( Tension refers to muscle spasm more than life stress.) Although tension-type headaches are common, the pathophysiology and likely mechanism remain unclear. Tension-type headache is not a wastebasket diagnosis of exclusion but a specific diagnosis. Screening tests are of little value a laborious history and physical examination are required. Headaches are common and usually benign, but any headache brought to medical attention deserves a thorough evaluation. There are no data to support their use, and there are side effects and habituation. Initially, they may be useful, but they increase the risk for chronic daily headache.ĭo not prescribe sumatriptan or ergotamine without knowledge of the patient’s previously prescribed medications, nor without arranging appropriate follow-up.ĭo not treat with muscle relaxants. LP may be more sensitive than CT for detecting subarachnoid hemorrhage within 12 hours of the onset of headache.ĭo not prescribe analgesics combined with butalbital (Fioricet) or opiates. Most CT scans and LP results should be normal. Many serious illnesses begin with minor cephalgia, and patients may postpone necessary early follow-up care if they believe that they were definitively diagnosed on their first visit.ĭo not obtain CT scans for patients who have long-term recurrent headaches with no recent change in pattern, no history of seizures, and no focal neurologic findings.ĭo not overlook possible subarachnoid hemorrhage or meningitis. Tolerance to the mood-altering and sedative effects develops to a greater extent than does tolerance to the lethal effects, increasing the risk of accidental overdose.ĭo not discharge the patient without providing follow-up instructions. Pharmacodynamic tolerance begins after acute doses and continues to develop over weeks to months. Daily doses of phenobarbital should rarely exceed 600 mg using this protocol.Ī major disadvantage of the use of the barbiturates is the development of pharmacokinetic and pharmacodynamic tolerance.
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The above are doses of various sedative-hypnotic agents for which a 30-mg dose of phenobarbital should provide adequate coverage of a withdrawal syndrome. Note: The substitution technique for sedative-hypnotic withdrawal requires calculation of equivalent doses of phenobarbital to replace the sedative-hypnotic agent that the patient is taking. Am J Obstet Gynecol 1982 143:597-8.īutalbital should be used during pregnancy and lactation only if the benefit justifies the potential perinatal risk. See Phenobarbital.īrown MI, Van Zutphen AR, Botto LD, et al. No specific interaction studies identified. Other barbiturates enter human breast milk, but the kinetics are poorly described. It is unknown whether butalbital enters human breast milk.
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There is no published experience in nursing women. Withdrawal seizures have been reported in neonates whose mothers used butalbital during pregnancy. The National Birth Defects Prevention Study examined the association between 21,090 case infants and 8373 unaffected controls and found periconceptual butalbital use was associated with tetralogy of Fallot, pulmonary valve stenosis, and secundum-type atrial septum defect. It is unknown whether butalbital crosses the human placenta. There are no adequate reports or well-controlled studies in animal and human fetuses.
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Side effects include thrombocytopenia, Stevens-Johnson syndrome, drowsiness, sedation, constipation, dyspnea, N/V, SOB, and abdominal pain. There are no adequate reports or well-controlled studies of butalbital in pregnant women. Ĭaution-hepatic or renal dysfunction, history of drug abuse.NOTE: Each Fioricet tab contains butalbital 50 mg, acetaminophen 325 mg, caffeine 40 mg max 6 tabs/d.Ĭontraindications-hypersensitivity to drug or class, porphyria, bronchopneumonia, pulmonary insufficiency Tension headache-1–2 tabs Fioricet PO q4h Preoperative sedation-50–100 mg PO 30–60 min preoperatively Sedation, insomnia, preoperative sedation, tension headacheĪlters sensory cortex, cerebellar, and motor activities