Butalbital for Headaches and Dependency Risk

Butalbital-containing medications, like Fiorinal (butalbital/aspirin/caffeine) and Fioricet (butalbital/acetaminophen/caffeine), are commonly over-utilized in the treatment of headaches.

Let's explore the use of butalbital-containing medications for your headaches, and how a person can safely withdraw from them under a healthcare provider's care.

Anxious mixed race woman sitting at table

JGI / Jamie Grill / Getty Images

What Is Butalbital?

Butalbital is a short-acting barbiturate, often used in combination with Tylenol (acetaminophen), aspirin, and/or caffeine to treat headaches. As a barbiturate, it depresses or slows down the central nervous system, causing a number of effects, depending on the dose. At lower doses, it relaxes muscles, providing headache relief for some. At higher doses, barbiturates are used as sedatives and even for anesthesia.

Why Butalbital Is Not an Ideal Headache Medication

A person who takes butalbital for their headaches is at risk of developing chronic headaches and/or medication overuse headache, also known as a rebound headache.

With a rebound headache, a person feels an increase in their head pain intensity after abruptly stopping their medication. This increased pain makes it extra difficult to discontinue the medication, which perpetuates the headache cycle. Taking medications as few as two to three times a week can lead to a rebound headache. According to scientists, it's more the frequency than the actual dose that is a bigger risk factor for developing a rebound headache. 

Breaking the Cycle

When a person stops butalbital, they are at risk for withdrawal symptoms, especially if they are taking frequent and/or high amounts. In this case, a gradual taper of butalbital is necessary to prevent seizures — a potential withdrawal symptom. 

Phenobarbital, a long-acting barbiturate, can help patients withdraw from large amounts of butalbital-containing medications. The administration of phenobarbital is done gradually, in a tapered fashion. This means that the dose is slowly decreased every couple of days and is done in a monitored setting under the care of a healthcare provider. On average, the withdrawal process can take 3 weeks. This is not a hard and fast rule though and may be longer or shorter based on the dose and frequency of butalbital the person had been taking. It also depends on the presence of distressing withdrawal symptoms while in the hospital. 

A Word From Verywell

If you are concerned about your use of butalbital, please speak with your healthcare provider before altering the dose or frequency on your own. It's also imperative you speak with your healthcare provider during the withdrawal process about safer strategies to treat your headaches in the future. Your healthcare provider may recommend a preventive headache medication or alternative therapies, like biofeedback or meditation, to supplement your headache medications.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • American Headache Society. (2008). Chronic Daily Headache and Chronic Migraine. 
  • American Headache Society. (2015). Too Many Migraine Patients Are Getting Opioids and Barbiturates for Their Pain. ​
  • Loder E & Biondi D. Oral phenobarbital loading: a safe and effective method of withdrawing patients with headache from butalbital compounds. Headache. 2003 Sep;43(8):904-9.

By Teri Robert
 Teri Robert is a writer, patient educator, and patient advocate focused on migraine and headaches.