Fiorinal is a combination medication containing aspirin, butalbital (a barbiturate), and caffeine, used off-label for cluster headache management. The butalbital acts as a central nervous system depressant to reduce anxiety and muscle tension, while aspirin provides analgesic and anti-inflammatory effects, and caffeine enhances the pain-relieving properties and promotes vasoconstriction. Its multi-modal mechanism can help interrupt the pain cascade and provide symptomatic relief during cluster headache episodes.