PubMed-compiled information sheet
This sheet was compiled from PubMed (NIH) abstracts using AI assistance. Every factual claim is cited to a real PubMed article (see the source list). It has not yet been human-reviewed — confirm with a healthcare provider before use.
Compiled from 28 PubMed articles · model: gemma4:31b
Summary
Butterbur (Petasites hybridus) is an herbal supplement used primarily for the prophylaxis of adult migraines [PMID:30725845] and the treatment of allergic rhinitis [PMID:30725845, PMID:36088149].
Background
Butterbur is a perennial shrub found in Europe, Asia, and North America, typically growing in wet, marshy ground or damp forests [PMID:11302783]. It is derived from the leaves or roots of the Petasites hybridus plant [PMID:30725845].
Traditional uses
Historically used in Asian and European traditional medicine for central nervous system (migraine), respiratory (asthma, allergic rhinitis, bronchitis, spastic cough), cardiovascular (hypertension), gastrointestinal (ulcers), and genitourinary (dysmenorrhea) disorders [PMID:35427728]. During the Middle Ages, it was used for plague and fever, and in the 17th century for cough, asthma, and skin wounds [PMID:11302783].
Active compounds
The primary pharmacologically active ingredients are petasins (eremophilane-type sesquiterpenes) [PMID:35585841, PMID:37364450]. Other constituents include sesquiterpene hydrocarbons such as petasitene and pethybrene [PMID:11937157], as well as naturally occurring pyrrolizidine alkaloids (PAs) [PMID:30725845, PMID:32486467].
Mechanism of action
Butterbur inhibits the synthesis of cysteinyl-leukotrienes and decreases intracellular calcium concentrations [PMID:12808361, PMID:16463791]. It diminishes inflammatory mediators by inhibiting cyclooxygenases, lipoxygenases, and phospholipase A2, and desensitizes nociception by acting on TRPA1 and TRPPV1 ion channels [PMID:35585841]. Additionally, it inhibits the release of calcitonin-gene related peptide (CGRP) from meningeal afferents during migraine attacks [PMID:35585841].
Clinical evidence
Evidence BMigraine Prophylaxis
A randomized trial found that a 75 mg bid dose of standardized root extract reduced migraine attack frequency by 48% over 4 months compared to 26% for placebo [PMID:15623680]. The American Headache Society has given it a level A recommendation for effectiveness in preventing migraine headaches [PMID:30725845].
Evidence CAllergic Rhinitis
Butterbur is cited as one of the therapies with the strongest evidence for the treatment of allergy and allergic rhinitis [PMID:36088149].
Safety & adverse effects
Butterbur contains pyrrolizidine alkaloids (PAs) which are potentially hepatotoxic and carcinogenic [PMID:12808361, PMID:32486467]. Preparations processed to remove PAs do not appear to cause liver injury [PMID:30725845]. However, some reports associate long-term administration with reversible cholestatic hepatitis [PMID:12808361]. Other side effects may involve the gastrointestinal tract [PMID:12808361].
Dosage & administration
In one clinical trial for migraine prevention, doses of 75 mg bid and 50 mg bid of standardized root extract were used [PMID:15623680]. No PubMed data available. Consult a healthcare provider.
Evidence summary
There is strong evidence (Level A/B) supporting the use of butterbur for migraine prophylaxis, provided the extract is processed to remove pyrrolizidine alkaloids. Evidence for allergic rhinitis is positive but less detailed in the provided abstracts.
PubMed sources
- 1.PMID: 26252585 (2015) — Preventive Migraine Treatment. · Continuum (Minneapolis, Minn.)
- 2.PMID: 39853578 (2025) — Nutraceuticals and Headache 2024: Riboflavin, Coenzyme Q10, Feverfew, Magnesium, Melatonin, and Butterbur. · Current pain and headache reports
- 3.PMID: 32310327 (2020) — Herbal treatments for migraine: A systematic review of randomised-controlled studies. · Phytotherapy research : PTR
- 4.PMID: 30725845 (2026) — Nutraceuticals in migraine. · Handbook of clinical neurology
- 5.PMID: 24867850 (2014) — Herbal therapy in migraine. · Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology