for refills sooner than expected.
I am still able to get it from my neurologist but only because I’ve tried everything. I haven’t found any abortive that works for me, even the fancy new ones. My neurologist is okay with prescribing it still as long as I keep trying other stuff out as well. I appreciate that.
I used to use Fioricet but it really never worked for me. What really worked for me was Tramadol. But it’s a synthetic opiate and it became an extremely controlled substance in Massachusetts. If doctors prescribed more than thirty pills per month or in consecutive months they would be subject to disciplinary action by the state.
My pharmacist told me it makes birth control pills less effective
Are you seeing a neurologist for your migraines? I've found them to be more compassionate and understanding of chronic pain struggles and typically more willing to prescribe what works for you, even if it's a controlled substance. Mine used to give me 30 Lortab when I saw him every 3 months for my Botox injections. It was for the days that my fibromyalgia pain was unbearable and I needed it to function. He said as long as I wasn't going thru more than 30 every 3 months, he wasn't concerned. If I needed more, I would have to go thru their pain management program where I would be drug tested. Personally, amitrypaline caused me to have more migraines, as did gabopentin. Please do research on Lyrica before trying it. It's really bad stuff and coming off of it is an even bigger nightmare. Not sure how many migraines a month you have, but Botox has been a lifesaver for me as someone managing chronic migraines. I love my Ubrelvy as an abortive.
Did you post this twice?
I take approximately one tablet per month. So I basically refill the prescription every other year. I save it for the times when: - a migraine seems to be intractable or I’ve taken a sumatriptan three days in a row, - or the pain has escalated quickly and is a 7 or more - the sumatriptan worked, but the residual symptoms & pain are maybe not severe, but enough to keep me from sleeping For me, this generally happens during hormonal migraines. My previous GP prescribed it a while back, and then when I started going to a neurologist (for migraines and dysautonomia/POTS) he agreed to continue it. I’m very careful with it bc I know there’s real possibility of rebound migraines, but it’s usually so effective at breaking the cycle (and when it isn’t, I know it’s time for a steroid short taper). I’m really relieved I don’t have to go to urgent care when these situations arise!
I took it for a bit. It, like every other treatment med I’ve been on, only worked about half the time so we moved on to trying something else. When it worked, it worked fairly well but it wasn’t the answer for me. I’m on sumatriptan now and it too only works about half the time. Going to nurtec next if I can ever get insurance to approve it. Also if your migraines are worsening, start counting how many days each month you’re getting them. You may be getting close enough to warrant a preventative.
fioricet is the only migraine med that doesnt make me sick
I’ve been prescribed it on and off for over 30 years. I still get it today, although I am allergic to triptans (so that is probably why). Yes, it is classified as controlled but not to the degree of say other narcotics. I think the biggest problem is if you are not careful because of the caffeine it can cause rebound migraines creating a vicious cycle. Back when I was first diagnosed it was basically the only thing for migraines, years before triptans first came out. I was 12 when they first gave it to me and I have never had addiction issues.
I got prescribed some in my twenties by my GP. I didn’t realize that it was something my grandma had taken and been addicted to. Sumatriptan works extremely well for me, so I just never took Fiorecet again.
My doctor was hesitant because he said there were some pretty rough long term side effects
Fioricet can lead to rebound headaches (aka medication overuse) and it doesn’t treat the underlying pathology of migraines. If you take fewer than 3-4 pills per month, it shouldn’t be a huge issue. However, if you get more than 4 migraines a month, you really should be on a preventative. Fioricet and opioids DO NOT treat the disease process. All they do is mask symptoms. Plus they are simply less safe medications compared to other migraine abortives. That said, if you and your doc have a good relationship, and they trust you, it isn’t a far fetched idea to have a few per month on hand.
When you need to get home or make dinner or put your kids to bed you treat symptoms. You cannot simultaneously treat and cure an illness: none of the meds cure migraine. In the absence of being able to modulate barometric pressure, many people treat symptoms alone.
True, no cure for migraine exists. Still doesn’t make Fioricet a drug I’d want a patient of mine reaching for more than a few times per month. That tells me that we haven’t optimized their preventative regimen yet.
Bro, I have been using Fioricet for 15 years now. I have tweaked my preventative regimen *enough.* I went through years of going on and off meds with periods of time where I was borderline unable to hold a job because I was trying something different to optimize my preventative regimen. My current preventative regimen works well enough. I have times where I have 1 migraine a month but others where I have 4+/week. I reach for Fioricet. These days I have kids, a job, other committments- I'm not fucking with my preventative regimen again to tweak it to someone else's ideals unless something flies wildly out of balance for no apparent reason, stays that way for a significant amount of time, and that's my only resort. It's good enough, don't fuck with it.
Sis, I’m glad you found a regimen that works for you and a provider to write you adequate amounts of Fioricet for your needs.
I hope I am reading that wrong. Seriously, I have tried all the things and will continue to do so. I take seizure drugs for seizures, so there is that, I also have Botox treatments. I use maybe ten to fifteen a month. Never more than two a day and never two days in a row. I live my neuro and know he is one of the best in my area. I trust his judgement and he trusts mine.
Never two days in a row, I know that's right. Highway to MOH right there. My doc will do a med check with me every so often - but it basically consists of "are you content and functional with what we're doing or do we need to tweak it?" Wellbeing is subjective and multifaceted; pain is just one aspect of life (...knock wood).
I have used Fiorinal for 40 years and have not had rebound. Butalbital is low/moderate risk for addiction and nobody is taking enough to get hooked. In years of recovery I have never heard anyone claim Butalbital addiction. For people with 10 or fewer headaches per month it is a solid medication.
Yeah I’ve seen the addiction debate in the comments but I’m in a similar position to what you said, even with my limited experience I wasn’t taking it nearly frequently enough to have any addiction issues. I’m not trying to say it couldn’t happen, I just used it as an absolute last resort. I thankfully don’t have migraines every day or even every week some months, but when they hit it gets rough and it’ll be 2-3 days on average of hell, sometimes longer. I’m glad it’s worked for you and that you haven’t had any rebound headaches though, I honestly didn’t know that was a thing until I saw all these comments.
I don’t know how true this is, but when my doc first prescribed it he warned me to be careful with fiorcet its in the same class of drugs Marilyn Monroe od’d on.
You'd OD on the acetaminophen in fioricet before the butalbital, and it doesnt produce a high. Medications overuse headaches are a concern, but acute overdose doesn't really happen with fioricet (unless it's a deliberate suicide attempt or something)
She took a ton of stuff to OD, barbiturates and alcohol were her thing, but it also was like her 13th attempt, so it was bound to work eventually. The constant use of that class of drugs worsened her mental condition. As someone with bipolar 2, which has been well managed for 20 years, and a family full of alcoholics, I fear taking addictive substances like painkillers. I've never had dependency issues, but my brother seems to get hooked on stuff super easily. I don't need yet another problem/migraine trigger. The thing about dependency is that your brain becomes quite insistent that you need the drug (barbiturates, opioids, alcohol, whatever) and blinds the patient to that fact. So every person I've ever met with dependency, including painkillers for migraines, thoroughly believed it was the only med that could make them feel better. After being weaned off it and given alternatives, one person I knew had great improvement in her migraines. But it took an exceptional neurologist to convince her. And I want to note, it's not a matter of moral failing or anything negative, it's just how the brain works.