is fioricet indicated in patients with cluster headaches? what narcotics are?
Cluster headaches?
Question posted by tammi0119 on 18 Aug 2010
Last updated on 11 October 2011 by ANTONE537
4 Answers
ANTONE537
12 Oct 2011
Im a cluster headache sufferer. I've been dealing with this for 15 years now and have yet to get any relief from any drug they have givin me. The only treatment that help was 100% pure oxigen, and what the doctors psovide to put me to sleep. I've been to the emergency room numeruos of times, and the oxigen made me dizzy but it helped. So for all of you that keep posting your remedies for this, fioricet does not work.
doc jaspy
19 Nov 2010
fioricet is a mild analgesic hence will give a slight and temporal relief yes it is indicated. caffaine is used
DrBB01
19 Nov 2010
Pardon my disagreement with this advice. I have seen no convincing that Fioricet would be an effective--or appropriate--treatment for cluster headaches. The physiological processes involved are very different than those for tension headaches, for which fioricet is indeed indicated. Searches of authoritative sites (e.g., National Institutes of Medicine, Mayo Clinic, headaches.com, clusterheadaches.com) find no support for using Fioricet. Indeed, because of the frequency of cluster headaches (1-8 or more each day, for a period of weeks or months), it would require extended use--not a good thing, since dependency may result--even if it were effective.
There is a very unscientific--but comprehensive--survey of treatments that have worked (and not worked) for visitors to clusterheadaches.com http://www.clusterheadaches.com/cgi-bin/survey.cgi). The long and short of it is that few treatments work well for most people (though triptans and oxygen seem to be exceptions), but many things work well for some people, so it is quite possible that some individuals who are CORRECTLY DIAGNOSED with cluster headaches may get relief with Fioricet. But--IMHO--unless it has been prescribed by a neurologist or other headache specialist with a great deal of experience with CHs, who is carefully monitoring the patient, be wary of advice to take Fioricet for CHs.
doc jaspy
23 Nov 2010
i apprecite correction, but on this i need more than a voice, since something temporal is acceptable and i think i stated that clearly... for caffeine you didnt comment but it works especially on combination with ergortamine..we call it cafergot.
DrBB01
25 Nov 2010
Guidelines for the treatment of cluster headaches can be found at the National Guideline Clearinghouse website (http://www.guideline.gov/content.aspx?id=10471). Ergotamine tartrate, the main ingredient in Cafergot, is considered an effective drug in the prevention of cluster headaches, though due to seriousness of side effects, is generally prescribed during an active cluster headache cycle. With respect to caffeine--the other ingredient in Cafergot--I had mentioned in my first post that the amount of caffeine in Fioricet (or Cafergot) would not likely have much direct effect, which is why I didn't comment on it initially. The value of caffeine in both Fioricet and Cafergot is that it is believed to increase the absorption of the other ingredients.
The guidelines support the use of oxygen as a low-risk, highly effective abortive treatment for CH. Still, as I noted in my original post, response to treatments for CH is varied, so other treatments during a CH cycle--both preventative and abortive--probably will be needed by many CH sufferers to replace or supplement the treatments of choice. Toward the bottom of the Guidelines is a list of likely side effects and drug interactions of each CH treatment to help inform physicians in choosing a treatment regimen.
DrBB01
7 Nov 2010
road2glory was right on. It is no secret that the single most effective, safe, and reliable abortive treatment of cluster headaches (as a CH is just beginning) is oxygen. Best estimates are that over 80% of sufferers can abort an oncoming CH within 30 seconds to 15 minutes when O2 is administered at 8-15 liters/minute using an appropriate mask. [Standard hospital masks or cannulas dilute the O2 too much to be consistently effective.] Though not 100% safe for everyone, pure oxygen is far safer than any other effective CH treatment.
As a long-time CH sufferer who discovered the oxygen treatment over 10 years ago at www.clusterheadaches.com, I disagree that drug companies are conspiring to keep this treatment from sufferers [at least not directly... :-) ]. Because CH is relatively rare, even many neurologists have little experience treating CH and are not familiar with the research and clinical evidence for treating CH with oxygen. Also O2 does not seem to prevent a CH, it seems only to abort a single headache at onset. For those who may have 4-10 (or more) CHs every day during a cycle, it means the sufferer who relies only on O2--by necessity or choice--needs to have several portable O2 tanks and a larger at-home tank available at all times. As a result, many CH sufferers need to take other medications as well.
Which brings us back to Fioricet. None of the ingredients in Fioricet--nor the combination--is known to be useful in the treatment of CH. Only caffeine has been anecdotally helpful in lessening a CH, though use of caffeine is also believed to result in rebound CHs and--as a vasodilator--may also exacerbate CHs, which are associated with vasodilation of blood vessels around nerves in the head. However, even those who find a good cup of Joe in the morning helps ward off morning CHs (before the rebound headaches hit later) would likely find the amount of caffeine in Fioricet to be pretty useless.
tammi0119, I trust that you asked this question out of curiosity and that neither you or a loved one was prescribed Fioricet by a physician to treat CH. However, on the chance that it was, find a neurologist who specializes in headaches, preferably one with experience treating cluster headaches. As many "clusterheads" have learned the hard way, don't assume a headache specialist will be aware of wide variety of treatments for CH, which ones are the safest and most effective, and the experience to know which ones are likely to work best if the first-line treatments don't work. [Did I mention that other than O2, there are many different treatments that work well for some people, but few that work for a majority?]
Good luck tammi0119. Wishing you or your loved one many pain-free days. If Fioricet seems to contribute to that goal, great. But there is no evidence to believe that it would.
road2glory
8 Nov 2010
No, I don't believe there's any conspiracies here. The pharmaceutical companies shouldn't be expected to advertise products that aren't theirs, and drug stores don't have the space or interest in producing, storing, and delivering oxygen. I just don't think it lends itself to normal retail channels which has contributed to its obscurity, though as you mention, there's so few clusterheads anyway, we don't make up much of a market.
Oh, and one more thing. Clusterheads, get a good loud kitchen timer to set so you won't fall asleep and suck down an entire tank, which we've all done but I'm told is not good for your lungs.
tammi0119
30 Nov 2010
thank you very much! i finally got my neurologist to prescribe oxygen... unfortunately, it arrived two days after my headaches FINALLY went away... but that's ok because i know they'll be back in january or february. thank you everyone for responding... at least i know that there are many more cluster sufferers who know exactly what i'm going through! you know, i was finally able to quantify to my husband what a cluster headache might be like... NOT having a cluster headache is better than HAVING an orgasm... thanks again, everyone!
Inactive
18 Aug 2010
Fioricet (acetaminophen) is a pain reliever and fever reducer.
Butalbital is in a group of drugs called barbiturates. It relaxes muscle contractions involved in a tension headache.
Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.
The combination of acetaminophen, butalbital, and caffeine is used to treat tension headaches that are caused by muscle contractions.
Cluster headaches
Over-the-counter pain medications (such as aspirin, paracetamol, and ibuprofen) typically have no effect on the pain from a cluster headache. Unlike other headaches such as migraines and tension headaches, cluster headaches do not respond to biofeedback.
Medications to treat cluster headaches are classified as either abortives or prophylactics (preventatives). In addition, short-term transitional medications (such as steroids) may be used while prophylactic treatment is instituted and adjusted. With abortive treatments often only decreasing the duration of the headache and preventing it from reaching its peak rather than eliminating it entirely, preventive treatment is always indicated for cluster headaches, to be started at the first sign of a new cluster cycle.
Abortives
The TCAs include the following agents which are predominantly serotonin and/or norepinephrine reuptake inhibitors:
Amitriptyline (Elavil, Tryptizol, Laroxyl)
Amitriptylinoxide (Amioxid, Ambivalon, Equilibrin)
Butriptyline (Evadyne)
Clomipramine (Anafranil)
Demexiptiline (Deparon, Tinoran)
Desipramine (Norpramin, Pertofrane)
Dibenzepin (Noveril, Victoril)
Dimetacrine (Istonil, Istonyl, Miroistonil)
Dosulepin/Dothiepin (Prothiaden)
Doxepin (Adapin, Sinequan)
Imipramine (Tofranil, Janimine, Praminil)
Imipraminoxide (Imiprex, Elepsin)
Lofepramine (Lomont, Gamanil)
Melitracen (Deanxit, Dixeran, Melixeran, Trausabun)
Metapramine (Timaxel)
Nitroxazepine (Sintamil)
Nortriptyline (Pamelor, Aventyl)
Noxiptiline (Agedal, Elronon, Nogedal)
Pipofezine (Azafen/Azaphen)
Propizepine (Depressin, Vagran)
Protriptyline (Vivactil)
Quinupramine (Kevopril, Kinupril, Adeprim, Quinuprine)
As well as the following atypical compounds:
Amineptine (Survector, Maneon, Directim) - Norepinephrine-dopamine reuptake inhibitor
Iprindole (Prondol, Galatur, Tetran) - 5-HT2 receptor antagonist
Opipramol (Insidon, Pramolan, Ensidon, Oprimol, Seroquel ) - σ receptor agonist
Tianeptine (Stablon, Coaxil, Tatinol) - Selective serotonin reuptake enhancer
Trimipramine (Surmontil) - 5-HT2 receptor antagonist
Prophylaxis is any medical or public health procedure whose purpose is to prevent, rather than treat or cure a disease. In general terms, prophylactic measures are divided between primary prophylaxis (to prevent the development of a disease) and secondary prophylaxis (whereby the disease has already developed and the patient is protected against worsening of this process).
Triptans are a family of tryptamine-based drugs used as abortive medication in the treatment of migraines and cluster headaches.
Triptans
Sumatriptan and zolmitriptan have both been shown to improve symptoms during an attack.
Other
Some non-narcotic treatments that have shown mixed levels of success are botox injections along the occipital nerve, as well as sarapin (pitcher plant extract) injections.
Lidocaine and other topical anesthetics sprayed into the nasal cavity may relieve or stop the pain, normally in a few minutes, but long term use is not suggested due to the side effects and possible damage to the nasal cavities.
Narcotic
It originally referred to any substance that relieved pain, dulled the senses, or induced sleep. Now, the term is used in a number of ways. Some people define narcotics as substances that bind at opiate receptors (cellular membrane proteins activated by substances like heroin or morphine) while others refer to any illicit substance as a narcotic. From a legal perspective, narcotic refers to opium, opium derivatives, and their semi-synthetic substitutes.Though in U.S. law, due to its numbing properties, cocaine is also considered a narcotic
Take care
road2glory
22 Sep 2010
Oddly, this very comprehensive post missed the single most effective and cheapest remedy for a cluster attack -- oxygen. I have knocked out hundreds, maybe thousands of cluster attacks with this wonder drug which has no bad side effects and costs me around $7.50 a tank delivered to my door. Once I feel an attack coming on I wheel out an E-tank with mask, start inhaling and the attack disappears without a trace in between 4 minutes and 11 minutes. I don't bother with Imitrex anymore. Sometimes I use ice, but there's hardly time for it. Surveys on the clusterhead web site indicate the majority of clusterheads obtain relief from oxygen.
The reason we hear very little about it's use in aborting cluster attacks is there's no patent covering it, anyone can make it with a concentrator, it doesn't advertise in medical journals, pharmacies don't bother with it,and it's distribution is all mom and pop so no corporations are involved. So get a tank and try it. Migraineurs should try it too, but mainly it works for clusterheads. You'll need a prescription and your doctor should be able to turn you onto a provider.
In addition to oxygen I use 1200mg lithium and 320mg Verapamil to prevent them. I've gone from a thousand a year to 5 or 6 very mild clusters a year. The meds still seem to be playing a role. When I get sloppy taking them the result can be an attack that can still bring an attack on and I suspect the lithium is the more critical of the two.
Good luck to all my fellow clusterheads
Inactive
19 Nov 2010
maso,
Great info.
olo
Inactive
19 Nov 2010
OLO SL.-
doc jaspy
23 Nov 2010
oh yes you got it almost right, but we dont use narcotics in doses that are that bad, when it is medically prescribed we have morphine that works wonders, diacetylmorphine that is equally good... but never for CHS since their kind of somatic pain relief is not long term... wears of and people have a tendency to habituation.
Related topics
fioricet, headache, cluster headaches
Further information
- Fioricet uses and safety info
- Fioricet prescribing info & package insert (for Health Professionals)
- Side effects of Fioricet (detailed)
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