Question Title: Fiorinal w/codeine

Posted by Bert Brewer on August 02, 1999 at 20:30:21

I have had classic migraines on a fairly regular basis since about age 12. Until a few years ago, I normally had about two per month. However, as the stress of my job and family demands has mounted, and following a severe back & neck injury (four years ago)resulting in chronic spondilolysis, I began to have more headaches, both migraines and severe tension-type headaches. In response to this, I began to use more and more Fiorinal with codeine. (I have tried many, many other migraine drugs, but no other has been reliably effective.) The step to dependency was natural enough, as the drug helps both my headaches and the frequent bouts of back pain, enabling me to function reasonably well. At any rate, I now average about one pill per day; some days none, other days (when a real migraine strikes- maybe once every two weeks) as many as six. My HMO, of course, has been instrumental in keeping my physician's hands tied as far as non-drug therapies are concerned. My question, then, is two-fold:
1. Is my current usage high enough to be considered a physical dependency, with all its perils and side effects? Or is it more an issue of "mind over matter" in my case?
2. Is there another alternative drug, safe for long-term frequent usage, that might be helpful in combatting my various pains?
Sorry to be so long-winded; I am very frustrated, but seemingly unable to get on top of this myself...

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Posted by Acey on August 03, 1999 at 20:48:24

Okay, here's another person stuck in the bind of bad tension headaches, migraine headaches, fiorinal (I didn't know it had codeine in it ... that wasn't listed as one of the components in what I read and was told -- just the barbituate, caffeine, and aspirin)and resulting REBOUND headaches. The rebound headaches are the worst. I have been doing my best to keep a grip on things but I worry about addiction ... there really aren't very many days when I don't wind up taking at least one pill. On days when I take more than one (so far I haven't taken more than three per day but my prescription and the doctor who wrote it said I should never NEED to take more than two), I make sure to take one less the next day ... yet I remain stuck in the one-pill track. The problem is headaches. The cure CAUSES headaches.

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Posted by SA, M.D. - HVMA on August 12, 1999 at 20:38:51

Not all fiorinal contains codeine - only if listed as such. You are both wise to be concerned about daily use of controlled substances for headache control. This is, in fact, a pathway into substance dependence for some people. However, it sounds to me that neither of you is abusing these controlled substances to a significant extent (aside from the occasional "extra" pill - something which is to be discouraged and which would indicate an incipient problem if it began occurring with greater and greater frequency). And the rather moderate daily intake does not represent a high degree of physical dependence. It is, as you have noted, possible that you are experiencing withdrawal headaches.

If you are not satisfied with your physicians' management of your headaches, you should consider getting evaluated by doctors who specialize in headache management and/or chronic pain. My good friend, Larry Lockerman, D.M.D., is a local headache specialist here in Massachusetts (he's a dentist with a particular interest in TMJ), and he is frequently able to help patients overcome their chronic headaches using treatment protocols which involve minimal amounts of controlled substances.

Good luck to both of you!

DrSteve

This information is for educational purposes only. For diagnosis and treatment of your individual medical problems, consult your personal physician.

Keywords: chronic pain, barbiturate, codeine, headache

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