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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

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  • Steelmagnolia
    5 years ago

    Think you Dr. Alex Mauskop for this article. I have been a migraine sufferer all my life. I am 64 years old and my mother told me I had my first when I was around six weeks old. I was rushed to the ER with no diagnosis…just meds for the throwing up. When I was old enough to tell my mother my head was hurting when this would happen my pediatrician took notice and went back over my medical charts and the episodes I had with the lifelessness and throwing up since the first one. He concluded it had to be Migraines and they continued to get worse as I grew and aged. I would miss a several days of school every month due to them. If the lunchroom ladies were cooking particular foods that had odd aromas I would get so sick and have to go home. If the weather changed I would get a severe one. If I ate any chocolate, bananas or cheese I would get one. It took until I was in my thirties to find out about the foods that I had trouble with. After seeing numerous doctors and neurologists for the headaches and winding up in the ER every time I had one getting put to sleep for at least 24 hours, I finally found something that would stop them with thirty minutes instead of three days. That “something” is feverfew and I am still having to take it as I still have Migraines. Everyone kept telling me I would “outgrow” them when menopause hit….not true!!! It has done nothing to alleviate the Migraines. The only thing I have ever found is the feverfew. I now take one a day as a preventative and it is working. I haven’t had one in over a month and although I have felt bad when the barometric pressure changes and have had a few visual disturbances like I might be about to have one the pain and the nausea hasn’t started. So I will continue with my feverfew and pray for all the people,e who have them. If they are having them half as bad as I did all my life I am so sorry and wish I could help them. The pain is the most horrific thing you can experience.

  • AdamWest
    10 months ago

    May I ask what dosage of Feverfew you are taking daily?

  • Steelmagnolia
    5 years ago

    Sorry about the typos. I am on my iPad with auto correct and it acts up occasionally.

  • Shinetrue
    5 years ago

    I don’t use butterbur as a preventative, I take it when I feel a headache coming on and usually the headache just slowly disappears. I do take the petadolex brand but since I only take it once or twice a month I not so concerned with toxicity than if I take it every day. For those asking I do take chelated magnesium at 250 mg twice a day and riboflavin once in the morning. I was only doing 250mg but since I am working out more frequently I upped the dose. I never noticed a difference with coq10 but the magnesium is a necessity for me. I suggest trying different types of magnesium before giving up on it. Of course I also follow other suggestions – sleep and staying hydrated are huge for me and making sure I stay away from my dietary triggers.

  • KarenR
    5 years ago

    I was taking butterbur last year and I think it really did decrease the frequency of my migraines. BUT it also definitely caused liver issues. My routine blood tests showed elevated ALT — a sign of liver disease. It took two more rounds of testing for me to mention that I was taking butterbur. My GP had been in a tizz, wondering what the heck was going on with my liver. As soon as I mentioned it, she was certain that’s what the issue was. And, sure enough, I stopped taking it and a month later my tests were clear.

  • Janet
    5 years ago

    As a migraineur..chronic for the past 13 years..all the natural remedies never worked for me..or I should say some did for a while..but never long enough. Butterbur, CQ-10 both gave me horrible heartburn and stomach issues. Magnesium..I built up a tolerance to and now if I try taking anything but a very small dose, the itching and uncomfortable itch-hive like symptoms keeps me awake and it’s painful on the bottoms of my feet. I’m now taking Zyrtec and xzyal for those symptoms in hopes of some relief from migraine. Feverfew..I use tincture drops in a small amount of water…not sure if it helps or not.

    While this never worked for me..I’ve read these herbal remedies work for many.

    Been on a ketogenic diet for 4 weeks with my new migraine headache specialist who actually emails me back within 24 hours when I write. Things were slow at the beginning…then I got 5 days free of migraine pain under level 4!!!!!! 🙂

    Traveling to,Chicago for Mother’s Day to see my Alzheimer’s mom in one place and my Parkinson’s dad in another…and away from my refrigerator proved to be a bad cocktail and triptans were being downed like m&ms…..

    So butterbur is the topic…I’ve tried it several times and I can’t agree with you doc….

    Blessings
    Janet

  • AdamWest
    10 months ago

    I’m confused, and very curious, why do you get an itch-hive sensation when you take magnesium? Is this a common side effect? I’ve never heard of this, and I’ve been taking high dose magnesium daily for years and have never had any negative side affects, aside from the occasional loose stool.

  • Steelmagnolia
    5 years ago

    Janet I take the feverfew capsules that I buy from a health food store and make sure they are pure. I have been taking it for over 15 years and it is the ONLY thing that ever come close to helping me. While it doesn’t totally stop them it will stop one within thirty minutes if you have one instead of the three days I was used to. I started back taking it everyday about 8 weeks ago as I did a few years ago and I have not had one in over a month. I never leave my house without a small plastic container that will fit in a small purse with feverfew caps in it.

  • Shan43
    5 years ago

    I just recently tried Petadolex butterbur and actually it didn’t cause a lot of burping..however, noticed some acid reflux. I also started to have some fatigue problems and felt butterbur was causing it since the fatigue went away once I stopped it. I am willing to try it again to make sure it was the butterbur and not something else! I am intolerant to many things and was surprised I tolerated butterbur as well as I did…just didn’t like the fatigue! Has anyone had fatigue issues while on butterbur? Thanks!

  • KarenR
    5 years ago

    Taking it caused liver damage for me and elevated my ALT. My doc was worried. I don’t remember being fatigued, at least not any more than normal. But I do know it was affecting me.

  • AdamWest
    10 months ago

    That should not happen if you’re taking PA free Butterbur.

  • bluesjr
    5 years ago

    curious about the doses and forms of:
    Magnesium?
    riboflavin?
    CoQ10?

    btw, was on Petadolex for 2+ years. Can not say it helped, one way or the other. Changed neurologist and the new doc did not recommend. Did not notice a change when I went off it. Good to know that Germany and the UK currently ban the herb.

  • rrpjr
    5 years ago

    I tried it for about a year on a daily regime, both Petadolex and Butterbur from Swanson Vitamins, and kept results in a headache diary. It made no appreciable difference to me. Indeed, after I stopped I had the longest break from migraines I’d had in years. I have tried about every vitamin and herbal bromide known and have not found anything that was really effective.

  • Garangwyn
    5 years ago

    I couldn’t really tell if it was helping because my neurologist also put me on Topamax at the same time. I did start the Petadolex however. I had previously purchased a small package (9 capsules for about $14!) At a health food store in town; it was for migraine pain, and the dosage was 3 50 capsules. I don’t remember what the mg. On those were. But they DID help the pain. Then I tried a cheaper brand of butterbur capsule, a powder, and supposedly stronger — and they did nothing. So that is why I was willing to pay for the Petadolex when the doctor recommended it. If you sign up for their automatic shipment program, you do get a bit of a discount.

    I know that me neuro said it can take several months for it to build up in your system enough to start working. I wonder what the effects of taking a month off would be? Then again, what are the affects of NOT taking some time off? A liver function test can check your liver…what checks for the carcinogens??

  • sgirl
    5 years ago

    I just started Butterbur, Ginger, Magnesium and Vit B2 as well. Really haven’t noticed anything yet although my migraine seemed worse this time. How long until you can tell if it is helping?

  • Luna
    5 years ago

    I tried butterbur for a month but always felt on the edge of a mild migraine. Does it make one feel worse before getting better? Or is it just not for me? Haven’t heard anything in all the literature about feeling worse on it.

  • Luna
    3 years ago

    Back then I was more episodic and quit feeling on the edge 24/7 after quitting the Butterbur. I’ve had a bad reaction to Boswellia, medical marijuana, cat’s claw, and many preventatives that did not prevent also.

  • Garangwyn
    5 years ago

    I wonder if you could have an allergy to that plant family? There is always that possibility when dealing with herbal medications.

    Did you feel on the edge of a migraine before you started taking it? “On the edge” would be an improvement for me!

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