Preventing Migraine Headaches with Butterbur (Petasites hybridus)

Dr. Leah Hassall, ND

Migraine sufferers can be struck with headaches that are so debilitating that they get in the way of everyday activities such as work, school, taking care of children or just enjoyment of life. Migraine prevention therapy is recommended for people that have frequent attacks, if those attacks last multiple days, if they do not respond to acute therapy or are debilitating. Over the counter medications and triptans (a class of medication) are often the mainstay treatment for migraines but can come with unwanted side effects and are not effective for everyone when it comes to migraine prevention.

Many people are turning to butterbur (Petasites hybridus) for migraine prevention. Butterbur is a flowering plant that was used in the middle ages for plague and fever. Later, in the 17thcentury, the root was used to treat cough, asthma, skin wounds and headache. In the modern era, researchers have studied this herb in preventing migraine headaches compared to drug therapy and to placebo (pills that contain no active medication). The few studies that have been done show that butterbur is more effective than placebo in reducing the frequency of headache. Based on two high quality studies, the American Academy of Neurology and the American Headache Society have endorsed the use of butterbur to reduce the frequency of migraines. Recent studies (2017) point to a chemical found in butterbur called isopetasin as the active ingredient. It works by desensitizing pain receptors, reducing neurologic inflammation and helping to normalize the constriction and dilation of blood vessels.

The most common side effects of butterbur seem to be mild gastrointestinal effects, mostly burping. The concern about butterbur is that the unprocessed herb contains pyrrolizidine alkaloids (PA), which can be toxic to the liver and the kidneys and is carcinogenic (cancer-causing). The way around this is to purify butterbur to remove this toxic chemical. The challenge is that many different companies are producing and selling butterbur, and some of these companies are not properly purifying/processing it to remove the PAs.  If you are considering trying butterbur for migraine prevention, I recommend speaking to your naturopathic physician or healthcare provider to learn more about sources of purified/PA-free butterbur and looking for the PA-free certified supplements. A naturopathic physician can also treat migraine triggers such as food sensitivities, chemical sensitivities and environmental/emotional stressors. Butterbur should not be used during pregnancy or lactation, in young children, or in people with severe kidney or liver disease until further safety testing has been conducted

References

  1. Benemei S, De Logu F, Li Puma S, Marone IM, Coppi E, Ugolini F, Liedtke W, Pollastro F, Appendino G, Geppetti P, Materazzi S, Nassini R. 2017. The anti-migraine component of butterbur extracts, isopetasin, desensitizes peptidergic nociceptors by acting on TRPA1 cation channel. Br J Pharmacol174(17):2897-2911.
  2. Butterbur. Natuonal Center for Complementary and Integrative Health. US Department of Health and Human Services. Accessed at: https://nccih.nih.gov/health/butterbur. April 29, 2018.
  3. Hulisz, D. Does Butterbur prevent Migraines? Medscape – Feb 02, 2015.
  4. Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A. 2004. Petasites hybridusroot (butterbur) is an effective preventive treatment for migraine. Neurology. 28;63(12):2240-4.
  5. Utterback G, Zacharias R, Timraz S, Mershman D. 2014. Butterbur extract: prophylactic treatment for childhood migraines. Complement Ther Clin Pract. 20(1):61-4.

 

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