With numerous natural products claiming to alleviate migraines, distinguishing between genuine remedies and ineffective options can be challenging. In our article we examine a supplement extensively studied in clinical trials for migraine prevention: butterbur.
In ancient times, butterbur was employed to combat the plague, and in the 17th century, it was used for coughs, asthma, and wounds. In modern times, derivatives of the plant have been utilized to address urinary tract symptoms, stomach discomfort, hay fever, and, notably, migraine attacks.
Butterbur is a perennial shrub thriving in marshy areas of Europe, Asia, and North America, has a rich history of treating various ailments, primarily using extracts from its roots, which are considered safe.
In comparison to other natural remedies such as magnesium, capsaicin, feverfew and B2, butterbur boasts a greater number of clinical studies supporting its efficacy. While anecdotal evidence and smaller studies hold value, it is reassuring when scientific research unequivocally supports the use of butterbur.
However, concerns have been raised regarding the safety of butterbur. To dispel any confusion, in this article we present the most recent resources and current findings on butterbur. Research indicates its effectiveness in treating migraines, and medical professionals endorse its safety when used correctly.
By providing relevant information, this guide will assist you in determining whether butterbur is a suitable addition to your migraine management plan.
How Does Butterbur Work in Preventing Migraines?
One key point is understanding how exactly butterbur works to prevent migraine attacks. Dr. Richard B. Lipton, the director of the Montefiore Headache Center in New York City and former president of the American Headache Society, highlights the supplement Petadolex, a butterbur root extract, as the natural product that demonstrates effectiveness comparable to topiramate and divalproex sodium, the best prescription drugs.
In April 2022, Frontiers in Neurology published new findings shedding light on the mechanism of butterbur’s effectiveness in migraine prevention. The key lies in its active ingredient called petasins. These natural compounds, derived from specific plants, are responsible for butterbur’s anti-inflammatory effects. Petasins function by desensitizing the sensory neuron channels where pain signals are registered.
Petasins, which are active components of butterbur, are responsible for its medicinal properties. Derived from the rhizome of Petasites hybridus, Petadolex® stands out as the only butterbur extract that has undergone comprehensive evaluation to determine its safety and effectiveness in the preventive treatment of migraines.
According to a 2022 press release, a controlled clinical trial showed that Petadolex achieved a 50 percent responder rate, which was competitive with the new prescription medications targeting CGRP. By blocking CGRP signals, butterbur effectively prevents migraine attacks.
Recent research has revealed that Petadolex modulates CGRP in a different manner compared to monoclonal antibody drugs like Aimovig, Ajovy, Vyepti, and Emgality, which have entered the market in recent years.
Apart from migraine prevention, the butterbur extract has also exhibited potent antioxidant properties and significant anti-inflammatory effects. Studies have explored its potential in preventing allergic rhinitis and hay fever, showcasing promising benefits when taken during allergy seasons, as reported in Frontiers in Neurology. While this connection might be speculative, the dual benefit of butterbur could prove advantageous since migraines can sometimes be mistaken for sinus headaches, and allergies can act as triggers for migraine attacks.
Butterbur as a Safe Supplement for Migraine Relief: What You Need to Know
To ensure your safety when using butterbur, it is crucial to understand its processing methods before consumption.
According to reputable research conducted by two prominent studies, the American Academy of Neurology and the American Headache Society, butterbur extract derived from underground parts of the plant, such as the root or rhizome, is supported for use. It is important to emphasize that only supplements extracted from the roots or rhizomes are considered safe.
However, caution should be exercised with unprocessed butterbur products, such as teas, as they may contain toxic chemical pyrrolizidine alkaloids (PAs) present in the raw plant parts.
When selecting a suitable butterbur product to aid in your migraine relief plan, opt for those that are marked or certified as PA-free.
Liver damage has been a major concern regarding butterbur’s safety. Dr. Jürgen Borlak, an esteemed toxicologist and professor at Hannover Medical School in Germany, who advises the U.S. Food and Drug Administration (FDA) and the World Health Organization (WHO) on drug-induced liver injury, has deemed Petadolex safe after thoroughly analyzing its safety data. Dr. Borlak specifically noted that cases of herb-induced liver injury associated with Petadolex are rare and unpredictable, often complicated by concomitant medication. He highlighted the absence of reported adverse effects in the United States and Canada during 1.3 million patient months of Petadolex usage.
Previously, extensive studies concluded that PA-free butterbur products are safe and well-tolerated when taken orally in recommended doses for up to 16 weeks. However, recent research has assessed the safety of butterbur root extract for a period of 6 months.
Some of these studies have included children and adolescents, demonstrating the safety of the product for younger individuals. However, it is advisable for younger migraine sufferers to use butterbur under the supervision of a medical professional.
The safety of butterbur for pregnant and lactating women remains unknown and should be avoided.
Additionally, it is important to note that the aforementioned studies were conducted over a span of 16 to 24 weeks, and long-term safety has yet to be established through trials. However, if deemed safe by your healthcare provider, you can continue using butterbur beyond 24 weeks. Routine lab work may be recommended for long-term users.
Dosage and Potential Side Effects of Butterbur
Multiple double-blind and placebo-controlled trials have been conducted to investigate the effectiveness of butterbur root extract for migraines. These trials spanned a duration of 16 weeks and consistently demonstrated that a dosage of at least 75 milligrams (mg) taken twice a day can reduce the frequency, severity, and duration of migraine attacks by nearly 50 percent.
While butterbur is generally well-tolerated, there are some potential side effects to be aware of. These may include headaches, itchy eyes, diarrhea, breathing difficulties, fatigue, and drowsiness. The most common side effect reported is belching. Additionally, individuals who are sensitive to plants like ragweed, chrysanthemums, marigolds, and daisies may experience an allergic reaction when using butterbur.
Mechanism of Action of Butterbur for Migraines
The key to butterbur’s effectiveness in migraine prevention lies in its petasins, which are natural chemical compounds found in the plant’s roots. These compounds play a crucial role in reducing inflammation by modulating the body’s pain response. Specifically, they inhibit the release of CGRP (calcitonin gene-related peptide), a protein known to trigger inflammation and migraine pain in the brain. It is noteworthy that the effectiveness of butterbur extract has been likened to that of prescription medications used for migraines, highlighting its significance in managing this condition.
Top Recommended Brands for Butterbur
While healthcare professionals typically refrain from endorsing specific brands, Dr. Lipton makes an exception by recommending Petadolex from Weber & Weber, a reputable German company, distributed by Linpharma in the US.
The rationale behind mentioning a specific brand lies in the importance of ensuring proper extraction methods and the absence of toxic alkaloids in the supplement. It is crucial to choose a product that is certified as PA-free.
Dr. Lipton explains, “The German government naturally regulates national products, so I know what people are taking when they take the Weber & Weber product.”
Key take aways
Considering the evidence from multiple studies, it is clear that butterbur is a safe and effective natural choice for preventing and alleviating migraines.
A dosage of 75 mg taken twice daily has shown promising results, reducing migraine episodes by up to 50 percent. It is crucial to select a butterbur extract that is certified as PA-free to ensure its quality.
Can Butterbur Help with Migraine Attacks?
Scientific research indicates that butterbur supplements can be beneficial for individuals seeking to prevent migraine attacks. There is substantial scientific evidence supporting the effectiveness of this herbal remedy as a preventive treatment for migraines. The American Academy of Neurology and the American Headache Society endorse the use of butterbur for individuals with chronic migraines.
Are There Any Side Effects of Butterbur?
When used correctly, butterbur root extract generally poses minimal safety concerns. The plant does contain pyrrolizidine alkaloids, which are toxic substances, but they are not present in the roots of the plant. Therefore, it is crucial to choose a butterbur product that is PA-free, such as Petadolex, which is derived exclusively from butterbur root extract and has undergone thorough research.
One of the main safety concerns associated with butterbur is liver toxicity. However, studies have shown that liver damage is rare among 1.3 million Petadolex users. Overall, butterbur has been well tolerated for migraine treatment, with minor side effects reported including headaches, itchy eyes, diarrhea, breathing difficulties, fatigue, and drowsiness. The most commonly reported side effect is belching. If you have known allergies or sensitivities to plants in the butterbur family, such as ragweed, chrysanthemums, marigolds, and daisies, there is a possibility of experiencing an allergic reaction.
What is the Recommended Butterbur Dosage for Headaches?
For migraine prevention, the optimal dosage of butterbur root extract is 150 mg per day, divided into two equal doses of 75 mg each. Clinical studies have shown that taking this dosage can lead to a 50 percent reduction in migraine attacks when used for a duration of up to six months. If you are under the supervision of a healthcare professional, they may allow you to continue taking butterbur extract for longer periods; however, it’s important to note that the long-term use of butterbur has not been extensively studied in scientific research.