Common Names: butterbur, petasites, purple butterbur

Scientific Names: Petasites hybridus (also referred to as Petasites officinalis or Tussilago hybrida)

Background

• Butterbur is a perennial shrub found throughout Europe, as well as parts of Asia and North America. The plant earned its name due to the historical use of its wide leaves in wrapping butter during warm weather. In some cultures, the name translates to "rain hat" or "hat plant" based on the traditional use of its broad leaves for protection from rain.

• Historically, butterbur has been used for medicinal purposes over many generations. During the Middle Ages, people believed the root’s scent and smoke could help ward off plague. Currently, it is commonly marketed as a natural supplement for managing migraines, seasonal allergies, and other conditions.

What Is Currently Known?

• There have been multiple scientific investigations exploring the effects of butterbur in managing migraines and hay fever. As a result, there is some understanding of how it impacts these particular issues.

Research Findings

• Supplements made from butterbur root may help decrease how often migraines occur in adults and children when taken by mouth. In 2012, the American Academy of Neurology recommended butterbur for migraine prevention. However, this endorsement was withdrawn in 2015 due to safety concerns.

• Some studies support that oral extracts from butterbur leaves may reduce symptoms of hay fever.

• Little is known about how butterbur may affect health conditions beyond migraines and allergic rhinitis, so no solid conclusions can be made about its other potential uses.

Safety Considerations

• Butterbur naturally contains compounds known as pyrrolizidine alkaloids (PAs), which can be harmful to the liver and lungs and might be linked to cancer. Only PA-free formulations should be considered for use.

• Research indicates PA-free butterbur extracts may be safe for oral use in both children and adults for up to 16 weeks. Still, rare liver toxicity cases have been reported even with products labeled as free of PAs.

• Applying butterbur products directly to the skin may not be safe if they contain PAs, as these can be absorbed, especially through broken skin.

• When used orally, butterbur is usually well tolerated. Known side effects include indigestion, bloating, drowsiness, itchy skin, and changes in bowel movements.

• Individuals with allergies to plants like daisies, ragweed, marigolds, or chrysanthemums may also react to butterbur.

• If you are taking any medications, consult your health care provider before using butterbur or other herbal supplements, as they could interact unfavorably with prescribed drugs.

• Butterbur products, especially those with PAs, should be avoided during pregnancy and breastfeeding. Not enough is known about the safety of PA-free butterbur use during these periods.

Points to Remember

• Be proactive about your health. Speak openly with your doctor or other health care provider about any herbal or alternative treatments you consider using. This ensures informed and collaborative decision-making.

• Regulation of herbal products varies based on their content and intended use. Many are distributed as dietary supplements, which are subject to different standards than prescription medications.

• Unlike traditional drugs, dietary supplements do not require prior approval by the U.S. Food and Drug Administration (FDA) before being sold. When safety issues surface, the FDA may take necessary steps to protect public health.

• Companies that make or distribute supplements are responsible for ensuring that product safety and labeling standards are met prior to marketing.

Additional Resources

• Tips for Safe Use of Dietary Supplements

• Learn How Supplements and Medications May Interact

• Understanding Scientific Articles and Clinical Research

NCCIH Clearinghouse

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PubMed®

Managed by the National Library of Medicine, PubMed® provides access to a vast number of research articles and summaries from healthcare journals.

Office of Dietary Supplements (ODS), National Institutes of Health (NIH)

ODS supports advancing knowledge about dietary supplements through funding research, sharing information, and educating the public. Resources include fact sheets and scientific reports on various vitamins and supplements.

Key References

• Butterbur. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases. Updated February 18, 2019.

• Butterbur. NatMed Pro, viewed September 27, 2023. [Subscription resource]

• Holland S, Silberstein SD, Freitag F, et al. Guidelines update: NSAIDs and other alternative treatments for episodic migraine prevention in adults. Neurology. 2012;78(7):1346-1353.

• Kulinowski Ł, Luca SV, Minceva M, et al. Review on the ethnobotany, phytochemistry, and safety concerns of butterbur (Petasites). Journal of Ethnopharmacology. 2022;293:115263.

This document is in the public domain and can be freely copied.

Provided for educational purposes by NCCIH. Consult with your health care provider for medical guidance. Product or service mention does not constitute an endorsement by NCCIH.