The Health Benefits of Butterbur

Learn more about this herbal remedy for migraines and allergies

butterbur plant
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Butterbur (Petasites hybridus) is an ancient perennial shrub that grows in Europe and parts of Asia and North America, typically in wet, marshy ground. It's a member of the Asteraceae family. The name, butterbur, was bestowed in Colonial times because the plant's broad leaves—they can approach three feet in diameter—were used then to wrap butter in warm weather to keep it from melting. Other common names include blatterdock, bog rhubarb, bogshorns, butter-dock, and pestwurz.

Butterbur has been used for various therapeutic purposes for more than 2,000 years. Its medicinal use was described as early as 65 A.D. by Dioscorides, a Greek physician, pharmacologist, and botanist. In the Middle Ages, butterbur was used for fever and plague, and in the 17th century, it was used to treat cough, asthma, and skin wounds. The most common current uses—and those for which there is good scientific evidence—are for migraines, a severe type of headache that typically occurs on one side of the head, and allergic rhinitis (aka hay fever).

It's important to be aware that the raw, unprocessed butterbur plant contains chemicals called pyrrolizidine alkaloids (PAs), which can cause liver damage and have also been shown to be carcinogenic in animal studies. While these substances are removed in commercially available preparations, be sure to use only butterbur products that are certified and labeled “PA‐free.”

Health Benefits

Migraines

In 2012, based on two high-quality studies, the American Headache Society (AHS) and the American Academy of Neurology (AAN) endorsed the use of a butterbur extract made from underground parts of the plant, like the root or rhizome, to reduce the frequency of migraines.

The exact way butterbur works is unknown, though it's believed to be linked to the anti-inflammatory and other effects of the active component called petasin—for instance, it likely relaxes blood vessels in the brain that become overexcited during a migraine. Regardless of the mechanism, at a dose of 75 milligrams twice daily, taken for up to three to four months, butterbur has been found to reduce the frequency of migraine headaches when compared to placebo with no significant adverse effects.

Allergic Rhinitis (Hay Fever)

Butterbur has been used traditionally to treat asthma and bronchitis and to reduce mucus, and an evaluation of six studies of the herb for allergic rhinitis, involving a total of 720 participants, indicated that butterbur may be helpful. Although how butterbur works still isn't known, it's thought to work in a similar way to allergy medications by blocking the action of histamine and leukotrienes, inflammatory chemicals involved in allergic reactions.

In an earlier study of 330 people, published in 2004, butterbur was compared with the antihistamine drug Allegra (fexofenadine) and a placebo. Butterbur was as effective as Allegra at relieving sneezing, nasal congestion, itchy eyes, and other hay fever symptoms, and both treatments were more effective than the placebo. Another study of 125 people with hay fever found a butterbur extract to be as effective as Zyrtec (cetirizine). It's worth noting that some of the larger trials were sponsored by manufacturers of butterbur extract and at least one double-blind, placebo-controlled study with negative results has been published.

Selection, Preparation, & Storage

Butterbur is sold in a variety of formulations, including capsules, powders, tinctures, and teas. There are a number of patented extract forms of butterbur including Petadolex, which contains no less than 15 percent petasins and is the formulation used in many of the migraine trials.

Again, only those products labeled or certified as PA-free should be used to avoid the potentially harmful chemicals found naturally in the butterbur plant but removed during processing.

Possible Side Effects

Several studies, including a few studies of children and adolescents, have reported that PA-free butterbur products are safe and well tolerated when taken by mouth in recommended doses for up to 16 weeks. The safety of longer-term use has not been established.

Butterbur is usually well tolerated but it can cause side effects such as belching, headache, itchy eyes, diarrhea, breathing difficulties, fatigue, and drowsiness. In addition, butterbur is in the ragweed plant family, so people who are allergic to ragweed, marigold, daisy, or chrysanthemum should avoid butterbur. Women who are pregnant, plan to become pregnant, or nursing should also not take butterbur.

As with any natural remedy, prescription, or over-the-counter treatment, you should first check with your doctor before taking butterbur to learn if it might interact with anything else you’re taking or if it could have a dangerous impact on any condition you have.

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