By Marcello Cherchi, MD PhD
For patients
Butterbur comes from a root. For some people, taking Butterbur makes their migraines happen less often. Butterbur may cause liver problems.
For clinicians
Overview
Butterbur (Petasites hybridus) is an herbal root extract sometimes used for migraine prophylaxis, though its use has diminished since reports emerged regarding potential hepatotoxicity of some preparations of this herb.
Introduction
Butterbur (also called Petasites hybridus) is an herbal root extract that has been used for various medicinal purposes for hundreds of years.
Pharmacology
There are numerous compounds in Butterbur extracts (Kulinowski et al. 2022).
Adverse effects, cautions and contraindications
Some, but not all, preparations of Butterbur, contain pyrrolizidine alkaloids, which can damage the liver in humans, and can cause cancer in some animal studies (Aydin et al. 2013). Since different preparations of Butterbur vary in their content of pyrrolizidine alkaloids (Avula et al. 2012), most patients prefer to avoid this supplement.
Relevance in otoneurology
The main application of Butterbur in otoneurology is in the prophylactic management of migraine and migraine associated vertigo (MAV). The mechanism of action is unclear, but there is some evidence that it inhibits the release of calcitonin gene-related peptide in meningeal afferents (Borlak et al. 2022).
For migraine prophylaxis Butterbur is usually taken at a dose of 50 to 75 mg twice per day. The efficacy of Butterbur becomes apparent around 16 weeks (Lipton et al. 2004).
Other notes
Since the emergence of data regarding hepatotoxicity from Butterbur emerged, it is less commonly recommended as a treatment.
References
Avula B, Wang YH, Wang M, Smillie TJ, Khan IA (2012) Simultaneous determination of sesquiterpenes and pyrrolizidine alkaloids from the rhizomes of Petasites hybridus (L.) G.M. et Sch. and dietary supplements using UPLC-UV and HPLC-TOF-MS methods. J Pharm Biomed Anal 70: 53-63. doi: 10.1016/j.jpba.2012.05.021
Aydin AA, Zerbes V, Parlar H, Letzel T (2013) The medical plant butterbur (Petasites): analytical and physiological (re)view. J Pharm Biomed Anal 75: 220-9. doi: 10.1016/j.jpba.2012.11.028
Borlak J, Diener HC, Kleeberg-Hartmann J, Messlinger K, Silberstein S (2022) Petasites for Migraine Prevention: New Data on Mode of Action, Pharmacology and Safety. A Narrative Review. Front Neurol 13: 864689. doi: 10.3389/fneur.2022.864689
Kulinowski L, Luca SV, Minceva M, Skalicka-Wozniak K (2022) A review on the ethnobotany, phytochemistry, pharmacology and toxicology of butterbur species (Petasites L.). J Ethnopharmacol 293: 115263. doi: 10.1016/j.jep.2022.115263
Lipton RB, Gobel H, Einhaupl KM, Wilks K, Mauskop A (2004) Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology 63: 2240-4.
