- Side Effects
Generic drug: butalbital, aspirin, caffeine, and codeine phosphate
Brand name: Fiorinal with Codeine
What is Fiorinal with Codeine, and how does it work?
Fiorinal with Codeine (butalbital, aspirin, caffeine, and codeine phosphate) is a prescription medicine used to treat the symptoms of Tension Headache. Fiorinal with Codeine may be used alone or with other medications.
Fiorinal with Codeine belongs to a class of drugs called Analgesics, Opioid Combos.
It is not known if Fiorinal with Codeine is safe and effective in children younger than 16 years of age.
What are the side effects of Fiorinal with Codeine?
ADDICTION, ABUSE, AND MISUSE; LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS; ULTRA-RAPID METABOLISM OF CODEINE AND OTHER RISK FACTORS FOR LIFETHREATENING RESPIRATORY DEPRESSION IN CHILDREN; NEONATAL OPIOID WITHDRAWL SYNDROME; and INTERACTIONS WITH DRUGS AFFECTING CYTOCHROME P450 ISOENZYMES
Addiction, Abuse, and Misuse
- Fiorinal with Codeine exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing Fiorinal with Codeine, and monitor all patients regularly for the development of these behaviors and conditions.
Life-Threatening Respiratory Depression
- Serious, life-threatening, or fatal respiratory depression may occur with use of Fiorinal with Codeine. Monitor for respiratory depression, especially during initiation of Fiorinal with Codeine or following a dose increase.
- Accidental ingestion of even one dose of Fiorinal with Codeine, especially by children, can result in a fatal overdose of Fiorinal with Codeine.
Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants
- Reserve concomitant prescribing of Fiorinal with Codeine and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate.
- Limit dosages and durations to the minimum required.
- Follow patients for signs and symptoms of respiratory depression and sedation.
Ultra-Rapid Metabolism of Codeine and Other Risk Factors for Life-Threatening Respiratory Depression in Children
- Life-threatening respiratory depression and death have occurred in children who received codeine. Most of the reported cases occurred following tonsillectomy and/or adenoidectomy, and many of the children had evidence of being an ultra-rapid metabolizer of codeine due to a CYP2D6 polymorphism.
- Fiorinal with Codeine is contraindicated in children younger than 12 years of age and in children younger than 18 years of age following tonsillectomy and/or adenoidectomy.
- Avoid the use of Fiorinal with Codeine in adolescents 12 to 18 years of age who have other risk factors that may increase their sensitivity to the respiratory depressant effects of codeine.
Neonatal Opioid Withdrawal Syndrome
- Prolonged use of Fiorinal with Codeine during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts.
- If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.
Interactions with Drugs Affecting Cytochrome P450 Isoenzymes
- The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex. Use of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with Fiorinal with Codeine requires careful consideration of the effects on codeine, and the active metabolite, morphine.
- Fiorinal with Codeine may cause serious side effects including:
- difficulty breathing,
- swelling of your face, lips, tongue, or throat,
- slow breathing with long pauses,
- blue colored lips,
- difficulty to wake up,
- noisy breathing,
- shallow breathing,
- breathing that stops during sleep,
- slow heart rate,
- weak pulse,
- unusual thoughts or behavior,
- easy bruising or bleeding,
- bleeding gums,
- severe constipation,
- bloody or tarry stools,
- coughing up blood,
- vomit that looks like coffee grounds,
- loss of appetite,
- worsening tiredness,
- fast heart rate,
- muscle stiffness
- loss of coordination, and
- Get medical help right away, if you have any of the symptoms listed above.
- The most common side effects of Fiorinal with Codeine include:
- Tell the doctor if you have any side effect that bothers you or that does not go away.
- These are not all the possible side effects of Fiorinal with Codeine. For more information, ask your doctor or pharmacist.
- Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Does Fiorinal with Codeine cause addiction or withdrawal symptoms?
Drug Abuse And Dependence
- Fiorinal with Codeine contains codeine. Codeine in combination with butalbital, aspirin, and caffeine is a Schedule III controlled substance.
- Fiorinal with Codeine contains codeine, a substance with a high potential for abuse similar to other opioids, including fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. Fiorinal with Codeine can be abused and is subject to misuse, addiction, and criminal diversion.
- All patients treated with opioids require careful monitoring for signs of abuse and addiction, because use of opioid analgesic products carries the risk of addiction even under appropriate medical use.
- Prescription drug abuse is the intentional non-therapeutic use of a prescription drug, even once, for its rewarding psychological or physiological effects.
- Drug addiction is a cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use and includes: a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal.
- “Drug-seeking” behavior is very common in persons with substance use disorders. Drug-seeking tactics include emergency calls or visits near the end of office hours, refusal to undergo appropriate examination, testing, or referral, repeated “loss” of prescriptions, tampering with prescriptions, and reluctance to provide prior medical records or contact information for other treating healthcare provider(s). “Doctor shopping” (visiting multiple prescribers to obtain additional prescriptions) is common among drug abusers and people suffering from untreated addiction. Preoccupation with achieving adequate pain relief can be appropriate behavior in a patient with poor pain control.
- Abuse and addiction are separate and distinct from physical dependence and tolerance. Healthcare providers should be aware that addiction may not be accompanied by concurrent tolerance and symptoms of physical dependence in all addicts. In addition, abuse of opioids can occur in the absence of true addiction.
- Fiorinal with Codeine, like other opioids, can be diverted for non-medical use into illicit channels of distribution. Careful record-keeping of prescribing information, including quantity, frequency, and renewal requests, as required by state and federal law, is strongly advised.
- Proper assessment of the patient, proper prescribing practices, periodic re-evaluation of therapy, and proper dispensing and storage are appropriate measures that help to limit abuse of opioid drugs.
Risks Specific to Abuse of Fiorinal with Codeine
- Fiorinal with Codeine is for oral use only. Abuse of Fiorinal with Codeine poses a risk of overdose and death. The risk is increased with concurrent abuse of Fiorinal with Codeine with alcohol and other central nervous system depressants.
- Parenteral drug abuse is commonly associated with transmission of infectious diseases such as hepatitis and HIV.
- Barbiturates may be habit-forming. Tolerance, psychological dependence, and physical dependence may occur especially following prolonged use of high doses of barbiturates.
- The average daily dose for the barbiturate addict is usually about 1,500 mg. As tolerance to barbiturates develops, the amount needed to maintain the same level of intoxication increases; tolerance to a fatal dosage, however, does not increase more than twofold. As this occurs, the margin between an intoxication dosage and fatal dosage becomes smaller.
- The lethal dose of a barbiturate is far less if alcohol is also ingested.
- Major withdrawal symptoms (convulsions and delirium) may occur within 16 hours and last up to 5 days after abrupt cessation of these drugs.
- Intensity of withdrawal symptoms gradually declines over a period of approximately 15 days.
- Treatment of barbiturate dependence consists of cautious and gradual withdrawal of the drug.
- Barbiturate-dependent patients can be withdrawn by using a number of different withdrawal regimens.
- One method involves initiating treatment at the patient’s regular dosage level and gradually decreasing the daily dosage as tolerated by the patient.
- Both tolerance and physical dependence can develop during chronic opioid therapy. Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia (in the absence of disease progression or other external factors). Tolerance may occur to both the desired and undesired effects of drugs, and may develop at different rates for different effects.
- Physical dependence is a physiological state in which the body adapts to the drug after a period of regular exposure, resulting in withdrawal symptoms after abrupt discontinuation or a significant dosage reduction of a drug.
- Withdrawal also may be precipitated through the administration of drugs with opioid antagonist activity (e.g., naloxone, nalmefene), mixed agonist/antagonist analgesics (e.g., pentazocine, butorphanol, nalbuphine), or partial agonists (e.g., buprenorphine). Physical dependence may not occur to a clinically significant degree until after several days to weeks of continued opioid usage.
- Do not abruptly discontinue Fiorinal with Codeine in a patient physically dependent on opioids. Rapid tapering of Fiorinal with Codeine in a patient physically dependent on opioids may lead to serious withdrawal symptoms, uncontrolled pain, and suicide. Rapid discontinuation has also been associated with attempts to find other sources of opioid analgesics, which may be confused with drug-seeking for abuse.
- When discontinuing Fiorinal with Codeine, gradually taper the dosage using a patient-specific plan that considers the following: the dose of Fiorinal with Codeine the patient has been taking, the duration of treatment, and the physical and psychological attributes of the patient. To improve the likelihood of a successful taper and minimize withdrawal symptoms, it is important that the opioid tapering schedule is agreed upon by the patient. In patients taking opioids for a long duration at high doses, ensure that a multimodal approach to pain management, including mental health support (if needed), is in place prior to initiating an opioid analgesic taper.
- Infants born to mothers physically dependent on opioids will also be physically dependent and may exhibit respiratory difficulties and withdrawal signs.
What is the dosage for Fiorinal with Codeine?
Important Dosage And Administration Instructions
- Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.
- Initiate the dosing regimen for each patient individually, taking into account the patient's severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse.
- One or two capsules every 4 hours. Total daily dosage should not exceed 6 capsules.
Safe Reduction Or Discontinuation Of FIORINAL With CODEINE
- Do not abruptly discontinue Fiorinal with Codeine in patients who may be physically dependent on opioids. Rapid discontinuation of opioid analgesics in patients who are physically dependent on opioids has resulted in serious withdrawal symptoms, uncontrolled pain, and suicide.
- Rapid discontinuation has also been associated with attempts to find other sources of opioid analgesics, which may be confused with drug-seeking for abuse. Patients may also attempt to treat their pain or withdrawal symptoms with illicit opioids, such as heroin, and other substances.
- When a decision has been made to decrease the dose or discontinue therapy in an opioid dependent patient taking Fiorinal with Codeine, there are a variety of factors that should be considered, including the dose of Fiorinal with Codeine the patient has been taking, the duration of treatment, the type of pain being treated, and the physical and psychological attributes of the patient.
- It is important to ensure ongoing care of the patient and to agree on an appropriate tapering schedule and follow-up plan so that patient and provider goals and expectations are clear and realistic. When opioid analgesics are being discontinued due to a suspected substance use disorder, evaluate and treat the patient, or refer for evaluation and treatment of the substance use disorder. Treatment should include evidence-based approaches, such as medication assisted treatment of opioid use disorder. Complex patients with co-morbid pain and substance use disorders may benefit from referral to a specialist.
- There are no standard opioid tapering schedules that are suitable for all patients. Good clinical practice dictates a patient-specific plan to taper the dose of the opioid gradually. For patients on Fiorinal with Codeine who are physically opioid-dependent, initiate the taper by a small enough increment (e.g., no greater than 10% to 25% of the total daily dose) to avoid withdrawal symptoms, and proceed with dose-lowering at an interval of every 2 to 4 weeks. Patients who have been taking opioids for briefer periods of time may tolerate a more rapid taper.
- It may be necessary to provide the patient with lower dosage strengths to accomplish a successful taper. Reassess the patient frequently to manage pain and withdrawal symptoms, should they emerge.
- Common withdrawal symptoms include
- Other signs and symptoms also may develop, including
- If withdrawal symptoms arise, it may be necessary to pause the taper for a period of time or raise the dose of the opioid analgesic to the previous dose, and then proceed with a slower taper. In addition, monitor patients for any changes in mood, emergence of suicidal thoughts, or use of other substances.
- When managing patients taking opioid analgesics, particularly those who have been treated for a long duration and/or with high doses for chronic pain, ensure that a multimodal approach to pain management, including mental health support (if needed), is in place prior to initiating an opioid analgesic taper. A multimodal approach to pain management may optimize the treatment of chronic pain, as well as assist with the successful tapering of the opioid analgesic.
What drugs interact with Fiorinal with Codeine?
Table 1 includes clinically significant drug interactions with Fiorinal with Codeine.
Table 1: Clinically Significant Drug Interactions with Fiorinal with Codeine
|Inhibitors of CYP3A4|
|Clinical Impact:||The concomitant use of Fiorinal with Codeine with CYP3A4 inhibitors may result in an increase in codeine plasma concentrations with subsequently metabolism by cytochrome CYP2D6, resulting in greater morphine levels, which could increase or prolong adverse reactions and may cause potentially fat depression, particularly when an inhibitor is added after a stable dose of
Fiorinal with Codeine is achieved.
After stopping a CYP3A4 inhibitor, as the effects of the inhibitor decline, it may result in lower codeine levels, greater norcodeine levels, and less metaboli with resultant lower morphine levels, resulting in decreased opioid efficacy or a withdrawal syndrome in patients who developed physical dependence to codeine.
|Intervention:||If concomitant use with CYP3A4 inhibitor is necessary, consider dosage reduction of
Fiorinal with Codeine until stable drug effects are achieved. M patients for respiratory depression and sedation at frequent intervals.
If a CYP3A4 inhibitor is discontinued, consider increasing the Fiorinal with Codeine dosage until stable drug effects are achieved. Monitor for signs withdrawal.
|Examples:||Macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g. ketoconazole), protease inhibitors (e.g., ritonavir)|
|Clinical Impact:||The concomitant use of Fiorinal with Codeine and CYP3A4 inducers
can result in lower codeine levels, greater norcodeine levels, and
less metabolis with resultant lower morphine levels, resulting in
decreased efficacy or onset of a withdrawal syndrome in patients who
developed physical dependence.
After stopping a CYP3A4 inducer, as the effects of the inducer decline, the codeine plasma concentration may increase with subsequently greater metaboli cytochrome CYP2D6, resulting in greater morphine levels, which could increase or prolong both the therapeutic effect reactions, and may cause serious respiratory depression.
|Intervention:||If concomitant use of a CYP3A4 inducer is necessary, follow the patient for reduced efficacy and signs of opioid withdrawal and consider increasing the FI with CODEINE dosage as needed.
If a CYP3A4 inducer is discontinued, consider Fiorinal with Codeine dosage reduction, and monitor for signs of respiratory depression and sedation intervals.
|Examples:||Rifampin, carbamazepine, phenytoin|
|Inhibitors of CYP2D6|
|Clinical Impact:||Codeine in Fiorinal with Codeine is metabolized by CYP2D6 to form morphine. The concomitant use of
Fiorinal with Codeine and CYP2D6 i increase the plasma concentration of codeine, but can decrease the plasma concentrations of active metabolite morphine which could result in reduced anal
efficacy or symptoms of opioid withdrawal, particularly when an inhibitor is added after a stable dose of Fiorinal with Codeine is achieved.After stopping a CYP2D6 inhibitor, as the effects of the inhibitor decline, the codeine plasma concentration will decrease but the active metabolite morphin concentration will increase, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression.
|Intervention:||If concomitant use with a CYP2D6 inhibitor is necessary, or if a CYP2D6 inhibitor is discontinued after concomitant use, consider dosage adjustment of FI with CODEINE and monitor patients closely at frequent intervals.
If concomitant use with CYP2D6 inhibitors is necessary, follow the patient for reduced efficacy or signs and symptoms of opioid withdrawal and consider the Fiorinal with Codeine as needed.After stopping use of a CYP2D6 inhibitor, consider reducing the Fiorinal with Codeine and monitor the patient for signs and symptoms of respiratory or sedation.
|Examples:||paroxetine, fluoxetine, bupropion, quinidine|
|Benzodiazepines and other Central Nervous System (CNS) Depressants|
|Clinical Impact:||Due to additive pharmacologic effect, the concomitant use of benzodiazepines or other CNS depressants including alcohol, increases the risk of respiratory profound sedation, coma, and death.|
|Intervention:||Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to th required. Follow patients closely for signs of respiratory depression and sedation.|
|Examples:||Benzodiazepines and other sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol.|
|Clinical Impact:||The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome.|
|Intervention:||If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. Discontinue FIORINAL with C serotonin syndrome is suspected.|
|Examples:||Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT antagonists, drugs that effect the serotonin neurotransmitter system (e.g., mirtazapine, trazodone, tramadol), certain muscle relaxants (i.e., cyclobenzaprine metaxalone), monoamine oxidase (MAO) inhibitors (those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methyle|
|Monoamine Oxidase Inhibitors (MAOIs)|
|Clinical Impact:||MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (e.g., respiratory depression, coma)|
|Intervention:||Do not use Fiorinal with Codeine in patients taking MAOIs or within 14 days of stopping such treatment.
If urgent use of an opioid is necessary, use test doses and frequent titration of small doses of other opioids (such as oxycodone, hydrocodone, oxymorphone hydrocodone, or buprenorphine) to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression.
|Examples:||phenelzine, tranylcypromine, linezolid|
|Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics|
|Clinical Impact:||May reduce the analgesic effect of Fiorinal with Codeine and/or precipitate withdrawal symptoms.|
|Intervention:||Avoid concomitant use.|
|Intervention:||butorphanol, nalbuphine, pentazocine, buprenorphine|
|Clinical Impact:||Codeine may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression.|
|Intervention:||Monitor patients for signs of respiratory depression that may be greater than otherwise expected and decrease the dosage of Fiorinal with Codeine an muscle relaxant as necessary.|
|Clinical Impact:||Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone.|
|Intervention:||Monitor patients for signs of diminished diuresis and/or effects on blood pressure and increase the dosage of the diuretic as needed.
The effectiveness of diuretics in patients with underlying renal or cardiovascular disease may be diminished by the concomitant administration of aspirin du inhibition of renal prostaglandins, leading to decreased renal blood flow and salt and fluid retention.
|Clinical Impact:||The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus.|
|Intervention:||Monitor patients for signs of urinary retention or reduced gastric motility when Fiorinal with Codeine is used concomitantly with anticholinergic dru|
|Clinical Impact:||Aspirin may enhance the effects of anticoagulants. Concurrent use may increase the risk of bleeding. Aspirin can also displace warfarin from protein bindin leading to prolongation of both the prothrombin time and the bleeding time.|
|Intervention:||Monitor patients for signs of bleeding.|
|Examples:||Warfarin, heparin, enoxaparin, clopidogrel, prasugrel, rivaroxaban, apixaban|
|Clinical Impact:||Aspirin inhibits the uricosuric effects of uricosuric agents.|
|Intervention:||Avoid concomitant use.|
|Carbonic Anhydrase Inhibitors|
|Clinical Impact:||Concurrent use with aspirin can lead to high serum concentrations of the carbonic anhydrase inhibitor and cause toxicity due to competition at the renal tub secretion.|
|Intervention:||Consider reducing the dose of the carbonic anhydrase inhibitor and monitor patient for any adverse effects from the carbonic anhydrase inhibitor.|
|Clinical Impact:||Aspirin may enhance the toxicity of methotrexate by displacing it from its plasma protein binding sites and/or reducing its renal clearance.|
|Intervention:||Use caution if using concomitantly, especially in elderly patients or patients with renal impairment. Monitor patients for methotrexate toxicity.|
|Clinical Impact:||Concomitant use with aspirin may lead to additive nephrotoxicity due to the inhibition of renal prostaglandins by aspirin. Also, the plasma concentration of increased by conditions that reduce the glomerular filtration rate or tubular secretion.|
|Intervention:||Use Fiorinal with Codeine with caution if used concomitantly with nephrotoxic agents. Closely monitor the renal function of patients|
|Examples:||Aminoglycosides, amphotericin B, systemic bacitracin, cisplatin, cyclosporine, foscarnet, or parenteral vancomycin|
|Angiotensin Converting Enzyme (ACE) Inhibitors|
|Clinical Impact:||The hyponatremic and hypotensive effects of ACE inhibitors may be diminished by the concomitant administration of aspirin due to its indirect effect on th angiotensin conversion pathway.|
|Intervention:||Use caution if using concomitantly. Monitor the blood pressure and renal function of patients.|
|Clinical Impact:||The hypotensive effects of beta blockers may be diminished by the concomitant administration of aspirin due to inhibition of renal prostaglandins, leading renal blood flow, and salt and fluid retention.|
|Intervention:||Use caution if using concomitantly. Monitor the blood pressure and renal function of patients|
|Clinical Impact:||Aspirin may increase the serum glucose-lowering action of insulin and sulfonylureas leading to hypoglycemia.|
|Intervention:||Patients should be advised to consult a physician if any signs or symptoms of hypoglycemia occur.|
|Examples:||Insulin, glimepiride, glipizide|
|Clinical Impact:||Aspirin can displace protein-bound phenytoin and valproic acid, leading to a decrease in the total concentration of phenytoin and an increase in serum valproic levels.|
|Intervention:||Use caution if using concomitantly.|
|Examples:||Phenytoin, valproic acid|
|Nonsteroidal Anti-inflammatory Drugs (NSAIDs)|
|Clinical Impact:||Concurrent use with aspirin may increase the risk of bleeding or lead to decreased renal function. Aspirin may enhance serious side effects and toxicity of k displacing it from its plasma protein binding sites and/or reducing its renal clearance.|
|Intervention:||Avoid concomitant use.|
|Examples:||Ketorolac, ibuprofen, naproxen, diclofenac|
|Clinical Impact:||In patients receiving concomitant corticosteroids and chronic use of aspirin, withdrawal of corticosteroids may result in salicylism because corticosteroids e clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance.|
|Intervention:||Avoid concomitant use|
Is Fiorinal with Codeine safe to use while pregnant or breastfeeding?
- Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome.
- Use of aspirin, including Fiorinal with Codeine, during the third trimester of pregnancy increases the risk of premature closure of the fetal ductus arteriosus.
- Avoid use of NSAIDs, including Fiorinal with Codeine, in pregnant women starting at 30 weeks of gestation (third trimester).
- Available data with Fiorinal with Codeine in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage.
- Breastfeeding is not recommended during treatment with Fiorinal with Codeine.
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Fiorinal with Codeine (butalbital, aspirin, caffeine, and codeine phosphate) is a prescription medicine used to treat the symptoms of Tension Headache. Fiorinal with Codeine may be used alone or with other medications. Serious side effects of Fiorinal with Codeine include risk of addiction, abuse, and misuse; life-threatening, or fatal respiratory depression; and fatal overdose in children caused by accidental ingestion.
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Migraine headache is a type of headache in which the exact cause is not known; however, they may be inherited, and certain foods and environmental factors can trigger and may contribute them. A stroke (brain attack) happens when a blood vessel in the brain leaks, bursts, or becomes blocked, which can be caused by many other health problems. Both migraines and strokes can can cause severe head pain (migraine pain usually is only on one side of the head). Migraine aura symptoms may mimic or feel like a stroke or mini-stroke (transient ischemic attack, TIA) because they have similar symptoms and signs like severe headache, numbness in the legs, feet, arms, hands, or face, nausea, vomiting, and dizziness. Other migraine aura symptoms include vision problems like flashing lights or blind spots in one eye. The main difference between migraine headache and stroke symptoms and signs is that a migraine headaches usually come on gradually while a stroke symptoms come on suddenly and unexpectedly.
Migraine vs. Headache: Differences and Similarities
Headaches are the most common reason why a person goes to the doctor or other healthcare professional for treatment. There are different types of headaches, for example, migraine, tension, and cluster headaches. The most common type of headache is tension headache. Migraine is much less common. There are few similarities between migraine and other headaches, for example, the severity of the pain can be the same, mild, moderate, or severe; and they can occur on one side or both sides of the head. However, there are many differences between migraine and other types of headaches. Migraine headaches also have different names, for example, migraine with aura and menstrual migraine. Symptoms of migraine that usually aren't experienced by a person with another type of headache include nausea, vomiting, worsens with mild exercise, debilitating pain, eye pain, throbbing head pain. Migraine trigger include light, mild exercise, strong smells, certain foods like red wine, aged cheese, smoked meats, artificial sweeteners, chocolate, alcohol, and dairy products, menstrual period, stress, oversleeping, and changes in barometric pressure. Untreated migraine attacks usually last from 4 to 72 hours, but may last for weeks. Most headaches resolve within 24-48 hours. Doctors don't know exactly what causes migraine headaches; however, other headaches like tension headaches have more specific triggers and causes. Additional tests usually are required to diagnose migraine from other types of headaches, diseases, or other medical problems. Most headaches can be treated and cured with home remedies like essential oils, massage, and over-the-counter pain medication like acetaminophen (Tylenol) and NSAIDs (nonsteroidal anti-inflammatory drugs) like naproxen (Aleve, Anaprox, Naprosyn) or ibuprofen (Advil, Midol, Motrin). Most headaches resolve with OTC and home remedy treatment, while your doctor may need to prescribe medication to treat your migraines. If you have the "worst headache of your life," seek medical care immediately.
What Does a Pseudotumor Cerebri Headache Feel Like?
Pseudotumor cerebri headaches usually feel like a headache that occurs at the back of the head or behind the eyes. The pain starts as a dull, aching pain that worsens at night or in the morning. They may be associated with vomiting as well. Patients may also eventually develop visual problems and blindness due to inflammation of the optic nerve.
How Long Do Migraines Last For?
Migraines typically last from four to 72 hours. The frequency of migraines differs for everyone, but usually, there would be two to four headaches per month. In some, the migraines may occur every few days, while others may get them once or twice a year.
How Do You Get Rid of a Migraine Fast?
Migraine is a neurological condition that is characterized by recurrent episodes of intense headaches. It may be associated with symptoms such as nausea, vomiting, and other clinical features.
Are Migraine Auras Serious?
Migraine with aura (also called classic migraine) is repeated episodes of headache that occur during or after sensory disturbances (aura or migraine aura). These disturbances may include symptoms such as flashes of light, blind spots, and other vision changes or tingling over the hand or face.
Can NMO Cause Headaches?
Neuromyelitis optica (NMO) also known as Devic disease is a rare yet severe disease. In this condition, antibodies (proteins) are produced against the cells in the central nervous system. It specifically affects the myelin, which is the insulation sheath around the nerves.
What Is the Most Common Type of Migraine?
The most common type of migraine is migraine without aura (common migraine). 70-90% of people with migraine experience this type. The frequency of this type of migraine may range from once a year to several times per week.
Which Are the Pressure Points to Relieve Migraines?
Migraines are complex disorders involving episodes of recurrent and severe headaches. They generally present as a headache on one side and may be associated with visual or sensory symptoms (such as seeing flashes of light, colorful or bright shapes, or hearing sounds of various types) collectively called “aura.”
What Triggers Tension Headaches?
A tension headache is the most common type of headache seen in adults. A tension headache is also called a tension-type headache (TTH) or stress headaches. It is usually associated with muscle tightness in the head, scalp or neck. A tension headache is so common that we often consider it a normal occurrence. There are two types of tension headaches: Episodic tension headaches and chronic tension headaches.
What Are the First Signs of a Migraine?
The first sign of a migraine is severe eye pain associated with a dull headache. Migraines gradually worsen with physical activity.
What Causes Migraines?
A migraine is a complex disorder that involves episodes of recurrent and severe headaches. An episode of a migraine can be very painful, lasting for hours, making day-to-day activities difficult until the episode is resolved. The frequency and severity of migraine attacks tend to decline with age. And women are more likely to suffer from migraines than men.
A spinal tap or an epidural block can cause a spinal headache. In these procedures, a needle is placed within the fluid-filled space surrounding the spinal cord. This creates a passage for the spinal fluid to leak out, changing the fluid pressure around the brain and spinal cord. A spinal headache may occur up to five days after the procedure is performed. Such a headache may be prevented with bed rest after a procedure.
When to Call the Doctor for Your Headache?
Almost everyone must have experienced a headache at some point in their life. The most common reasons for your headache are migraines, tension headaches, cluster headaches, and sinus headaches. Headache is also most often experienced in some common viral infections such as the flu or even in something as simple as the cold.
What Foods Trigger Migraines?
Migraine is a chronic neurological disorder that features intense headaches on one or both sides of the head. Migraine attacks may resolve in few hours or may take as long as several days.
Headaches in Children
Kids get headaches and migraines too. Many adults with headaches started having them as kids, in fact, 20% of adult headache sufferers say their headaches started before age 10, and 50% report their headaches started before age 20.
What Could Headache Be a Sign of?
Medically, headache is not a sign; it is a symptom. It can occur as a separate entity (primary headache) or as a symptom of various underlying conditions (secondary headache).
What Is the Best Cure for Migraine?
The best cure for migraine involves preventive medications and lifestyle changes. Some newer medications and therapies are effective in controlling the symptoms of migraine. Avoiding or controlling triggers may provide considerable benefit. Migraine can be prevented mainly by using medications, avoiding triggers and implementing lifestyle changes.
Treatment & Diagnosis
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- Migraine & Headache Q & A
- Sinus Headache
- Tension Headache
- Headaches: Living With Chronic Daily Headaches
- Cluster Headache
- Headaches and Migraine: Easing the Pain -- Seymour Diamond, MD
- Migraines Survival with Christina Peterson, M.D.
- Migraine: Managing Migraine Misery
- Headaches FAQs
- Migraine Headaches FAQs
- Migraine Headache Treatment
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Medications & Supplements
- codeine/butalbital/aspirin/caffeine - oral, Fiorinal with Codeine #3
- codeine (for Pain)
- butalbital/acetaminophen/caffeine (Esgic, Fioricet)
- Types of Migraine Headache Medications
- butalbital/aspirin/caffeine - oral, Fiorinal
- butalbital/acetaminophen - oral, Phrenilin
Migraines and Headaches Resources
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