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Pain Information

This section about chronic pain is not intended as a comprehensive source of medical information, but as a hub for links to other more detailed sources.

Acute pain is the body's alarm system. It signals that something is wrong. It signals that you are in danger of injury or that the injured part needs to be protected and rested.

Chronic pain serves no useful purpose and may cause disability and distress to sufferers and their families. Estimates of the number of people with chronic pain vary from 8% to 45% depending on severity and whether medical help is sought. Chronic pain is more common in women and in the elderly. Many types of chronic pain have been identified. However some people with chronic pain do not have a diagnosis from their doctor. The Pain Relief Foundation funds research into the causes and treatment of chronic pain.

If you have a pain problem, which needs treatment you should contact your own doctor who can refer you to a pain clinic in your area. This site is for information only and cannot be treated as a substitute for the medical advice of your own doctor. The Pain Relief Foundation is not able to offer individual medical advice.

What other drugs will affect aspirin/butalbital/caffeine?

Do not take aspirin/butalbital/caffeine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. Dangerous sedation could result.

Aspirin/butalbital/caffeine may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine unless your doctor approves.

Dangerous side effects may occur if aspirin is taken with any of the following medicines:

oral anticoagulants such as warfarin (Coumadin);
probenecid (Benemid) or sulfinpyrazone (Anturane);
nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil, Nuprin, others), ketoprofen (Orudis, Orudis KT, Oruvail), and naproxen (Naprosyn, Anaprox, Aleve);
other salicylates (forms of aspirin) such as choline salicylate and magnesium salicylate;
steroids such as prednisone (Deltasone), prednisolone (Prelone, Pediapred, others), methylprednisolone (Medrol, others), dexamethasone (Decadron), and others; or
insulin and oral antidiabetic drugs such as glipizide (Glucotrol) and glyburide (Micronase, Diabeta, Glynase).

Do not take this medication without first talking to your doctor if you are taking any of the medications listed above.

Many other medicines contain aspirin, especially over-the-counter pain, fever, cold, and allergy medications. Too much aspirin can be very dangerous.

Drugs other than those listed here may also interact with aspirin/butalbital/caffeine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

Where can I get more information?

Your pharmacist has additional information about aspirin/butalbital/caffeine written for health professionals that you may read.

What does my medication look like?

Aspirin/butalbital/caffeine is available with a prescription generically and under the brand name Fiorinal. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Aspirin/butalbital/caffeine strengths are as follows:

Fiorinal 325 mg/50 mg/40 mg--white, round tablets
Fiorinal 325 mg/50 mg/40 mg-dark green and lime green capsules

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Aspirin, Butalbital, and Caffeine

Acetaminophen, Butalbital, and Caffeine

Aspirin

Diphenhydramine Topical

Tension headache

Illustrations

Brain

Headache

Tension-type headache

Alternative names

Muscle contraction headache; Benign headache; Headache - tension

Definition

A tension headache is a condition involving pain or discomfort in the head, scalp, or neck, usually associated with muscle tightness in these areas.

Causes, incidence, and risk factors

Tension headaches are one of the most common forms of headaches. They may occur at any age, but are most common in adults and adolescents. If a headache occurs 2 or more times weekly for several months or longer, the condition is considered chronic. Tension headaches can occur when the patient also has a migraine.

Tension headaches result from the contraction (tensing) of neck and scalp muscles. One cause of this muscle contraction is a response to stress, depression, head injury, or anxiety. Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Such activities include typing or use of computers, fine work with the hands, and use of a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger this type of headache.

Other causes include eye strain, fatigue, alcohol use, excessive smoking, excessive caffeine use, sinus infection, nasal congestion, overexertion, colds, and influenza. Tension headaches are not associated with structural abnormalities in the brain.

Symptoms

Headache
- Dull, pressure-like
- Generalized (all over, not just in one point or one side), worse in the scalp, temples or back of the neck
- Feels like a tight band or vise on the head
- Occurs as an isolated incident, or occurs constantly or daily
- Worsened or triggered by stress, fatigue, noise, glare
Difficulty sleeping

Signs and tests

A headache that is mild to moderate, not accompanied by other symptoms, and which responds to home treatment within a few hours may not need further examination or testing. If a neurologic (nervous system) examination is performed, a tension headache causes no abnormal findings. However, tenderness in the muscles near the skull is often present.

The health care provider should be consulted -- to rule out other disorders that can cause headache -- if the headache is severe, persistent (does not go away), or if other symptoms happen with the headache.

Headaches that disturb sleep, occur whenever the person is active, or that are recurrent or chronic may also require examination and treatment by a health care provider.

Treatment

The goal is to relieve symptoms and prevent future headaches. Prevention is the best treatment. If possible, remove or control your headache "triggers."

Learn and practice stress management strategies. Some people find relaxation exercises or meditation helpful. Biofeedback may improve relaxation exercises and may be helpful for chronic tension headache.

Other preventive measures may include keeping warm if the headache is associated with cold, using a different pillow, or changing sleeping positions. Use good posture when reading, working, or doing other activities that may cause headache. Exercise the neck and shoulders frequently when typing, working on computers, or doing close work.

Enough sleep and rest, or massage of sore muscles can help reduce the chance that a headache will occur. Hot or cold showers or baths may relieve a headache for some people.

Over-the-counter analgesics such as aspirin, ibuprofen, or acetaminophen may relieve pain if the above measures are ineffective. An antidepressant or other medication may be advised for chronic headache. A nonsedating muscle relaxant like metaxalone (Skelaxin) helps some patients. In severe cases, the combination of butalbital and acetaminophen (Fioricet) or butalbital and aspirin (Fiorinal) may be helpful.

A headache diary may help you identify the source of chronic headaches. When a headache occurs, write down the date and time the headache began. Note what you ate for the preceding 24 hours, sleep pattern and amount of sleep, what was being experienced immediately before the headache, unusual stress or other circumstances, how long the headache lasted, and what made it stop.

Lifestyle changes may be required for chronic tension headaches. This may include adequate rest and exercise, change in job or recreational habits, or other changes.

Expectations (prognosis)

Tension headaches usually respond well to treatment without residual effects. They are annoying, but not dangerous.

Complications

The headache may not be a tension headache, but it may be a symptom of another, more serious, disorder.
Rebound headaches may occur from overuse of analgesic medications.

Calling your health care provider

See your health care provider if headaches are severe, persistent, recurrent, or are accompanied by other symptoms (drowsiness, vision changes, changes in movement or sensation, seizures, changes in alertness, nausea and vomiting).

Also call if headaches disturb sleep, occur whenever you are active, are recurrent or chronic, or if a headache does not respond to treatment.

Prevention

Avoid situations that may cause a tension headache. This can include keeping warm if the headache is associated with cold, using a different pillow or sleeping position, or similar changes.

Use good posture when reading, working, or involved in activities that may cause a headache. Exercise the neck and shoulders frequently.

Update Date: 9/7/2006