Safety of Buttebur for Migraine Therapy

butterbur plant
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In 2012, the American Headache Society (AHS) and American Academy of Neurology (AAN) updated guidelines on medications they recommend for the prevention of episodic migraine. Petasites hybridus or butterbur was listed a Level A drug, establishing it as a reasonable option for migraine prevention. But now there may be concerns about the long-term safety of butterbur.

What is Butterbur?

Butterbur is an ancient perennial plant that contains chemotypes, called "petasins," that are believed to have an anti-inflammatory effect. This herbal therapy has been used to treat a number of medical conditions, including allergic rhinitis, migraine prevention, and as an anti-spasmodic. There are a number of patented extract forms of Butterbur—such as Petadolex.

At a dose of 75mg twice daily, taken for up to 3 to 4 months, butterbur has been found to reduce the frequency of migraine headaches when compared to placebo with no significant adverse effects. The main side effect is mild stomach and intestinal upset, predominantly belching.

Other potential side effects of Butterbur include:

  • headache
  • itchy eyes
  • asthma
  • fatigue
  • drowsiness

In addition, Butterbur may cause allergic reactions in people who are sensitive to plants such as ragweed, chrysanthemums, marigolds, and daisies.

What is the Safety Concern?

Butterbur extract contains pyrrolizidine alkaloids (PAs), which can be damaging to the liver and have also been shown to be carcinogenic in animal studies. The extract, therefore, must be manufactured carefully to eliminate these PAs. According to the NIH, there have been a number of studies on PA-free butterbur (i.e. Petadolex) showing that it is safe when taken at the recommended dose for up to 12 to 16 weeks. The problem is that we do not have studies on longer-term use of PA-free butterbur. Like other herbal therapies, butterbur is not regulated by the FDA, so it has not gone through the rigorous testing needed to make sure this drug is safe.

According to an article in Neurology Times, "Migraine Preventative Butterbur Has Safety Concerns," the American Headache Society, "is currently evaluating a position statement cautioning against its use."

What Does This Mean?

Speak with your doctor if you are taking butterbur. He will be able to assess the risks involved in greater detail and may recommend stopping it until there are good quality clinical trials available. Right now, there is simply not enough information to really understand the long-term safety of butterbur.

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Article Sources
  • Agosti R, Duke RK, Chrubasik JE, et al. Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review. Phytomedicine. 2006;13(9–10):743–746.
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  • Bravo TP, Vargas V. Migraine Preventative Butterbur Has Safety Concerns. Neurology Times. 2015 Jan.
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