Butterbur for Migraine Prevention
When thinking about trying a natural remedy to treat migraines, it’s important to use the same common sense wisdom you would use with any other medication. The key is to recognize that there’s no doctor or pharmacist to blame if things go wrong. It’s your responsibility to make wise choices for yourself and accept the risks and benefits.
You need to get answers to these basic questions before you can make an informed choice. Instead of asking a doctor or pharmacist, you will have to find the answers yourself.
Does it work?
As with any migraine preventive, it won’t work for all patients. That doesn’t mean it’s not worth a try. There are some clinical trials and literature reviews that show promise.
How does it work?
The active ingredients are Petasin and Isopetasin. They inhibit the production of leukotrienes and histamine. Some researchers have suggested it affects calcium channels, similarly to Verapamil or Norvasc.(5) There has been no interference when used in combination with Propranolol and is assumed safe for concurrent use with prescription migraine preventives.(3).
It is thought that Butterbur works for migraine prevention by preventing swelling and relieving pressure on blood vessels. Petasin and Isopetasin relax smooth muscles in the vascular system because they have antispasmodic and antimuscarinic properties.
Like most of you, I could easily understand the meaning of “antispasmodic”, however, I had never heard of the term “antimuscarinic”. So I had to look it up. Antimuscarinics inhibit the action of acetylcholine (ACh) which is responsible for muscle contraction.(8) ACh has two different types of reptors: nicotinic and muscarinic. The muscarinic receptors are found in the eyes, the GI tract, lungs, and heart. In these receptors, Butterbur blocks the release of ACh so the muscles are not as likely to contract.(9) I didn’t find any research to support this, but I have to wonder if Butterbur can help reduce the nausea and vomiting that occurs with migraines by keeping the GI muscles relaxed Interestingly enough, I also learned that Botox works by blocking these same ACh receptors.(3)
While we now know that migraines do not have a vascular cause, vasoldilation does occur with many migraines. My thought is that Butterbur may help prevent blood vessels from being as reactive to the migraine process. I see this as “resistance training” that helps your body withstand the neurochemical onslaught of a migraine attack.
How much should I take?
Research has shown that taking 50 – 75 mg twice a day yields results. The best results were seen with the 75 mg dose.(1,2)
How long before I know if it works?
Butterbur should be taken for at least 3-4 months before assessing its effectiveness. If it works, you can expect a 50% reduction in frequency of attacks.(1)
What are the potential side effects?
Butterbur contains naturally-occuring pyrrolizidine alkaloids which research has shown may cause liver or kidney damage. Most Butterbur producers have removed these alkaloids and label their products as “PA-free”. When in doubt, check the label. PA-free Butterbur has been shown safe and well-tolerated by children and adolescents. The most popular brand is Petadolex®
Burping is possible, as is mild GI distress. However, note that the risk of this side effect is 2-8 times higher from NSAIDs than from Butterbur.(7) Taking with meals and a full glass of water will reduce this risk.
Some people experience fatigue, drowsiness, or mild tension headaches when first starting Butterbur.(4) These symptoms usually disappear with continued use. If they do not go away within 90 days, you should discuss the continued use of Butterbur with your health care provider.
Who should not use it?
If you are pregnant or nursing it’s best to avoid taking Butterbur.(6)
Anyone with sensitivity to ragweed, marigold, daisies, or chrysanthemus should use with caution and discontinue use if experience itchy eyes, sneezing, rash, or asthma attacks as this could be a sign of allergy to Butterbur.(4)
Men with low testosterone levels should not use Butterbur as some research has indicated that Butterbur may lower testosterone.
Anyone with diseases of the liver or kidneys (including transplant recipients) should not use Butterbur without first consulting their doctor.
Are there any adverse drug reactions?
Butterbur is broken down in the liver. So concurrent use of Butterbur with any medication that is also broken down in the liver may induce stress and make it difficult for those with impaired liver function to excrete it. Check with your doctor and pharmacist for specific concerns.
- “Acetylcholine.” New World Encyclopedia, . 17 Aug 2012, 19:22 UTC. 4 Sep 2015, 21:12
“Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review.:, Agosti R, Duke RK, Chrubasik JE, Chrubasik S., Phytomedicine. 2006 Nov;13(9-10):743-6.
“Mechanisms of relaxant action of S-petasin and S-isopetasin, sesquiterpenes of Petasites formosanus, in isolated guinea pig trachea.” Ko WC, Lei CB, Lin YL, Chen CF., Planta Med. 2001 Apr;67(3):224-9.
- “muscarine.” Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. 2003. Saunders, an imprint of Elsevier, Inc 4 Sep. 2015
- “Petasites hybridus root (butterbur) is an effective preventive treatment for migraine.” Neurology, Lipton RB, Gobel H, Einhaupl KM, Wilks K, Mauskop A., 2004 Dec 28:63(12):2240-4
“Safety of a patented special butterbur root extract for migraine prevention.”Danesch U, Rittinghausen R., Headache. 2003 Jan;43(1):76-8.
DISCLAIMER: This post is for educational purposes only and not intended to be the definitive source on Butterbur. Please follow the links to do your own research. Choosing to use natural remedies is an individual process that should take into account your preferences, health history, and a thorough analysis of the benefits and risks.