Why do migraineurs abuse butalbital-containing combination analgesics?

About 50 years ago, the neurologist and headache specialist, Arnold P. Friedman, MD, co-founder of the first specialized headache clinic in the world, helped to develop a new combination medication. He named it as an amalgamation of the name of his hospital (Montefiore in the Bronx, New York) and butalbital, thus Fiorinal (Seymour Solomon, MD, personal communication) containing 50 mg butalbital, 40 mg caffeine, and 325 mg aspirin. Butalbital-containing combination (BCC) analgesics may be effective for acute migraine relief, although placebo controlled studies have not been performed. However, the risk for physical and psychological dependency and medication overuse headaches is such a concern that some specialists have called for a ban on butalbital combinations in the USA.