Medication Overuse Headache.

Young WB.

Department of Neurology, The Thomas Jefferson University Hospital, Jefferson Headache Center, 111 South Eleventh Street, Gibbon Building, Suite 8130, Philadelphia, PA 19107, USA. william.b.young mail.tju.edu

Medication overuse headache is common and affects 2% of the United States population. Simple analgesics, caffeine-containing analgesics, butalbital-containing analgesics, opioids, ergotamine, and triptans may cause medication overuse headache. The recidivism rate is higher after detoxification from butalbital and opioids than after detoxification from other substances. Treatment venues have included the patient's home, an infusion center, or a hospital setting. No consensus exists to determine the setting that is most appropriate. Patients with analgesic overuse headache have a different psychologic substrate than psychiatric substance abusers. Most should not be treated in psychiatric detoxification facilities, although, psychiatric assessment and support may be beneficial.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=&dopt=Abstract butalbital fioricet barbiturate




Investigations of hydrolytic products of butalbital.

Maulding HV, Nazareno J, Polesuk J, Michaelis A.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=&dopt=Abstract butalbital fioricet barbiturate




Metabolism of butalbital, 5-allyl-5-isobutylbarbituric acid, in the dog.

Dain JG, Bhuta SI, Coombs RA, Talbot KC, Dugger HA.

Butalbital, 5-allyl-5-isobutylbarbituric acid, labeled in the 2-position with 14C, was administered to dogs. Ninety-two percent of the radioactivity of the dose was excreted in the urine. The drug and three major urinary metabolites were identified in the urinary excretion of the dog. The major metabolite was 5-isobutyl-5-(2,3-dihydroxypropyl)barbituric acid, which accounted for 50.2% of the dose. Smaller amounts of the unchanged drug (2.6% of the dose) and urea (8.6% of the dose) were present. 5-Allyl-5-(3-hydroxy-2-methyl-1-propyl)barbituric acid, formed by omega-hydroxylation, accounted for 10.1% of the dose; the optical rotation of the 1,3-diethyl derivative was [alpha]D20 = +10.5. Five minor and unidentified metabolities accounted for an additional 10.7% of the dose. A total of 82.2% of the dose was accounted for.

Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=&dopt=Abstract butalbital fioricet barbiturate




Headache as a model for assessing mild analgesic drugs.

von Graffenried B, Hill RC, Nuesch E.

A method for the evaluation of the efficacy of mild analgesic drugs in outpatients with nonmigrainous headache is described. During the 3-hour drug evaluation period, patients were required to record at hourly intervals their pain intensity using both a verbal rating and a visual analog scale, their pain relief, and the occurrance of side effects. The results obtained in six studies consisted of comparisons of reference compounds aspirin (1000 mg) and two analgesic combinations (containing aminophenazone, caffeine, and butalbital); test medications aspirin (500 mg), codeine (30 mg), proquazone (300 mg), and new formulations of the two analgesic combinations (aminophenazone replaced by propyphenazone); and, in every study, placebo. In a seventh study, the analgesic effects of three doses aspirin (250, 500, and 1000 mg) were compared with that of placebo. Every study was conducted under double-blind, complete crossover conditions, and between 24 and 36 patients were used in each study. Using parametric and nonparametric statistical analyses, the reference compounds and the majority of the test medications exhibited significant analgesic properties. Also, a highly significant dose--response effect was demonstrated for aspirin. It is concluded that the headache model is a practicable, reliable, and sensisive method for the evaluation of the effectiveness of mild analgesic drugs.

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Neonatal withdrawal from intrauterine exposure to butalbital.

Ostrea EM Jr.

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