Migraines or Allergies Try Butterbur

Petasites hybridus is native to Europe, northern Africa, and southwestern Asia. In the Middle Ages, this herb was used to treat plague and fever, while during the seventeenth century it was prescribed for coughs, asthma, and skin wounds. Its common name, butterbur, comes from one of its historical uses, when its leaves were used to wrap butter during warm weather. In modern times, the primary therapeutic uses of butterbur have been to prevent migraine headaches and to treat seasonal allergies.

Relieve Migraines
Migraines vary in intensity and duration, but many sufferers describe a debilitating pain that gets worse. In most people, migraines occur without warning. However, in cases of classic migraine headaches, a visual disturbance called an aura happens before the headache starts.

One randomized, double-blind, placebo-controlled trial investigated the efficacy of 50 mg or 75 mg butterbur root extract or placebo twice a day for the prevention of migraines. Butterbur extract was standardized to contain at least 15 percent petasin with no detectable pyrrolizidine alkaloids. (Pyrrolizidine alkaloids can be toxic to the liver, so removing them increases the safety profile of butterbur and other plants.)

Researchers enrolled 245 volunteers ages 18 to 65 with a history of two to six migraine headaches per month in the three months prior to treatment and at least two headaches during the four-week baseline phase. Treatment with 150 mg butterbur extract per day appears the most effective dose, resulting in a greater than 50 percent reduction in migraines per month over baseline after one, two, three, and four months in a significant percentage of patients compared to placebo.

This trial demonstrated the safety and efficacy of 150 mg per day of butterbur in preventing migraine headaches. The authors note the efficacy attained with 150 mg per day butterbur is comparable to prescription medications (e.g., topiramate and gabapentin), while the safety of this butterbur extract appears superior to these drugs.

Hay Fever
Allergic rhinitis (AR) is inflammation of the nasal mucous membranes caused by environmental allergens such as pollen and dust. Symptoms include sneezing, congestion, nasal itching, and runny nose. Antihistamines are commonly used to treat AR symptoms but can sometimes cause drowsiness.

Several clinical trials have tested the efficacy of different preparations of butterbur extracts on people with AR. One prospective, randomized, double-blind, clinical trial compared butterbur extract to fexofenadine, a nonsedating antihistamine, and placebo for AR. More than 300 volunteers were randomized to receive butterbur extract (standardized to 8 mg petasine), fexofenadine, or placebo for two weeks. Butterbur proved equally effective as fexofenadine in treating symptoms of intermittent allergic rhinitis, and both were superior to placebo for decreasing runny nose, sneezing, itchy nose, itchy/red eyes, and nasal congestion. A second study comparing the same butterbur extract to the antihistamine cetirizine also showed that butterbur extract was as effective at decreasing the symptoms of AR as the pharmaceutical.

Dosage and Interactions
For prevention of migraine headaches, 75 mg of butterbur twice daily is effective. For reducing symptoms of allergic rhinitis, try 8 mg petasine three to four times daily. Be sure to look for pyrrolizidine-free extracts.

No herb-drug interactions have been documented, but this herb is not advised during pregnancy or lactation. Allergies to any plants in the Asteraceae/Compositae family (e.g., echinacea, sunflower, artichoke, milk thistle) increase the risk for allergic reactions to butterbur.

"Butterbur: An Evidence-Based Systematic Review by the Natural Standard Research Collaboration" by Mary Giles et al., Journal of Herbal Pharmacotherapy, 2005 "Effects of Butterbur Treatment in Intermittent Allergic Rhinitis: A Placebo-Controlled Evaluation" by R. D. Gray et al., Ann Allergy Asthma Immunol, 7/04 "Petasites hybridus Root (Butterbur) Is an Effective Preventive Treatment for Migraine" by R. B. Lipton et al., Neurology, 12/04 "Test of the Antiallergenic Properties of Butterbur (Petasites hybridus)" by Brenda Milot, ELS, HerbClip, 11/15/06 "Treating Intermittent Allergic Rhinitis: A Prospective, Randomized, Placebo and Antihistamine-Controlled Study of Butterbur Extract Ze 339" by A. Schapowal, Phytother Res, 6/05

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