Pain Management/Headaches


I have been having frequent headaches 2-3 times a week for the past three years or so. The pain is always just across my brow and is a constant dull pressure. I usually take Excedrin which will relieve the headache about 50% of the time. The remaining times the headaches will last until I fall asleep at night and be gone in the morning. My gp believes they are tension headaches and has recently prescribed me fioricet. Other than only having to take one of them as opposed to two Excedrin to get the same effect, I have not noticed any other benefits as it also only works about 50% of the time. He was surprised that fioricet did not help saying that it was a strong medicine and prescribed me imitrex to use only when the headaches don't go away. As of yet the insurance hasn't approved it yet so I have not tried it. My question is would the imitrex be a good treatment option for me? He also mentioned taking amitriptyline to help prevent the number of headaches but I am already on lexapro at 20mg so would that even help? Thanks

Fioricet is a pretty effective medication and is commonly used for migraine headaches with good results.  I am drawing a blank right now but one of the two has tylenol in it and the other one has aspirin in it (the two drugs being Fioricet and Fiorinal) Excedrin has aspirin in it so changing to a medication without aspirin may be a benefit because aspirin can be hard on the stomach.  Imitrex would have been my next recommendation as well. I am actually pretty surprized that your insurance is balking at it because since the generic came out it is pretty cheap. It is certainly worth a try.  Amitrityline is also good for mha - however, nortriptyline may be just as good and not as sedating.  Tricyclic anti-depressants have been used for headaches for over 50 years so that is also worth a try- there is not problem taking it with Lexapro.

Finally, there are medications from beta-blockers to anti-seizure medication that can be taken regularly to prevent the headaches - you may want to talk to your doctor about some preventitive medication like that.

Hope that helps.

Dr. J

Ps - its odd - i havent made a recommendation for tricyclic anti-depressants for migraines in a lon time and i sent one out oday for a regular patient - coincidence :)

Pain Management

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Dr. Joshua P. Cappuccilli


I will be able to answer most questions regarding pain management with medications, physical manipulation and trigger point injections.


My current pharmacy practice is specialized to manage challenging patients with chronic pain. I work closely with a number of physicians in the surrounding area to ensure safe and effective pain management while working to minimize the potential from drug abuse, drug addiction and drug diversion. My practice is approximately 40% chronic pain patients on long term therapy.

BA from the University of South Florida 1998 PharmD from the University of Florida College of Pharmacy 2008 AphA certified in Medication Therapy Management

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