Fiorcet and Tramodol

  1. For the second time in a month I've had a student return back from a trip to our local ER with rx for Fiorcet and Tramodol for headache.

    Neither received Immitrex or other comparable known migraine med.

    I assume they got a referral for migraine and some additional medication but....that just seems like a lot of medication. Is this best practice at this point?
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    About ruby_jane, BSN, RN

    Joined: Apr '17; Posts: 1,262; Likes: 4,057

    9 Comments

  3. by   JenTheSchoolRN
    Fiorcet - doesn't that contain a barbiturate? Was it prescribed for school use? I can't see the drowsiness being helpful for learning. I also though Ultram was prescribed for folks under 16...

    I've never seen a kid with migraines on that in MS or HS on my end. I've seen amitriptyline at night headache prevention, treatment with ibuprofen or excedrin, and Imitrex to break a bad migraine (usually with a stipulation of doses that can be taken in one week). I did have one student with fierce migraines get Botox and it worked wonders, but that was only approved after a long try on the meds above and after the student was 18.
  4. by   Flare
    I get migraines and manage them with a combination of daily topamax and fioricet for breakthrough. While the fioricets don't affect me negatively - no drowsiness - i would probably feel very cautious about giving that in school. Same with the Tramadol.
    On the other hand - when I was given immitrex i found it helpful, but that it also made me tired - usually wanting a nap lasting about a half hour or so then i'd wake up feeling worse than before i took it - the headache would be gone, but i just felt awful - hard to describe feeling. So... my own experiences with those particular medications would certainly give me something to think about. Certainly not everyone is the same and won't feel side effects the same way.
  5. by   JenTheSchoolRN
    Quote from Flare
    I get migraines and manage them with a combination of daily topamax and fioricet for breakthrough. While the fioricets don't affect me negatively - no drowsiness - i would probably feel very cautious about giving that in school. Same with the Tramadol.
    On the other hand - when I was given immitrex i found it helpful, but that it also made me tired - usually wanting a nap lasting about a half hour or so then i'd wake up feeling worse than before i took it - the headache would be gone, but i just felt awful - hard to describe feeling. So... my own experiences with those particular medications would certainly give me something to think about. Certainly not everyone is the same and won't feel side effects the same way.
    I have seen topomax in the school setting for migraine treatment with one student. It worked well - when the student would also follow through with dosing at home, which never happened unfortunately.
  6. by   Farawyn
    I've seen it, but I would call the mom. Maybe there's a reason the kid can't take imitrex.
  7. by   BeckyESRN
    Quote from Farawyn
    I've seen it, but I would call the mom. Maybe there's a reason the kid can't take imitrex.
    That's what I was thinking too. As a teen, Imitrex triggered SVT, so I used Fiorcet. (But I kept mine in my backpack, not the nurse's office-shame on me!)
  8. by   ruby_jane
    Quote from BeckyESRN
    That's what I was thinking too. As a teen, Imitrex triggered SVT, so I used Fiorcet. (But I kept mine in my backpack, not the nurse's office-shame on me!)
    Ok well THAT's good info there! Sorry, SVT is no fun.
  9. by   ruby_jane
    Quote from JenTheSchoolRN
    Fiorcet - doesn't that contain a barbiturate? Was it prescribed for school use? I can't see the drowsiness being helpful for learning.
    Yup, and I am not opposed to barbituates but in a relatively drug-naïve teen...that seems like a lot.

    Nope. It was in a backpack. Kid took one each in the morning and I found it out incidentally (came in for another reason, happened to mention, saw it and had to do something).

    I am all for pain management and whatever that takes. Immitrex makes most people who take it tired. Topomax seems to work well for my chronic migrainers.....when they remember to take it. One sweet child o' mine stopped her Topomax because she felt soooo much better! Until she did not.
  10. by   maxthecat
    Does the kid have a migraine or some other sort of headache? I was told that Imitrex worked only on migraines. I'd also watch the fioricet. it's great if you can take it without side effects, but I know of at least one case where it triggered extreme irritability and anger outbursts.
  11. by   ruby_jane
    Quote from maxthecat
    Does the kid have a migraine or some other sort of headache.
    Initial presentation in both cases was intractable h/a. One from a concussion and the other with no trigger.

    That info on Fiorcet is interesting, thanks!!!

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