Butterbur

Butterbur

Used by small farm animals for natural shade and used by herbalists for centuries to help prevent migraine headaches and provide seasonal health support, butterbur is a plant with many unique purposes. Keep reading to learn more about the potential health benefits and uses of butterbur.

What is Butterbur?

Butterbur (Petasites hybridus) is an herbaceous perennial flowering shrub within the genus Petasites in the daisy family, Asteraceae (Compositae). Petasites, commonly describing butterbur or coltsfoot plant varieties, is derived from the Greek word “petasos,” which were the felt hats worn by shepherds.(1)

Native to Europe, Southwestern Asia, and North Africa, butterbur (also called bog rhubarb, Devil's hat and pestilence wort) is a plant with thick underground rhizomes (underground stems) and large, broad heart-shaped leaves – sometimes growing to 3 feet in diameter – that begin as white downy and become grey when mature. Butterbur features both male (stamen-bearing) and female (seed-producing) purple-hued or pale reddish flowers that grow on different spikes. The plant grows in wet, marshy meadows and by riversides.(2, 3, 4)

Typically, butterbur root, rhizome and leaf extracts are cultivated for medical purposes to help prevent and provide temporary pain relief for migraines and to provide support for allergy sufferers during seasonal health challenges.(5, 6) Butterbur is also sometimes used with coltsfoot in homeopathic tinctures to help support against nerve pain in the lower back or the loins.(7)

Raw, unprocessed butterbur should not be ingested, because it contains harmful substances known as pyrrolizidine alkaloids (PAs), which can cause liver toxicity. However, many commercial products are processed and standardized to reduce or remove PAs entirely. Whether alone or in botanical blends, butterbur products typically contain extracts from butterbur root or rhizomes, or sometimes the leaves, and are available as a dietary supplement in various forms, such as liquid extracts, tinctures, powders, capsules, and softgels.(8)

How Does It Work?

Butterbur contains bioactive substances that have anti-inflammatory and spasmolytic (muscle-relaxant) effects.(9, 10) Specifically, butterbur includes natural chemical compounds known as sesquiterpenes (petasin, isopetasin, and oxopetasin), which help inhibit proinflammatory substances in the body.(11, 12) Petasine is a specific petasin that is considered important in butterbur. It is believed to help “relax blood vessels and various smooth muscles in the body, such as those that are found in the uterus and lungs.”(13)

A Brief History of Butterbur

Butterbur is an herbal remedy that has been used for over 2,000 years to treat various health issues ranging from gastric disorders to allergies to migraine headaches and more.(14)

Butterbur got its name due to its large leaves that were used to wrap butter to help preserve it during hot weather. Poultry grazing in farm meadows would hide from rain or hot weather beneath the plant’s large fan-like leaves.(15)

In Germany, butterbur (called Pestilenzenwurt) was seen as a remedy for pestilence. During the Middle Ages, Europeans used butterbur extract derived from the root of the butterbur shrub to treat fevers and various symptoms of the plague.(16) Botanist Henry Lyte, in his book, Herball (1578), even referred to butterbur as a “plague flower,” since it was largely used as a remedy for the disease.(17)

Historically, butterbur has also been used to treat allergic rhinitis, as an antispasmodic, and in the prevention of migraines.(18, 19) “Originally, the plant’s root was used. However, higher levels certain potentially toxic ingredients were found in the root. Now, supplements use only the leaves.”(20)

In modern medicine, butterbur is still used to help temporarily relieve symptoms of asthma, hay fever, coughs, and stomach ulcers. Butterbur extract is also used to help support preventing and treating migraine headaches. In the U.S., standardized butterbur is available as a dietary supplement under the brand name Petadolex; however, Germany has since banned all butterbur products due to controversy in manufacturing processes.(21)

Butterbur Infographic

Potential Health Benefits of Butterbur

May Prevent or Provide Temporary Pain Relief for Migraines

Headaches, caused by stress, muscle strain, and anxiety, are uncomfortable feelings of pressure, aching, or pain in the forehead, temples, or back of the neck that can range from mild to severe. Migraines, on the other hand, are intense or severe headaches that have other symptoms in addition to head pain. Migraine attacks are characterized by severe recurring symptoms that may last several hours or days, including throbbing or pulsating headaches, extreme sensitivity to light or sound, blurry vision or blind spots, and nausea or vomiting.(22)

There are many possible triggers for migraines, including stress, tension, anxiety, malnutrition, lack of sleep, intense sensory stimuli (such as bright lights, loud noises, cigarette smoke, or strong odors), low levels of magnesium and high levels of calcium and glutamate that cause that abnormal electrical changes in the brain, and more. Changes in electrical activity in the brain irritate the nerves, causing severe pain in the face and the head.(23)

According to the Department of Pharmaceutical and Biological Chemistry, UCL School of Pharmacy in London, migraines affect approximately 324 million people of all ages worldwide, but more prominently affect women than men in a 3:2 ratio.(24) Prescription medicines such as prescription painkillers are commonly used to treat a migraine headache. However, in Europe and North America, natural herbal remedies are also often used to prevent or provide temporary pain relief for migraine attacks using formulations that include butterbur (such as in Petadolex products, derived from an extract of the butterbur root). Other herbal remedies for migraines include formulations containing feverfew leaves, the flowering aerial parts of St. John’s wort, or ginkgo leaves, which have anti-inflammatory, antioxidant, and neuroprotective properties.

When it comes to butterbur remedies for migraine support, studies have shown that butterbur extracts successfully support healthy blood vessel relaxation in the brain. In fact, the American Academy of Neurology and the American Headache Society have endorsed the use of a butterbur extract to reduce the frequency of migraines.(25)

When it comes to oral butterbur supplementation, the PA-free Petadolex butterbur rhizome extract, produced in Germany, has been the main subject of several randomized clinical studies for migraine prevention. In a study on adults who took Petadolex extract standardized to 15% petasin and isopetasin over 16 weeks, it reportedly helped reduce the frequency, intensity, and duration of migraine headaches by 48%. For adults, their dose was 75 mg twice daily. For children ages 8-9, they took 50-75 mg of butterbur rhizome extract daily, while children ages 10-12 took 100-150 mg daily and had a similar success rate in reducing migraine headaches.(26)

Even with the success rate of Petadolex on the prevention of a migraine, due to manufacturing changes and questions about ingredient purity, the proprietary extract once approved for use by BfArM, a German-based health regulatory authority, has since lost its backing by BfArM and is now unavailable in Germany.(27) Although Petadolex is still commercially available, its long-term safety has not been established. “There’s no evidence that it helps after a migraine develops or that it helps with other kinds of headaches.”(28)

May Support Seasonal Health Challenges & Other Claims

In addition to being used for migraine prevention, butterbur is also a popular ingredient in herbal remedies for seasonal health support, specifically in the temporary relief of symptoms related to allergic rhinitis, otherwise known as hay fever.

Allergic rhinitis causes the inflammation of the mucus membranes of the nose, triggering an uncontrollable runny nose, congestion, itching, and sneezing. These symptoms occur due to outdoor or indoor allergies, caused by inhaling dust, animal dander, pollen, mold, ragweed, or cigarette smoke, for example. It may also be caused by a food allergy. Allergic rhinitis develops when the body’s immune system becomes sensitized and overreacts to something in the environment – oftentimes a seasonal condition occurring in the spring, summer and early fall – which affects 40 to 60 million Americans, according to the American College of Allergy, Asthma & Immunology.(29)

Unlike over-the-counter allergy medications that may leave users feeling fuzzy headed or drowsy due to antihistamines and other ingredients, natural butterbur extract helps temporarily lessen feelings of itchiness, sneezing, and sinus pain associated with allergies, without affecting alertness or focus. In fact, according to one study, “in 508 patients with seasonal allergic rhinitis who supplemented with butterbur extract for two weeks found that 90% of participants reported improvements in symptoms such as sneezing, nasal congestion, watery eyes, itchy eyes and nose, and red eyes.”(30)

In addition, a review of clinical trials found that there is encouraging evidence suggesting that butterbur “may be an effective herbal treatment for seasonal allergic rhinitis” because it inhibits leukotrienes and histamines, substances in the body that can trigger allergic responses.(31, 32) However, more research is needed to confirm this claim.

In another human clinical study, data indicates that different petasins may partially block intracellular signaling molecules in the body that trigger allergic reactions. The report states that people with allergies who took butterbur tablets for a week had fewer allergy symptoms and had fewer leukotriene and histamine in their system.(33)

Other research states that people have also used butterbur to treat asthma, upset stomachs, and urinary tract issues, but there is not enough scientific evidence to support these claims.(34)

How to Buy Butterbur

Look for PA Free Supplements

Raw, unprocessed butterbur plant contains harmful chemicals called pyrrolizidine alkaloids (PAs), which are toxic to humans and result in liver damage or in serious illness. PAs have also been shown to be mutagenic and carcinogenic in animal studies. That’s why you should never ingest unprocessed butterbur – even as a tea. When you are shopping for a butterbur supplement, look for butterbur products that have been carefully processed to remove PAs and are certified and labeled as “PA-free.”

PA-free butterbur supplements are usually well tolerated, according to studies, especially when standardized doses are taken according to product label instructions. Specifically, butterbur “rhizome and leaf extracts that are free of PAs seem to be safe when used for up to 16 weeks.” However, there is no clinical data available on use of butterbur longer than 16 weeks, so long-term use is not recommended.(35, 36, 37)

In June 2007, the U.S. FDA established dietary supplement "current Good Manufacturing Practice" (cGMP) regulations requiring that manufacturers evaluate their products through testing identity, purity, strength, and composition.(38) Therefore, it’s important to note that some U.S. health care providers are no longer recommending butterbur products such as Petadolex and other brands. In addition, despite butterburs potential efficacy, the American Headache Society is currently evaluating the safety and efficacy of butterbur products. However, it is up to each individual user to determine if butterbur supplementation could be beneficial to their health.

Watch Out for Sensitivities to Butterbur

Even though butterbur is well tolerated by most people, butterbur may still cause side effects in others, especially in people with allergies to plants in the Asteraceae (Compositae) family, such as ragweed, chrysanthemums, marigolds, and daisies.(39, 40, 41)

Potential Side Effects of Butterbur
  • Skin and allergic reactions
  • Drowsiness
  • Constipation
  • Upset stomach
  • Hair loss
  • Depression or neurological disorders
  • Skin or eye discoloration
  • Fatigue
  • Difficulty breathing or exhaling
  • Itchy eyes or skin
  • Bad breath
  • Discolored stool
  • A possible increase in liver enzymes(42)

If you don’t want to worry about the quality of the ingredients in your butterbur supplements, shop with Natural Healthy Concepts! NHC products are all vetted and carefully selected for safety and high standards of quality by a certified nutritionist. Try a PA free butterbur supplement today and see if it makes a difference to your health!(43)

Common Butterbur Dosages

When it comes to upper respiratory irritations due to seasonal health challenges such as allergic rhinitis, 50 mg twice daily of standardized butterbur leaf extract seems to decrease nasal inflammation and other symptoms, according to various studies.(44) For healthy adults, taking a dietary supplement of 50-75 mg of standardized butterbur extract twice daily for 16 days has demonstrated some support in migraine prevention.(45) In addition, PA-free butterbur rhizome extract standardized to contain 7.5 mg of petasine per capsule. Is usually taken orally as 1 to 2 capsules up to three times per day.(46)

Do not use butterbur if you are pregnant or breastfeeding. Young children should not use butterbur products. Talk to your health care provider about the potential benefits and risks of taking butterbur.(47)

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