Do you sometimes get a severe headache that feels like your head is being squeezed on both sides, and your neck muscles are tight? Even after taking regular painkillers, does it still bother you all day? Yes, today we are talking about a special medicine that doctors recommend for this type of severe headache (Tension Headache) when other medicines fail to provide relief. This is a combination of several types of medicines.
Simply put, what is this medicine?
This is not really one drug, but a combination of four main ingredients. Each of them does a different job.
1. Butalbital: This belongs to a class of drugs called barbiturates. Simply put, it calms your central nervous system. It relaxes the tense muscles in your head and neck, reducing the tension that causes headaches.
2. Aspirin: You've probably heard of this one. It's a pain reliever in the NSAID (Nonsteroidal Anti-inflammatory Drug) class. It reduces pain and swelling.
3. Caffeine: Caffeine is the same substance found in tea and coffee. Here, caffeine enhances the pain-relieving properties of the other two painkillers, aspirin and codeine.
4. Codeine: This is a powerful painkiller that belongs to the opioid class. It works by blocking pain signals from reaching your brain.
The most important thing is that this medicine is only used to treat an existing headache. It is not used to prevent headaches.
Things you need to tell your doctor before taking medicine
Because this is a powerful combination of medications, it is very important that your doctor is fully aware of your health condition. If you have any of the conditions listed below, be sure to tell your doctor before starting this medication.
| Your situation | Why should you inform? |
|---|---|
| A brain tumor, a head injury | This medication can affect pressure in the brain. |
| Heart disease, liver or kidney disease | Because medications are excreted from the body through these organs, their function is important. |
| Bleeding disorders (Hemophilia), low platelet count | The aspirin contained in the medicine may increase the risk of bleeding. |
| Asthma or other breathing problems | Codeine and butylbital can slow breathing. |
| Alcohol or drug addiction | This information is important for managing this medication, as it carries a risk of addiction. |
| Being pregnant, trying to get pregnant, or breastfeeding | This medicine may affect the unborn baby and the nursing baby. |
| Allergies to certain medications or foods | It is essential to inform the doctor if you have any allergies, especially to aspirin and codeine. |
How do you use this medicine?
- Take the dose exactly as prescribed by your doctor. Never take more than the prescribed amount.
- Fill a glass of water and swallow the tablet/capsule with it.
- If you experience stomach upset or heartburn, take the medicine with a meal or a glass of milk.
- This medicine is not suitable for children under 12 years of age . It is also not given to children under 18 years of age after surgery to remove the tonsils or adenoids.
What if there is an emergency?
If you think you have overdosed, don't delay. Immediately call the National Poisons Information Centre at the Colombo National Hospital (telephone number 0112 686 143), or go to the Emergency Department (ETU) of the nearest hospital.
This medicine has been prescribed for you only. Do not share it with anyone else, even if your symptoms are the same as yours. It may be dangerous.
Drug Interactions
This medicine may interact with some other medications, so it is very important to give your doctor a complete list of all the medications you are taking (including vitamins, herbal remedies, and supplements).
In particular, avoid taking this medicine with the following categories of medicines or take it only on the advice of your doctor.
| Avoid taking with these medications | |
|---|---|
| Drug category | Examples |
| MAOI antidepressants | Marplan, Nardil, Parnate (if it has not been 2 weeks since taking these) |
| Some other medications | Ketorolac, Linezolid, Methylene blue |
| Please specifically inform your doctor about these medications. | |
| Alcohol | The risk of excessive sleepiness and respiratory distress is very high. |
| Other medications that cause drowsiness | Sleeping pills, anxiety medications (e.g. Diazepam), and other strong painkillers. |
| Blood thinners | Warfarin, Apixaban, Rivaroxaban |
| Other painkillers (NSAIDs) | Ibuprofen, Naproxen |
Things to consider when taking the medicine
- Drowsiness: This medication may make you feel sleepy or dizzy. Therefore, avoid activities that require alertness, such as driving or operating machinery, until you know how this medication affects you.
- Alcohol: Do not drink alcohol while taking this medication for any reason. It can cause extreme drowsiness, slowed breathing, and even death.
- Stomach bleeding: There is a small risk of stomach ulcers or bleeding due to the aspirin in this medicine. If you experience severe stomach pain, vomit that looks like coffee grounds, or pass black tarry stools, see a doctor immediately.
- Tolerance & Dependence: When you take this medicine for a long time, your body can become accustomed to it. This means that you may need a higher dose to control the same pain (Tolerance). Also, if you stop taking the medicine suddenly, you may experience withdrawal symptoms. This is not an addiction. If your doctor wants you to stop taking the medicine, they will do so by gradually reducing the dose.
- Constipation: Constipation is a common side effect of codeine. If you have not had a bowel movement for 3 days, tell your doctor. Drinking plenty of water and eating a high-fiber diet can help with this.
Main possible side effects
| Serious side effects that require immediate medical attention | |
|---|---|
| Allergic Reaction | Skin rash, itching, swelling of the face, lips, tongue. |
| Slow breathing (CNS Depression) | Breathing is very slow, excessive sleepiness, and loss of consciousness. |
| Bleeding symptoms | Black stools, vomiting blood, dark brown urine, red/purple spots on the skin. |
| Symptoms of liver damage | Pain in the upper right side of the abdomen, yellowing of the eyes/skin, dark yellow/brown urine. |
| Common side effects that should be reported to the doctor if they persist | |
| Constipation | Dizziness |
| Drowsiness | Dry mouth |
| Nausea/vomiting | Stomach pain |
Take-Home Message
- This is a powerful painkiller combination. Never take more than the dosage prescribed by your doctor.
- Give your doctor a complete list of all other medications, vitamins, and traditional medicines you are taking.
- Avoid drinking alcohol completely while taking this medicine. It is very dangerous.
- Seek immediate medical attention if you experience symptoms such as excessive drowsiness, difficulty breathing, black stools, or severe skin irritation.
- Because this medicine can be addictive, keep it in a safe place out of the reach of children and others. Never share it with others.
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