The Health Benefits of Butterbur

Learn more about this herbal remedy for migraines and allergies

People have documented their use of the butterbur shrub since at least the 17th century, when medical practitioners used the wide leaves to treat asthma, coughs, and skin wounds. Since then, butterbur has been touted as a way to tame urinary tract symptoms, respiratory illnesses, and stomach upset. But the research spotlight has fallen onto two maladies in particular: Migraines and allergic rhinitis (hay fever).

One use of butterbur has definitely fallen out of favor since Colonial times: People no longer wrap butter in butterbur's huge leaves to prevent it from melting in the sun. You can blame the invention of refrigeration for that.

This article recounts the history of butterbur and explains what research has disclosed about its effect on migraines and hay fever.

Butterbur plant close up
Jurgen Wiesler / imageBROKER / Getty Images 

Butterbur's History

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. It's a native of Europe, but butterbur eventually made its way to America (just like the Colonialists).

Known as Petasites hybridus, butterbur also has several common names: Blatterdock, bog rhubarb, bogshorns, butter-dock, and pestwurz. It grows best in USDA zones 4 to 9, preferably in wet, marshy soil.

Today, butterbur's leaves and stems are often used to make an extract, though butterbur is available in powder and pill form, too. It can be ingested orally, as a tea or tincture. The typical oral dosage is between 100 and 150 mg per day in two or three divided doses. But for people pinning their hopes on using butterbur as a way to treat migraines or hay fever, the National Center for Biotechnical Information cautions that "its long-term efficacy and safety have not been established, and it is not specifically approved for these uses in the United States."

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

Heed the Typical Dosage

The typical oral dosage butterbur is between 100 and 150 mg per day in two or three divided doses.

— Heed the Typical Dosage

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 an active component called petasin. For instance, it likely relaxes blood vessels in the brain that become overexcited during a migraine.

Regardless of the mechanism, a study found that at a butterbur dose of 75 milligrams twice daily, taken for up to three to four months, had reduced the frequency of migraines when compared to placebo with no significant adverse effects.

Allergic Rhinitis (Hay Fever)

Traditionally, butterbur has been used to treat asthma and bronchitis and reduce mucus. And indeed, an evaluation of six studies of the herb for allergic rhinitis, involving a total of 720 participants, indicated that butterbur may be helpful. Butterbur is 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, 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.

And finally, a study of 125 people with hay fever found 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 was published in 2004.

The Body Fights Allergens

When a person with hay fever breathes in pollen, mold, animal dander, dust, or another type of allergen, the body releases chemicals that cause allergy symptoms. Hay fever tends to run in families.

Selection, Preparation, & Storage

Butterbur is sold in a variety of formulations, including capsules, softgels, powders, tinctures, and teas. There are a number of patented extract forms of butterbur, including Petadolex, which contains no less than 15% petasins. The same formulation has been used in many 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.

Put Caution First

You may be tempted to use butterbur as a topical treatment, just as people did hundreds of years ago to treat skin wounds. However, not enough research has been done yet to say whether it's safe to apply butterbur to the skin.


Possible Side Effects

Several studies, including a few 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 a member of the ragweed plant family, so people who are allergic to ragweed, marigolds, daisies, or chrysanthemums should avoid butterbur.

Women who are pregnant, plan to become pregnant, or who are nursing should also not take butterbur because not enough is known about its potential effects. Similarly, people with liver disease or liver dysfunction should avoid butterbur because some the compounds could damage the liver.

As with any natural remedy, prescription, or over-the-counter treatment, check first with your healthcare provider before taking butterbur to learn if it might interact with anything else you’re taking or if it could affect a present condition.

Migraines Are Still Headaches

Migraines can be so painful that it may be tempting to put them in a category by themselves. In fact, migraines are one of five types of headaches. Tension headaches are the most common type of headache, followed by migraine, sinus, exertional, and cluster.

Summary

Butterbur has been used for various therapeutic purposes for more than 2,000 years. But even after all this time, it still remains something of an enigma. The exact way butterbur works is unknown, though it's believed to be linked to the anti-inflammatory and other effects of an active component called petasin. In other words, it may relax blood vessels in the brain that become overexcited during a migraine. It may also relieve hay fever. In the end, the National Center for Biotechnical Information advises caution about using butterbur because "its long-term efficacy and safety have not been established and it is not specifically approved for these uses in the United States."

A Word From Verywell

If you deal with headaches, it should help you to know when they intensify to the point of becoming a migraine. Headaches can hurt on both sides of the head and the temples while migraines are distinguished by a throbbing sensation on one or both sides of the head. The pain can flare up to the point that keeping up with everyday activities can be a strain. Even lights and sound can add to the pain.

Some people with migraines experience what's called an "aura"—a visual disturbance marked by bright spots, dark spots, or wavy lines. In addition, some people experience an “aura”—visual disturbances that can include dark spots, bright spots, or wavy lines. Migraines can also trigger fatigue and brain fog as well as nausea and vomiting.

A migraine can last from a few hours to up to about 72 hours. It can be exhausting and undercut your quality of life. So schedule an appointment with your healthcare provider and let them help you conquer migraines once and for all.

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12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Center for Complementary and Integrative Health. Butterbur.

  2. National Center for Biotechnical Information. Butterbur.

  3. Silberstein SD, Holland S, Freitag F, et al. Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache SocietyNeurology. 2012;78(17):1337–1345. doi:10.1212/WNL.0b013e3182535d20.

  4. Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology. 2004;63(12):2240-4. doi:10.1212/01.wnl.0000147290.68260.11.

  5. Guo R, Pittler MH, Ernst E. Herbal medicines for the treatment of allergic rhinitis: A systematic reviewAnnals of Allergy, Asthma & Immunology. 2007;99(6):483-495. doi:10.1016/s1081-1206(10)60375-4.

  6. Gray R. A placebo-controlled evaluation of butterbur and fexofenadine on objective and subjective outcomes in perennial allergic rhinitisJournal of Allergy and Clinical Immunology. 2004;113(2). doi:10.1016/j.jaci.2004.01.149.

  7. Schapowal A; Petasites Study Group. Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitisBMJ. 2002;324(7330):144–146. doi:10.1136/bmj.324.7330.144.

  8. Diener H, Freitag F, Danesch U. Safety profile of a special butterbur extract from Petasites hybridus in migraine prevention with emphasis on the liverCephalalgia Reports. 2018;1:251581631875930. doi:10.1177/2515816318759304.

  9. U.S. Department of Health and Human Services. National Institutes of Health. National Center for Complementary and Integrative Health. Butterbur.

  10. Memorial Sloan Kettering Cancer Center. Butterbur.

  11. St. Joseph's Medical Center. 5 types of headaches explained.

  12. Science Focus. What's the difference between a headache and a migraine?

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