Can Butterbur Reduce Migraine Frequency?

What Is Butterbur?

Butterbur (Petasites hybridus) is a perennial shrub in the daisy family, also called petasites, blatterdock, bog rhubarb, or sweet coltsfoot. Its large leaves were historically used to wrap butter, giving the plant its name.

Why It’s Used for Migraine

Migraine attacks are characterized by intense, throbbing head pain, often accompanied by nausea, vomiting, and heightened sensitivity to light and sound. Butterbur extract, made from the plant’s leaves and roots, contains petasins—compounds with anti‑inflammatory, antispasmodic, and vasodilatory effects—that may reduce migraine frequency by decreasing inflammation, relaxing smooth muscle, and widening blood vessels.

Clinical Evidence

Early studies suggested a benefit:

In a trial of 108 children (50–150 mg/day), 77 % reported at least a 50 % reduction in migraine days after four months.⁶
A 12‑week study of 58 children showed both butterbur (50–100 mg/day) and music therapy lowered attack frequency compared with placebo.⁷
A 4‑month randomized trial of 245 adults found 36 % (50 mg) and 48 % (75 mg) reductions in migraine days versus placebo.⁸
Several other trials have reported similar reductions in attack frequency.^9‑11

Although these results are promising, most research was conducted before 2005 and newer studies are limited.

Safety Concerns

Butterbur contains pyrrolizidine alkaloids (PAs), which are hepatotoxic and potentially carcinogenic. Because of this risk, the American Academy of Neurology and the American Headache Society withdrew their “Level A” recommendation in 2015.^12‑13 The UK and Germany have banned butterbur products altogether.^14‑15

Reported side effects include indigestion, headache, fatigue, drowsiness, skin irritation, belching, and diarrhea. Liver toxicity has been observed, especially when butterbur is taken with other medications such as St. John’s wort or anticholinergics.

PA‑free extracts are available in the United States and Canada, but users should verify “PA‑free” labeling and purchase from reputable manufacturers. Even PA‑free products like Petadolex have been linked to isolated cases of liver injury when combined with other drugs.^16‑17

Pregnant or nursing individuals should avoid butterbur due to insufficient safety data.^13‑16

How to Use Butterbur Safely (If You Choose to Try)

Consult a healthcare professional to assess potential drug interactions and baseline liver function.
Choose a certified PA‑free supplement and follow the manufacturer’s dosage instructions.
Monitor liver enzymes periodically, especially if you are taking other medications.

Alternative Migraine Management

Effective migraine care often combines lifestyle changes, acute therapies, and preventive options:

Stress management: therapy, yoga, meditation
Lifestyle modifications: regular exercise, balanced diet, smoking cessation, limiting alcohol
Alternative therapies: acupuncture, acupressure, massage, Botox, biofeedback, aromatherapy
OTC pain relievers: aspirin, ibuprofen, acetaminophen, naproxen
Prescription options: triptans, ergotamines, dihydroergotamine, anti‑nausea agents, beta‑blockers, calcium‑channel blockers, certain antidepressants
Hormonal therapy: for menstrual‑related migraine

Bottom Line

Butterbur has demonstrated the ability to lower migraine frequency in several early studies, but the risk of liver toxicity and other side effects has led most clinicians to discourage its use. Safer, evidence‑based treatments are available, and any decision to use butterbur should be made in consultation with a qualified healthcare provider.