Butterbur

A Guide to Migraine Headaches

What other names is Butterbur known by?

Blatterdock, Bog Rhubarb, Bogshorns, Butter Bur, Butter-Dock, Butterfly Dock, Capdockin, Chapelière, Common Butterbur, Contre-Peste, Exwort, Feuille de Pétasite, Flapperdock, Fleur de Pétasite, Grand Bonnet, Herbe à la Peste, Herbe aux Teigneux, Langwort, Pestwurz, Pétasite, Pétasite Hybride, Pétasite Officinal, Pétasite Vulgaire, Petasites, Petasites hybridus, Petasites officinalis, Petasites Vulgaris, Petasitidis Folium, Petasitidis Hybridus, Petasitidis Rhizoma, Plague Root, Purple Butterbur, Racine de Pétasite, Rhizome de Pétasite, Tussilago hybrida, Umbrella Leaves.

What is Butterbur?

Butterbur is a shrub that is found throughout Europe as well as mild parts of Asia. It also now grows in parts of the US. The name "butterbur" developed because the large leaves of the shrub are used to wrap butter during warm weather.

People take butterbur by mouth for pain, upset stomach, stomach ulcers, migraine and other headaches, ongoing cough, chills, anxiety, plague, fever, trouble sleeping (insomnia), whooping cough, asthma, a lung disease called chronic obstructive bronchitis, hay fever (allergic rhinitis), eczema, mental illnesses that cause symptoms in the body (somatoform disorders), and for irritable bladder and urinary tract spasms. Butterbur is also taken by mouth to stimulate the appetite.

Some people apply butterbur to the skin to improve wound healing.

Possibly Effective for...

  • Hay fever caused by grass pollen. Taking a specific butterbur leaf extract called Ze 339 (Tesalin, Zeller AG) seems to decrease nose discomfort in people with hay fever. Some evidence also suggests that this extract might be as effective as 10 mg daily of cetirizine (Zyrtec) or 180 mg daily of fexofenadine (Allegra). But this extract does not seem to improve airflow, nasal and eye symptoms, or quality of life when taken for 2 weeks.
  • Migraine headaches. Taking butterbur by mouth seems to prevent migraine headache. Using a specific extract from the butterbur root (Petadolex, Weber & Weber, GmbH & Co, Germany) over 16 weeks can reduce the number and severity of migraine headaches and the length of time they last. This butterbur extract seems to reduce the number of migraine headaches by almost half. Doses of at least 75 mg twice daily seem to be necessary for best results. Lower doses of 50 mg twice daily may not be effective in adults. There is also some evidence that this butterbur extract can decrease the frequency of migraine headaches in children aged 6-17 years.
  • Mental illnesses that cause physical pain (somatoform disorders). Research shows that taking a product called Ze185 that contains butterbur, valerian root, lemon balm leaf, and passionflower (Relaxane, Max Zeller Söhne AG, Switzerland) reduces anxiety and depression in people with physical pain.

Possibly Ineffective for...

  • Itchy and inflamed skin (eczema). Some research shows that taking butterbur extract (Petaforce, Bioforce Ltd, Irvine, UK) twice daily for one week does not reduce skin inflammation caused by allergies.

Insufficient Evidence to Rate Effectiveness for...

More evidence is needed to rate the effectiveness of butterbur for these uses.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

Quick GuideMigraine or Headache? Migraine Symptoms, Triggers, Treatment

Migraine or Headache? Migraine Symptoms, Triggers, Treatment

How does Butterbur work?

Butterbur contains chemicals that might relieve spasms and decrease swelling (inflammation).

Are there safety concerns?

Pyrrolizidine alkaloid (PA)-free butterbur products are POSSIBLY SAFE when taken by mouth appropriately for up to 16 weeks. Some butterbur products may contain PAs, and that's the major safety concern. PAs can damage the liver, lungs, and blood circulation, and possibly cause cancer. Butterbur products that contain PAs are LIKELY UNSAFE when taken by mouth or applied to broken skin. Broken skin allows chemicals to be absorbed into the body. Do not use butterbur products unless they are certified and labeled as free of PAs.

Not enough is known about the safety of using PA-free butterbur products on unbroken skin. Don't use it.

PA-free butterbur is generally well tolerated. It can cause belching, headache, itchy eyes, diarrhea, asthma, upset stomach, fatigue, and drowsiness. However, it seems to cause less drowsiness and fatigue than cetirizine (Zyrtec). Butterbur products might cause allergic reactions in people who are allergic to ragweed, marigolds, daisies, and other related herbs.

Special Precautions & Warnings:

Children: Pyrrolizidine alkaloid (PA)-free butterbur is POSSIBLY SAFE when taken by mouth appropriately. There is some evidence that a specific PA-free butterbur rhizome extract (Petadolex, Weber & Weber, GmbH & Co, Germany) can be safely used in children aged 6-17 years for up to 4 months.

Pregnancy and breast-feeding: Taking butterbur by mouth is LIKELY UNSAFE while pregnant or breast-feeding. Butterbur preparations containing pyrrolizidine alkaloids (PAs) might cause birth defects and liver damage. Not enough is known about the safety of using butterbur products that do not contain PAs during pregnancy or breast-feeding. Don't use it.

Allergy to ragweed and related plants: Butterbur may cause an allergic reaction in people who are sensitive to the Asteraceae/Compositae family. Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many others. If you have allergies, be sure to check with your healthcare provider before taking butterbur.

Liver disease: There is some concern that butterbur might make liver disease worse. Don't take it.

Are there any interactions with medications?



Medications that increase breakdown of other medications by the liver (Cytochrome P450 3A4 (CYP3A4) inducers)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Butterbur is broken down by the liver. Some chemicals that form when the liver breaks down butterbur can be harmful. Medications that cause the liver to break down butterbur might enhance the toxic effects of chemicals contained in butterbur.

Some of these medicines include carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, rifabutin (Mycobutin), and others.

Dosing considerations for Butterbur.

The following doses have been studied in scientific research:

ADULT:

BY MOUTH:
  • For hay fever (allergic rhinitis): Up to 6 tablets of a specific butterbur leaf extract called Ze 339 (Tesalin, Zeller AG), has been taken daily in up to three divided doses for 1-2 weeks. 50 mg of a specific whole butterbur root extract (Petaforce, Bioforce) has been taken twice daily for 2 weeks.
  • For migraine headache: 75-150 mg of a specific butterbur rhizome extract (Petadolex, Weber & Weber, GmbH & Co, Germany) has been taken daily in up to two divided doses for up to 4 months.
  • For mental illnesses that cause physical pain (somatoform disorders): A specific product called Ze185 (Relaxane, Max Zeller Söhne AG, Switzerland) containing 90 mg of dry extracts of butterbur root, 90 mg of valerian root, 90 mg of passionflower herb, and 60 mg of lemon balm leaf, has been taken three times daily for 2 weeks.
CHILDREN:

BY MOUTH:
  • For migraine headache: 50-75 mg of a specific butterbur rhizome extract (Petadolex, Weber & Weber, GmbH & Co, Germany) has been taken daily in two or three divided doses for children 8-9 years-old, and in doses of 100-150 mg daily in two or three divided doses for children 10-17 years-old, for up to 4 months.
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Reviewed on 3/29/2011 12:35:40 PM

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