Butterbur

Medically reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD — GMJ Editorial Board

What is Butterbur?

Butterbur (Petasites hybridus) is a perennial shrub native to Europe, Asia, and parts of North America that grows in wet, marshy areas. The plant gets its name from the traditional use of its large leaves to wrap butter. For centuries, butterbur has been used in folk medicine to treat various ailments including headaches, allergies, and respiratory conditions.

The medicinal parts of butterbur are primarily the roots, rhizomes, and leaves, which contain active compounds called petasins. Commercial butterbur supplements are typically standardized extracts that have been specially processed to remove potentially harmful pyrrolizidine alkaloids (PAs) while preserving the beneficial compounds. Only PA-free butterbur extracts should be used as dietary supplements.

Health benefits & uses

Migraine prevention (Strong evidence): Multiple randomized controlled trials have demonstrated butterbur’s effectiveness in reducing migraine frequency. The extract appears particularly beneficial for preventing migraine headaches when taken regularly over several months.

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Seasonal allergic rhinitis (Moderate evidence): Clinical studies suggest butterbur may help reduce symptoms of hay fever, including nasal congestion, sneezing, and itchy eyes. Some research indicates it may be as effective as certain antihistamines for managing seasonal allergy symptoms.

Asthma support (Limited evidence): Preliminary studies suggest butterbur might help reduce asthma symptoms and improve lung function, though more research is needed to confirm these effects and establish optimal treatment protocols.

How it works

Butterbur’s therapeutic effects are primarily attributed to its petasin compounds, particularly petasin and isopetasin. These compounds appear to work through multiple mechanisms:

The extract exhibits anti-inflammatory properties by inhibiting the production of inflammatory mediators like leukotrienes and histamine. For migraine prevention, butterbur may help stabilize blood vessel function and reduce neuroinflammation. In allergic conditions, it appears to modulate immune responses and reduce the release of substances that trigger allergic symptoms.

Additionally, butterbur may have mild smooth muscle relaxant properties, which could contribute to its benefits in respiratory conditions and migraine prevention.

Dosage

Typical adult dosages for standardized PA-free butterbur extract include:

• Migraine prevention: 50-75 mg twice daily of extract standardized to 15% petasins
• Allergic rhinitis: 32-64 mg daily in divided doses
• General use: 50-100 mg daily in divided doses

No RDA (Recommended Dietary Allowance) or UL (Tolerable Upper Intake Level) has been established for butterbur. Dosing should always be guided by a healthcare provider, especially for long-term use. Most studies showing benefits used standardized extracts for 3-4 months.

Food sources

Butterbur is not consumed as a food and does not occur naturally in the typical human diet. The plant grows wild in certain regions, but raw butterbur contains pyrrolizidine alkaloids that can be toxic to the liver. Therefore, butterbur should only be consumed as specially processed, PA-free commercial extracts available as dietary supplements.

These supplements are typically available in capsule or tablet form and should be clearly labeled as “PA-free” or processed to remove pyrrolizidine alkaloids.

Safety & side effects

PA-free butterbur extracts are generally well-tolerated when used appropriately. Common mild side effects may include:

• Digestive upset or stomach discomfort
• Burping or belching
• Headache (paradoxically, in some users)
• Drowsiness or fatigue

Critical safety warning: Only use PA-free butterbur products. Raw butterbur and non-processed extracts contain pyrrolizidine alkaloids that can cause serious liver damage and potentially life-threatening hepatotoxicity. Always verify that products are specifically labeled as PA-free.

Interactions

Butterbur may interact with certain medications and supplements:

Drug interactions: Limited data exists on specific drug interactions, but butterbur may theoretically enhance the effects of other anti-inflammatory medications. It may also interact with medications metabolized by certain liver enzymes.

Supplement interactions: Butterbur may have additive effects when combined with other supplements that have anti-inflammatory or antihistamine properties. Exercise caution when combining with other herbal supplements that affect liver function.

Always consult healthcare providers before combining butterbur with prescription medications, especially those for allergies, migraines, or liver conditions.

Who should be cautious

Certain individuals should avoid or use butterbur with extreme caution:

• Pregnant and breastfeeding women: Safety data is insufficient; avoid use
• Children: Limited safety data available; use only under medical supervision
• Liver disease patients: Even PA-free extracts should be avoided due to potential liver sensitivity
• Ragweed/daisy family allergies: May trigger allergic reactions in sensitive individuals
• Surgery patients: Discontinue at least 2 weeks before scheduled surgery

Frequently asked questions

How long does butterbur take to work for migraines?

Most clinical studies show migraine reduction benefits after 6-12 weeks of consistent use. Some people may notice improvements sooner, but butterbur works best as a preventive treatment rather than for acute migraine relief.

Is butterbur safe for long-term use?

PA-free butterbur extracts have been used safely in studies for up to 4-6 months. However, long-term safety beyond this timeframe hasn’t been thoroughly studied. Regular monitoring by a healthcare provider is recommended for extended use.

Can I take butterbur with allergy medications?

While some studies suggest butterbur may be as effective as certain antihistamines, you should consult your healthcare provider before combining it with prescription allergy medications to avoid potential interactions or redundant effects.

What’s the difference between raw butterbur and supplements?

Raw butterbur contains dangerous pyrrolizidine alkaloids that can cause liver damage. Commercial PA-free supplements have been specially processed to remove these toxic compounds while preserving beneficial petasins. Never use raw butterbur or non-processed products.

Will butterbur help with tension headaches?

Most research focuses on butterbur’s effectiveness for migraine prevention specifically. While it may have some benefits for other types of headaches due to its anti-inflammatory properties, evidence is strongest for migraine prevention rather than tension-type headaches.