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Is Fiorinal the right medicine for migraine?

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Posted on Wed, 11 May 2016
Question: Hi, I suffer from Severe Migraine Syndrome, n have been using firional with caffeine, aspirin, n codeine, n it has always worked for me. My insurance on Medicare Part D is telling me it isn't used for any types of Migraines at all, but I have to say, they are wrong, due to the fact it is the only medication, that has worked with me over many trial, n errors of using all the latest medications now!! I am trying to research this due to the fact they are not willing to pay for my medication saying it isn't a medication for Severe Migraine Syndrome!! I have tried so many medications from the beginning with severe side-effects, n this medication is the only one that works for me!!
My email address is YYYY@YYYY !!Thank you!! Please Help Me!!
doctor
Answered by Dr. Olsi Taka (3 hours later)
Brief Answer:
Read below

Detailed Answer:
I read your question carefully and I understand your concern.

It is true that medication like Fiorinal are not approved for migraine treatment, at least not in the US, regulations may change from one country to the other. So technically the insurance has the right to deny you the use of that drug, depending on their rules they might be allowed to pay for non approved drug even if they wanted to.
The trouble with Fiorinal (or other butalbital containing drugs) is the lack of quality studies, there are very few trials and not of good quality, so it is hard to find supporting evidence apart from empiric everyday experiences. There was though one article in the Headache journal supporting its use when all else failed (http://www.medscape.com/viewarticle/770550). As I said though Medicare regulations might need more than that.
From personal experience I have used medication like Fiorinal and I know plenty of colleagues who do as well, although not as a first choice. Looking at your list of failed medications, you do have a point you seem to have tried usual options and failed. So I would approve the use of Fiorinal in your case.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (7 days later)
My Dr. here in Nortern Maine is trying to take me off furional with caffeine, aspirin, n codeine after being on it for a very long time, but it's the only thing that helps with my migraines, n tension headaches!! What they don't understand is that headache medications doesn't help with my fibromyalgia, RA, n among other illnesses!! The pain medication they have me on just takes care of the pain in my body, but not my headache pain at all!! They don't seem to understand I have been on so many different meds. such as lorica, n many other migraine medications, I can't remember all of there names,, but I was also given blood pressure meds, antidepressants, seizure meds, n many more, n furional with caffeine, aspirin, n codeine is the only meds. that work for me at all!! Is there anything I can suggest to them, through talking with a Dr. here!! They don't seem to understand any of this, n I was told by another Dr. that pain meds. for the body doesn't help with headache pain at all
doctor
Answered by Dr. Olsi Taka (19 minutes later)
Brief Answer:
Read below.

Detailed Answer:
Hello again!

I am sorry about the issues you are having with your doctor.

In terms of what arguments to use ....first of all let me correct you on your statement that "pain meds. for the body doesn't help with headache pain at all", that is not correct. Most pain medication may work for headaches as well actually. There are some pain killers which are specific to migraine like triptans or ergotamine, but traditional pain killers like Ibuprofen is the first step in headache treatment. Also in preventive treatment some antiepileptics and antidepressants are used both for migraine as well as other types of chronic pain.
I do agree with the rest of your post. Migraine preventive medication is divided in three big groups, antidepressants, antihypertensive and antiseizure medication which you say have all been tried and failed. I supose you have tried triptans for acute pain as well as the over the counter anti-inflammatory painkillers like Ibuprofen. So this is the argument you should use, the fact that there are no alternatives left but Fiorinal. If your doctor doesn't think your word is enough for it you should dig up past medical records to obtain written records of all the medication you have used, so that your doctor may indeed find out for himself that those options have been exhausted.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3668 Questions

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Is Fiorinal the right medicine for migraine?

Brief Answer: Read below Detailed Answer: I read your question carefully and I understand your concern. It is true that medication like Fiorinal are not approved for migraine treatment, at least not in the US, regulations may change from one country to the other. So technically the insurance has the right to deny you the use of that drug, depending on their rules they might be allowed to pay for non approved drug even if they wanted to. The trouble with Fiorinal (or other butalbital containing drugs) is the lack of quality studies, there are very few trials and not of good quality, so it is hard to find supporting evidence apart from empiric everyday experiences. There was though one article in the Headache journal supporting its use when all else failed (http://www.medscape.com/viewarticle/770550). As I said though Medicare regulations might need more than that. From personal experience I have used medication like Fiorinal and I know plenty of colleagues who do as well, although not as a first choice. Looking at your list of failed medications, you do have a point you seem to have tried usual options and failed. So I would approve the use of Fiorinal in your case. I remain at your disposal for other questions.