For MIGRAINES, Butterbur Extract is a specific and potent pain reliever. Butterbur acts in several ways to ease migraines: it desensitizes sensory neurons, decreases inflammatory signaling, stabilizes vascular and neurological disruptions, and enhances healthy brain blood flow. Used consistently, it can significantly reduce or, for some patients, prevent migraines.

Research confirms that butterbur helps migraines

The American Academy of Neurology and the American Headache Society support the use of butterbur extract from the root or rhizome of the plant, based on promising research results from high-quality studies. In May 2012, the American Academy of Neurology and the American Headache Society issued two sets of guidelines on migraine prevention. One addressed pharmacologic therapies demonstrated to be effective in trials, and the other evaluated NSAIDs and complementary treatments that have proven efficacy. The only complementary remedy recommended with top-ranking Level A evidence was butterbur.¹

Butterbur has stronger, evidence-based clinical research to verify its efficacy compared to other natural migraine remedies on their own, such as feverfew, capsaicin, magnesium, and vitamin B2. However, these substances can act synergistically to enhance the actions of butterbur.

How butterbur works

For pain relief, petasins, the most active constituents of butterbur, desensitize channels of sensory neurons, where pain is registered. They decrease the body’s inflammatory response by inhibiting the release of calcitonin gene-related peptides (CGRP). These protein peptides can cause inflammation and migraine pain if they are secreted around the brain. CGRP is known as a biomarker and promoting factor of migraines; blocking CGRP signaling is the crucial step necessary to curtail and prevent migraine attacks.²

Recent research confirms that butterbur modulates CGRP differently from the usual migraine drugs and from newer medications including the monoclonal antibody injectable drugs, which can have uncomfortable side effects including fatigue, nausea, dizziness, and constipation. By contrast, butterbur generally has zero side effects.

The first placebo-controlled trial of butterbur root extract in 2004 showed that a dose of 50 mg of butterbur root extract taken twice daily can lower the frequency of migraines. Close to 50% of the patients in the study reported that the average frequency of migraines decreased by half after 3 months, and butterbur was well-tolerated.³ This rate of improvement was similar to prescription medications including the newer monoclonal antibody injectable drugs such as Aimovig, Ajovy, Vyepti, and Emgality. The American Headache Society has observed that butterbur extract is the only natural product in the same category of effectiveness as the best older prescription drugs, like topiramate and divalproex sodium.⁴

Butterbur also eases migraines through its direct anti-inflammatory actions: Petasins work via other anti-inflammatory pathways in addition to CGRP inhibition. Research indicates that petasin and isopetasin inhibit the inflammation-causing enzyme lipoxygenase (LOX), bringing highly potent reduction of inflammation. Butterbur extract can also calm inflammation by inhibiting activity of the enzyme cyclo-oxygenase-2 (COX-2). Higher levels of COX-2 speed up the production of certain prostaglandins, chemical messengers that play a key role in promoting inflammation. Inhibition of the COX-2 enzyme relieves migraine pain and inflammation.⁵

Butterbur extract has a third important way to ease migraines: It is a strong antioxidant. By reducing free radical formation, this antioxidant action helps to stabilize vascular and neurological disruptions that contribute to migraine, thus reducing pain.

A fourth mechanism by which butterbur helps migraines is via its muscle-relaxing effects on blood vessels in the brain that become overexcited during a migraine. This leads to enhanced healthy brain blood flow. These muscle-relaxing actions help to prevent the initial stages of migraines and to stabilize blood vessels, allowing blood to flow more evenly to the brain. Butterbur’s active components isopetasin and oxopetasin induce smooth muscle relaxation, particularly in cerebral blood vessel walls. Butterbur petasins also decrease the intracellular concentration of calcium, offsetting calcium-induced vasoconstriction, adding to smooth muscle relaxation and improved blood flow.⁶

Strong evidence from clinical trials shows that the actions of petasins are a combination of effects that create a beneficial option for migraine prevention.

What is butterbur?

Butterbur is a perennial shrub that grows well in the marshy terrain of Europe, Asia, and North America. The variant Petasites hydridus is found in colder, northerly regions of Russia and Europe. An equally effective medicinal species called Petasites frigidus is found in the northern United States and Canada.

With its large, parasol-like leaves, Butterbur’s botanical name Petasites is thought to derive from the Greek word “petasos,” referring to the Thessalian sun hat worn by the ancient Greeks. Its common name may also stem from its use to wrap butter; the large heart-shaped leaves help to prevent butter from melting in warm weather.

Butterbur has a long history of traditional use stretching back at least 2,000 years when it was used to soothe headaches, ease digestive symptoms, and relieve asthma attacks. Butterbur’s medicinal use was recorded by the famous Greek physician, pharmacologist, botanist, and author Dioscorides in 65 A.D.

What causes migraines?

Vascular instability and neurological dysfunction are both likely to play roles in causing migraines. Inflammation can trigger vasodilation — where blood vessels dilate and blood rushes in with a drop of pressure; or vasoconstriction — where blood vessels are narrowed, blood flow slows, and pressure inside arteries and veins increases. Sudden narrowing and then dilation of blood vessels is common with migraines.

Inflammation and oxidative damage can also contribute to migraines by injuring neurons and increasing free radicals. An imbalance of neurotransmitters including GABA, serotonin, and acetylcholine affects blood flow. Likewise, hormones are linked with either vasodilation or vasoconstriction, and imbalances of cortisol, melatonin, testosterone, and estrogen can disturb brain blood flow and aggravate migraines.

Nutrients that support butterbur’s action

We find that other nutrients enhance the benefits of butterbur extract and are also helpful in their own right for migraines. These include the following:

• Vitamin B2 (riboflavin) in an ample dose by mouth seems to reduce the number of migraine headaches by about 2 attacks per month. Especially when used in combination with botanicals including butterbur and other vitamins and minerals, the effectiveness of riboflavin is even greater to ease the pain of a migraine. Evidence shows that vitamin B2 is well-tolerated as a preventive treatment for migraine and is shown to be effective in reducing migraine frequency and severity. Clinical guidelines for managing headaches indicate that 400 mg of riboflavin per day is effective in reducing migraines.
• Magnesium has a long track record for relieving the frequency and intensity of migraine pain due to its roles in smooth muscle tone and nerve function. Since migraine sufferers, asthmatics, and patients with seasonal and year-round allergies have lower magnesium levels within cells, taking extra magnesium is a first step in their care.
• Ginger reduces both pain and nausea and is therefore very useful for the treatment of migraine headaches. Ginger has a naturally occurring oil that is responsible for both its flavor and health benefits. The chemical compounds in this oil, including gingerols and shogaols, have anti-inflammatory and pain-relieving effects, and are also effective at treating nausea and vomiting. Ginger extracts may also increase serotonin, a chemical messenger involved with migraine attacks. Increasing serotonin levels in the brain may help stop migraines by reducing inflammation and stabilizing blood vessels.
• Feverfew is a botanical with traditional and research-supported actions for migraine relief. Scientific studies confirm that this may be due to its parthenolide, an active ingredient which helps relieve spasms in smooth muscle tissue, or to its anti-inflammatory action.
• 5-Hydroxytryptophan, or 5-HTP for short, relieves migraines as it encourages optimal neurotransmitter levels and healthy brain chemistry. 5-HTP raises serotonin levels in the brain and is effective at reducing the frequency, severity, and duration of migraine headaches.

Our patients’ experience with butterbur

Our patients regularly enjoy reduced frequency and intensity of pain with classic migraines, menstrual migraines, and even hypnic migraines that occur during sleep. Patients regularly report far fewer migraines, with less severe pain if they happen, and they tell us that they continue to experience ongoing improvements for years. Overall, we’ve seen significantly better results with a formula that has multiple nutrients for migraines than with plain butterbur root alone.

Recommendation: Butterbur extract 50–100 mg once to twice daily. To meet our specifications a butterbur formula must be a correctly standardized extract of butterbur root, certified free of unhelpful pyrrolizidine alkaloids (PAs). We look for an extract of the rhizome of Petasites hybridus that is standardized to contain 5 to 7.5 mg (10%) of petasine per dose. Butterbur is best taken between meals for optimal absorption, or as directed by your healthcare practitioner.

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