Butterbur's therapeutic uses

DEFINITION: Natural plant product used to treat specific health conditions.

PRINCIPAL PROPOSED USES: Allergies, migraine headaches (prevention)

OTHER PROPOSED USES: Asthma, musculoskeletal pain, ulcer protection

Overview

Butterbur can be found growing along rivers, ditches, and marshy areas in northern Asia, Europe, and parts of North America. It sends up stalks of reddish flowers very early in spring before producing very large heart-shaped leaves with a furry gray underside. Once the leaves appear, butterbur somewhat resembles rhubarb, giving it one of its common names—bog rhubarb. It is also sometimes referred to as “umbrella leaves” because of the size of its foliage. Other common names abound, including bogshorns, blatterdock, bog rhubarb, langwort, butterdock, capdockin, flapperdock, petadolex, and umbrella plant.

Butterbur is often described as possessing an unpleasant smell, but being malodorous has not protected it from harvesting by humans. The plant has a long history of use as an antispasmodic and is thought to be effective for such conditions as stomach cramps, whooping cough, and asthma.

Externally, butterbur has been applied as a poultice over wounds or skin ulcerations.

Therapeutic Dosages

The usual dosage of butterbur is 50 to 150 milligrams (mg) twice daily of a standardized extract that has been processed to remove potentially dangerous chemicals called pyrrolizidine alkaloids. Use of any butterbur product that contains pyrrolizidine alkaloids is not recommended.

Therapeutic Uses

A special toxin-free butterbur extract has been investigated for the treatment of a variety of illnesses. Two double-blind trials suggest that this butterbur extract may be useful for preventing migraine headaches. In addition, meaningful evidence indicates that this extract is helpful for hay fever. The American Academy of Neurology began recommending the use of butterbur for migraines in 2012, but they retracted this advice in 2015 because of the risks of liver toxicity. Further research indicated that butterbur effectively prevents migraines because it blocks the signaling of calcitonin gene-related peptides. While there are safety risks, using quality supplements may result in positive outcomes for many individuals.

There is some evidence that butterbur has anti-inflammatory and antispasmodic effects, and on this basis, it has been proposed as a treatment for a variety of musculoskeletal pain conditions; however, meaningful clinical trials have not been reported. Butterbur has also undergone a highly preliminary investigation for the treatment of asthma and for protecting the stomach lining from injury, thereby helping to prevent ulcers. Preliminary evidence suggests that butterbur is not likely to be particularly effective for allergic skin diseases, such as eczema.

Scientific Evidence

Migraines. Two double-blind, placebo-controlled studies suggest that butterbur extract may be helpful for preventing migraines, although the optimum dosage is not clear. Butterbur extract was tested as a migraine preventive in a double-blind, placebo-controlled study involving sixty men and women who experienced at least three migraines per month. After four weeks without any conventional medications, participants were randomly assigned to take either fifty mg of butterbur extract or a placebo twice daily for three months.

The results were positive: both the number of migraine attacks and the total number of days of migraine pain were significantly reduced in the treatment group compared with the placebo group. Three of four persons taking butterbur reported improvement, compared with only one of four persons in the placebo group. No significant side effects were noted.

In another double-blind, placebo-controlled study performed by different researchers, 202 people with migraine headaches received either fifty mg twice daily of butterbur extract, seventy-five mg twice daily, or a placebo. Over the three months of the study, the frequency of migraine attacks gradually decreased in all three groups. However, the group receiving the higher dose of butterbur extract showed significantly greater improvement than those in the placebo group. The lower dose of butterbur failed to prove significantly more effective than a placebo.

Based on these two studies, it does appear that butterbur extract is helpful for preventing migraines and that seventy-five mg twice daily is more effective than fifty mg twice daily. However, further research is necessary to establish this with certainty.

Hay fever (allergic rhinitis). Butterbur appears to affect the immune system in ways that suggest it should be helpful for hay fever (technically, “seasonal allergic rhinitis”). On this basis, it has been tested as an allergy treatment, with positive results in substantial studies.

In a two-week double-blind, placebo-controlled study of 186 people with intermittent allergic rhinitis, the use of butterbur at a dose of three standardized tablets daily, or one tablet daily, reduced allergy symptoms compared with a placebo. Significantly greater benefits were seen in the higher-dose group. Such “dose dependency” is generally taken as a confirming sign that a treatment really works.

In another double-blind study, 330 people were given either butterbur extract (one tablet three times daily), the antihistamine fexofenadine (Allegra), or a placebo. The results showed that butterbur and fexofenadine were equally effective, and both were more effective than a placebo.

A previous two-week double-blind study of 125 individuals with hay fever compared a standardized butterbur extract against the antihistamine drug certizine. According to ratings by both doctors and patients, the two treatments proved equally effective. This study did not use a placebo group.

Unlike standard antihistamines, butterbur does not appear to reduce reactions on allergy skin tests. It contains chemicals like Sesquiterpenes that help decrease swelling and limit muscle spasms. Butterbur may also have some antioxidant properties.

Safety Issues

In studies and postmarketing surveillance involving adults and children, burping and other mild gastrointestinal complaints have been the main side effects of butterbur extract. Butterbur contains liver-toxic and possibly carcinogenic components called pyrrolizidine alkaloids (PAs). It is possible to remove these compounds from butterbur products. In Germany, the maximum allowable content of pyrrolizidine alkaloids in butterbur products has been set at one microgram per daily recommended dose. Consumers should purchase products that are labeled and certified PA-free.

Though rare, long-term use has resulted in reversible cholestatic hepatitis in some individuals. Butterbur should not be used by pregnant or nursing women, young children, or people with severe kidney or liver disease until further safety testing has been performed.

Bibliography

"Butterbur." Drugs.com, 2 July 2024, www.drugs.com/npc/butterbur.html. Accessed 20 Sept. 2024.

"Butterbur." National Center for Complementary and Integrative Health, July 2020, www.nccih.nih.gov/health/butterbur. Accessed 20 Sept. 2024.

Din, Lennox, and Forshing Lui. "Butterbur." StatPearls, National Library of Medicine, 25 June 2023, www.ncbi.nlm.nih.gov/books/NBK537160. Accessed 20 Sept. 2024.

Schapowal, A. “Butterbur Ze339 for the Treatment of Intermittent Allergic Rhinitis: Dose-Dependent Efficacy in a Prospective, Randomized, Double-Blind, Placebo-Controlled Study.” Archives of Otolaryngology–Head and Neck Surgery, vol. 130, 2004, pp. 1381-86.

Lipton, R. B., et al. “Petasites hybridus Root (Butterbur) Is an Effective Preventive Treatment for Migraine.” Neurology, vol. 63, 2004, pp. 2240-44.

Thomet, O. A., and H. U. Simon. “Petasins in the Treatment of Allergic Diseases.” International Archives of Allergy and Immunology, vol. 129, 2002, pp. 108-12.