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A plant once used to protect butter from melting has become part of a modern debate about migraine prevention. Butterbur extract has shown promise in some studies, but questions about safety have made health experts more cautious.
Some research suggests that butterbur may help reduce the number of migraine attacks a person has. Because of this evidence, the American Headache Society and the Canadian Headache Society have endorsed butterbur for migraine prevention. However, other major organizations, including the American Academy of Neurology, don’t recommend it.
Health experts in the U.S., Germany, and England have also warned against using butterbur, largely because of safety concerns.
If you’re thinking about trying butterbur for natural migraine prevention, here’s what to know about the evidence, the risks, and what to discuss with your doctor.
Butterbur is an herb that grows in parts of Europe, Asia, and North America. Its scientific name is Petasites hybridus.
Butterbur is anti-inflammatory. It relaxes the blood vessels and calms down nerve signals in the brain. These effects are thought to be why butterbur could be helpful for migraine.
Other effects of butterbur make it a promising supplement for asthma, allergies, and Alzheimer’s disease. People usually take butterbur supplements by mouth. The typical dose is 50 to 150 milligrams per day.
What Does the Research Show?Original research supporting butterbur for migraine is from 2004. In one study, people with migraine were put into two groups. One group took butterbur supplements, and the other group received a placebo (a supplement with no active ingredients).
The “response rate” for the butterbur group was 45 percent versus just 15 percent for the placebo group.
There was another similar trial in the same year. Participants taking butterbur had 48 percent fewer migraine attacks, compared with a 26 percent reduction in the placebo group.
Research from 2005 and beyond has shown similar positive effects in children with migraine.
More recent research has tried to pin down exactly how butterbur affects migraine. Animal studies suggest that compounds in butterbur called petasins block pain signals in the brain. Specifically, they inhibit the release of calcitonin gene-related peptide (CGRP), which is associated with migraine.
Raw butterbur contains harmful chemicals called pyrrolizidine alkaloids (PAs). PAs may cause liver damage. Other possible effects include blood clots, lung problems, and a higher risk of cancer.
Cases of butterbur being associated with liver failure are very rare but have been reported. Consuming raw butterbur directly from the plant isn’t safe.
In addition, it’s not clear if butterbur is OK to take routinely. Even if you don’t have side effects right away, liver damage and other problems can show up with long-term use of butterbur.
Butterbur supplements usually go through a process that removes harmful substances. However, it’s not always easy to know if the supplement you’re buying is trustworthy.
Some brands of commercial butterbur may still contain PAs, even if the label says otherwise. In one study, researchers tested 21 butterbur supplements. They found PAs in seven of them.
Unlike prescription medicines, dietary supplements aren’t approved by the government before they are sold. This means that different butterbur products may vary in strength, purity, and quality.
One product may have different amounts of active ingredients than another. Some products may not have been tested carefully for harmful PAs. Others may contain ingredients that are not listed on the label. For these reasons, choosing a butterbur supplement isn’t as easy as picking up a product from the shelf.
If you decide to try butterbur, you should talk to your healthcare provider about finding a reliable product and monitoring for side effects. They can run blood tests to watch for negative effects on your liver function over time.
Butterbur hasn’t been studied in young children or pregnant or breastfeeding women, according to StatPearls. It’s not clear if it’s safe for these groups.
Butterbur may also affect how anticholinergic medications work. These medicines affect certain nerve signals in the body and are used for problems like allergies, motion sickness, nausea, and bladder control. Examples include diphenhydramine, scopolamine patches, and oxybutynin.
It’s important to discuss all herbal supplements like butterbur with your doctor or pharmacist when you take any type of medication.
Most people tolerate PA-free butterbur supplements without having any issues. However, some possible side effects include:
In addition, some people are allergic to butterbur. Butterbur allergy is more common for those with allergies to other plants, especially:
If you don’t feel well after starting butterbur, or if you have signs of an allergic reaction, stop taking it right away. Let your healthcare provider know if your symptoms are severe or don’t go away after stopping.
Today, there are several migraine prevention treatments with stronger evidence for both safety and effectiveness. While it can be tempting to look to “natural” products like butterbur, they’re not necessarily your best bet.
Depending on your health history and the number of migraine attacks you have each month, your healthcare provider may recommend prescription and over-the-counter medicines that have been studied in large clinical trials.
Migraine medications may include:
Lifestyle habits are also an important part of migraine prevention. Getting enough sleep, staying well hydrated, eating regular meals, managing stress, and knowing your personal migraine triggers can all help lower the chance of migraine episodes.
Other supplements, such as magnesium and riboflavin, have research supporting their use for certain people. While these supplements aren’t right for everyone, they generally don’t carry the same risks as butterbur when used correctly.
You can try strategies at home that don’t run the risk of negative side effects. These approaches can help ease migraine symptoms without interacting with your other treatments:
You can also ask your healthcare provider about additional treatments, like electrical stimulation and acupuncture. They can help you find alternative options to get more relief while managing your condition.
Thoughts From MyMigraineTeam MembersSome members find butterbur and other supplements helpful:
“I take both feverfew and butterbur twice daily,” explained one member. “I was doing much better so decided I might not need them any longer and quit. BIG MISTAKE. The migraine attacks came back even worse. I haven’t gotten them nearly back under the control I had them before. I regret stopping them.”
Others report the opposite experience:
“One neurologist told me to try PA-free butterbur. I felt worse when I took it and got more headaches,” said one member. “I did find that nettle tea and black cumin seem to be helpful for me.”
Another responded, “Butterbur is nuts and causes liver damage! It also made my migraines worse.”
Migraine can be different for different people. What works for one person may make things worse for someone else. That can be true for both medication and supplements.
Work with your headache specialist to come up with a plan to keep your migraine episodes under control. They can help you choose complementary treatments that are safe for you.
On MyMigraineTeam, people share their experiences with migraine, get advice, and find support from others who understand.
Have you considered butterbur as a preventive treatment for migraine? Let others know in the comments below.
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