Butterbur

Butterbur extract (Petasites hybridus) has been studied in RCTs for migraine prevention and allergic rhinitis. A key RCT (PMID: 15623680) found 75mg twice daily reduced migraine frequency by 48% vs placebo. For allergic rhinitis, butterbur was comparable to cetirizine (antihistamine) without sedation. The active compounds are petasin and isopetasin (sesquiterpenes). HOWEVER, butterbur contains hepatotoxic pyrrolizidine alkaloids (PAs) - only PA-free extracts (e.g., Petadolex) should be used. Due to liver toxicity concerns with some commercial products, butterbur has fallen out of favor despite efficacy evidence.

Quick Answer

What it is

Key findings

Grade B: Allergy Symptoms (Allergic Rhinitis (Seasonal Allergies / Hay Fever))
Grade B: Migraine Frequency (Migraine Headache)

Safety

Due to liver toxicity concerns with some commercial products, butterbur has fallen out of favor despite efficacy evidence.

ℹ️ Quick Facts: Butterbur

Quick Facts: Butterbur

Best Evidence:Grade B
Conditions Studied:2
Research Outcomes:2
Grade B Findings:2
Key Effect:Migraine Headache

Outcomes by grade:

2 conditions · 2 outcomes

Detailed Outcomes

Allergy Symptoms

Multiple RCTs: Butterbur comparable to cetirizine (Zyrtec) for seasonal allergy relief without sedative effects. 8mg petasin 4x/day effective.

5 studies500 participants

moderate↓Improves

Migraine Frequency

RCT (n=245, PMID: 15623680): 75mg twice daily reduced migraine attacks by 48% vs 26% placebo. AAN/AHS guidelines previously rated it Level A for migraine prevention.

3 studies400 participants

moderate↓Improves

Evidence by Condition

Best grade per condition (each condition may have multiple outcomes)

BMigraine Headache

1 outcome · 3 studies

↓Migraine FrequencyImproves

BAllergic Rhinitis (Seasonal Allergies / Hay Fever)

1 outcome · 5 studies

↓Allergy SymptomsImproves

Research Citations (7)

Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention

Neurology (2019)

PMID: 26122728

Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults

Neurology (2012)

PMID: 22547540

Hepatotoxicity of pyrrolizidine alkaloids

J Pharm Sci (2011)

PMID: 23096836

Butterbur root extract and petasin for treating seasonal allergic rhinitis: a randomized controlled trial

Phytother Res (2005)

PMID: 16869915

Petasites hybridus root (butterbur) is an effective preventive treatment for migraine

Neurology (2004)

PMID: 15623680

Comparing the efficacy of Petadolex, a butterbur-based extract, to cetirizine, a H1-antihistamine, in the treatment of intermittent allergic rhinitis

BMJ (2002)

PMID: 12197274

Efficacy of Petasites hybridus extracts in migraine prophylaxis: a randomized double-blind placebo-controlled trial

Phytomedicine (2000)

PMID: 11897646

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