Butterbur is a shrub that is found throughout Europe and also in some parts of Asia and North America. It grows on marshy grounds close to rivers and streams. Butterbur flowers are pink-lilac in color.
The genus name is ‘Petasites’ which comes from Greek word ‘petasos’ which is a felt hat worn by shepherds. The common name ‘butterbur’ comes from the large leaves of the plant that are used to wrap butter in warm seasons.
The most popular medicinal butterbur variety is Petasites hybridus. Its use in traditional medicine dates back to 2000 years. Traditionally it has been used as a pain reliever and anti-spasmodic agent. It improves digestion and benefits in bile duct obstruction.
It has been used to treat anxiety, fever, gastric ulcers, indigestion, urinary complaints, whooping cough and cold, insomnia, wound healing. Research studies have found that butterbur benefits in a condition like allergic rhinitis, asthma, and migraine prevention.
Rhizomes, roots, and leaves of butterbur are used for medicinal purposes. Active ingredients in butterbur are sesquiterpenes called isopetasin, oxopetasin, and petasin. They have two principal pharmacological properties:
- Smooth muscle relaxation– this helps to reduce spasms and benefits in urinary complaints, menstrual cramps, kidney stones, stomach cramps, migraine headache, etc.
- Anti-inflammatory action– they act on inflammatory mediators to relieve inflammation
Quite a bit of quality evidence points out that butterbur helps in prevention of a migraine and that’s exactly what we will be going through next.
Suggested Butterbur Supplements For Migraine
Please consult a health practitioner before taking any health supplements.
Petadolex is a patented Butterbur root extract that is developed by Weber and Weber GmbH and Co. It is ‘free of harmful levels of pyrrolizidine alkaloids (PAs)’ and is standardized to contain 7.5mg petasins per softgel capsule.
Source Naturals provides Petadolex butterbur extract as a dietary supplement.
|Petadolex 75 mg||Source Naturals MigraControl|
|Image Credit: Linpharma Inc.||Image Credit: Source Naturals|
|Provides purple butterbur root extract standardised to 15% petasins||Provides purple butterbur root extract standardised to 15% petasins|
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6 Proven Benefits of Butterbur In Migraine
Various studies have identified the pharmacological properties of butterbur that help in migraine prevention.
1.Butterbur can prevent a migraine attack
A review study published in Phytomedicine: International Journal of Phytotherapy and Phytopharmacology, 2006 revealed that butterbur extract has moderate effectiveness in preventing migraine and also higher (150mg) than prescribed dose (100mg) is beneficial.
Grossman et.al conducted a study in 2001 where they treated 60 patients with 50mg butterbur extract (Petadolex formulation two capsules of 25 mg) twice a day for three months.
A maximum decrease in migraine attack frequency of 60% was observed, and butterbur was found to be well tolerated.
Diener et.al further confirmed these findings in 2004. The response rate with 100mg butterbur extract was 45% compared to 15% in the placebo group.
Lipton et.al conducted a study where 245 patients with a migraine were treated with varying doses of butterbur extract or placebo for four months. The extracts were provided at a dose of 50mg twice a day or 75 mg twice a day.
Migraine attack frequency was reduced by 48% in 75mg group, 36% in 50mg group and 26% in placebo group. 50% or more reduction in migraine attack frequency was seen 68% of the patients in 75mg group and 49% of the patients in placebo group within four months.
Adverse events were in mild in the form of gastric side effects and primarily burping. Researchers concluded that 75mg butterbur extract was significantly more therapeutic than 50mg dosage and placebo in the prevention of a migraine.
Quick Gist: A dose of 75 mg twice a day (150 mg a day) of butterbur extract is found to be beneficial in preventing migraine in adults. However, the treatment period is limited to 4 months as per the study.
2.It benefits in a childhood migraine
Oelkers et.al conducted a study wherein primary school children with a migraine were treated with butterbur extract, music therapy or placebo. Frequency of migraine attacks was determined eight weeks after treatment and then six months later
At eight weeks, only music therapy had significant benefit compared to placebo. However, at six months both therapies were found to be better than placebo in migraine prevention.
All groups experienced a reduction in migraine attack frequency.
Another study published in Headache 2005, examined the effect of butterbur extract in a childhood migraine. 108 children and adolescents were enrolled in the study.
They were treated with 50-150 mg extract for four months. Children between the age of 6-9 years received 50mg per day while older children received 100mg per day. Those who responded to the treatment within one month received higher dose 75mg and 150mg respectively.
Migraine attack frequency reduced by 63%. 77% of the patients experienced at least 50% decrease in a migraine attack.
91% of the patients showed slight or substantial improvement within four months of therapy. 90% of both groups (doctors and patients) reported improved well being. No serious side effects occurred except for mild gastric side effects.
Researchers concluded that butterbur extract was safe and beneficial for migraine prevention in adults and children.
Quick Gist: Butterbur extract at a dose of 50-150mg per day for four months is found to be safe and effective in preventing pediatric migraine.
3.It acts at molecular levels to prevent a migraine
Studies identifying molecular players in migraine development describe calcitonin gene related peptide as an agent that contributes to neurogenic inflammation in a migraine.
Experimental studies demonstrate that S-petasin ( the active component of butterbur extract) may exert anti-inflammatory properties by reducing secretion of the calcitonin gene related peptide.
Calcium ion channels (think of them as molecular gates that close or open in response to the ions flowing through them) regulate neurotransmitter release and abnormal activity in these channels may contribute to a migraine.
A study published in Planta Medica, 2003 indicates that S-petasin regulates calcium ion channel activity and this activity could be possible in neurons as well.
Active ingredients like S-petasin, iso S-petasin and eudesmol found in butterbur extract are found to regulate the activity of these channels, and this may contribute to the prevention of a migraine.
Quick Gist: At a molecular level, abnormal activity in calcium ion channels is found to affect neurotransmitter release and thus contributes to a migraine. Active components found in butterbur root is found to regulate the activity of these channels to prevent a migraine.
4.Butterbur has a neuroprotective effect
A migraine is considered as a neurological disorder. Symptoms before a headache and also after a headache are suggestive of aberrant neurological activity. Mild disturbances in cognition are even observed after a migraine attack. (Read Understanding Migraine)
Sesquiterpenes found in butterbur varieties serve as neuroprotective agent and protects neurons from cell death in experimental conditions.
A group of Chinese researchers has found novel compounds in butterbur extract called bakkenolides. By their antioxidant activity, they offer neuroprotective action.
In an animal model of neurotoxicity, extract from butterbur variety is found to reduce lethality caused by a neurotoxin from 54% to 25%. It was also found to improve antioxidant activity.
The combination of butterbur with rough aster is found to reduce lethality by 12.5%, and they delay the onset of behavioral symptoms by two folds.
Quick Gist: Butterbur extracts have a neuroprotective activity that can help protect neurons from damage in a chronic migraine.
5.It is a natural anti-inflammatory agent
Prostaglandins are inflammatory mediators which play an important role in neuroinflammatory and neurodegenerative diseases.
Microglia is a type of immune cells found in the central nervous system that produces prostaglandins which may contribute to normal functioning of the nervous system or even accelerate neurodegenerative processes.
Activated microglia contributes to neuroinflammation which is also observed in a migraine.
A study published in Current Opinion in Neurology, 2013 reveals that prostaglandins are present in blood vessels associated with the central nervous system. They dilate the blood vessels during a migraine attack and contribute to pain.
Active ingredients found in butterbur extract, petasin and isopetasin inhibit inflammation in microglia. They inhibit the activity of COX enzymes and prevent the production of prostaglandins. They can benefit in countering inflammation in a migraine.
Quick Gist: Butterbur extracts contain active ingredients such as petasin and isopetasin which reduce neuroinflammation occurring in a migraine.
6.It can mitigate causes of a migraine
Still, there is no significant clarity on the cause of a migraine; however certain trigger factors have been identified.
Butterbur extract is found to counteract the toxic effects of monosodium glutamate and raise antioxidant defenses in the liver to assist in detoxification. It also alleviates metabolic disturbances caused by monosodium glutamate consumption.
Stress is a leading causative factor of a migraine. Butterbur in combination with other herbs is found to reduce anxiety and depression and bring about improvement in the health of individuals suffering from somatoform disorders.
Somatoform disorders are when individuals are suffering from psychological distress experience physical symptoms.
Asthma is identified as an important predisposing factor for migraine development. Butterbur extract is found to reduce the frequency of asthma attacks and also reduce dependence on anti-asthma medications.
A sinus headache is different from migraine attack, but research has identified a correlation between a migraine without aura and allergic rhinitis. More research is required to confirm this link.
Butterbur’s therapeutic effects are found to be similar as that of cetirizine in allergic rhinitis.
Quick Gist: Butterbur’s anti-inflammatory and anti-allergen activity can help mitigate causes of a migraine as well as other conditions that are associated with a migraine.
Is Butterbur safe for use in migraine therapy?
Apart from the beneficial active ingredients found in butterbur, there are certain agents called pyrrolizidine alkaloids which may cause safety concerns.
Studies have identified that these agents are toxic to the liver and also may cause cancer and veno-occlusive disease (as per results of experimental studies). They also serve as mutagens.
Raw, unprocessed butterbur plant must not be consumed, even in the form of tea, raw herb capsules, or unprocessed tinctures/extracts.
Products free from pyrrolizidine alkaloids are safe for use though long term safety (more than 12-16 months) has not been investigated.
Based on human toxicity studies, WHO has identified that ten μg/kg of body weight of pyrrolizidine alkaloids is toxic and can cause veno-occlusive disease.
German Federal Health Bureau has laid out certain restrictions on exposure to pyrrolizidone alkaloids. The restriction is as follows: in herbal preparations to 1.0 μg/day with a limit of use of six weeks per year or to 0.1 μg/day with no further restrictions of intake.
A recent study published in 2014 states that post marketing surveillance data for butterbur extract is limited to low doses (100mg) and for short duration (2 months).
Since there is no data on long term safety, regulatory authorities have expressed concern about this, and it has led to its withdrawal from the European market.
Based on evidence to date, it can be concluded that butterbur extracts are safe for 3-4 months at a dose of 100-150mg per day and more studies needs to be conducted to assess its long term safety.
Dosage of Butterbur For Migraine
Various formulations of butterbur are available in the market.
For migraine prevention in adults, the dose studied is 7.5mg petasin and isopetasin in a 50mg tablet (Petadolex) and a dose range of 50-75mg twice a day for 4 months is prescribed.
75mg twice a day is found to be more effective than 50 mg twice a day for migraine prevention.
For children the dose (for four months) that has been investigated in studies is:
- Age 6-9 years: 50-75 mg of butterbur extract per day
- Older children: 100-150 mg of butterbur extract per day
Consult a health practitioner before taking butterbur supplements, especially in the case of children.
As mentioned previously one must opt for products that have been processed and are free from pyrrolizidine alkaloids, to avoid any toxicity.
Also, butterbur may cause allergic reactions in sensitive individuals or those who are allergic to plants like ragweed, marigolds, daisies, and chrysanthemums.
Avoid use of butterbur during pregnancy and lactation. Please consult a health practitioner before giving butterbur supplements to children.
Butterbur extracts may have a drug interaction with anticholinergic agents and herbs that have pyrrolizidine extracts and anticholinergic activity.
Few possible side effects with butterbur use are:
- A headache, drowsiness or fatigue
- Itchy eye
- Gastric side effects such as nausea, constipation, diarrhea, stomach upset, vomiting, stool discoloration, etc.
- Difficulty in breathing
- Dermatitis (skin inflammation or itching), pruritis or skin discoloration
There are limited studies investigating the therapeutic efficacy of butterbur in a migraine but these studies show that indeed it effectively reduces migraine attacks with almost negligible side effects.
It’s active components have natural anti-inflammatory property, and they regulate dilation of blood vessels and activity of calcium ion channels; these properties aid in migraine prevention.
The presence of pyrrozolidone alkaloids in butterbur raise some safety concerns, but efficient extraction processes help in the development of pyrrozolidone free butterbur supplements.
The use of butterbur in migraine prevention is limited to a short period (less than four months). More research is required to confirm the long term safety of it’s use in migraine prevention.