Taking a Closer Look at the Herbal Remedy, Butterbur

Herbal remedies have great appeal because of their perceived lack of side effects. While most of such remedies are indeed free of side effects, a few are not. Another problem with herbal products is that they are not regulated and quality controls vary from manufacturer to manufacturer. One infamous case involved a Chinese herbal product for weight loss, which led to kidney failure in 100 Belgians, 70 of whom required either dialysis or a kidney transplant.

Among the herbal products recommended for migraine headaches are feverfew, boswellia, ginger, rhodiola, and butterbur. Of these, only the butterbur plant (Petasites hybridus) has known toxic ingredients, which are known carcinogens (cancer-causing chemicals), hepatotoxic substances (cause liver damage) and teratogens (which cause birth defects).

We at the New York Headache Center, along with two other headache clinics conducted the largest and the most rigorous study of any herbal product used for the prevention of migraine headaches. Butterbur used for this study was produced in Germany where, unlike in the US, the government strictly regulates herbal products. This product, sold in the US as Petadolex, was highly purified and subjected to extensive testing in laboratory animals to make sure it contained no toxic ingredients. We enrolled 245 patients who were divided into three groups – one group was given placebo, another one was given 100 mg of butterbur and the third one was given 150 mg of butterbur.

All patients met the International Headache Society’s criteria for migraine and had two to six attacks per month. Over 4 months of treatment, migraine attack frequency was reduced by 48% in the 150 mg group, by 36% in 100 mg group and by 26% in the placebo group. These results were statistically significantly better between 150 mg group and placebo but not in the 100 mg group when compared to placebo. This improvement in the 150 mg group was present already noted after one month, as well as after two, and three months. The most frequently reported side effect was burping (with a very unpleasant taste).

The results were published in 2004 in the leading neurological journal – Neurology and the American Academy of Neurology endorsed the use of butterbur for the prevention of migraine headaches.

We were very happy to have had a highly purified product manufactured in Germany, where it passed strict safety studies. However, Germany is no longer allowing butterbur to be sold there because the manufacturer changed its purification process and did not repeat all of the required safety studies. This manufacturer claims to have tested their product and to have found no toxic chemicals. However, because of its relatively high cost – from $50 to $65 a month, many American headache sufferers might opt for a cheaper version of butterbur, and there are some that cost as little as $4. However, while these cheaper products also claim to be free of toxic chemicals, in the absence of government regulation, it is hard to know if that is true. This is probably why the UK joined Germany in banning the sale of all butterbur products.

So, what is a migraine sufferer to do? I often recommend herbal products, but usually start with boswellia or feverfew, along with supplements such as magnesium, riboflavin, and CoQ10. If several supplements have been tried and failed and the patient is reluctant to try Botox injections or preventive medications, then I might recommend butterbur. I do suggest taking the Petadolex brand and advise taking it for 3 months and then taking a break for a month. I also periodically obtain a blood test to check liver functions.

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