Botanicals & Herbs

Butterbur

Q: Is butterbur safe for migraines?

Certified PA-free extracts have a good safety record in trials and clinical use, with GI upset the main complaint. Liver monitoring is prudent for long-term use, and raw butterbur is never safe.

Q: How does butterbur compare to prescription migraine preventives?

Its trial effects (roughly halving migraine frequency) are in the same range as some first-line preventives, but head-to-head data are limited. Discuss with a neurologist.

Q: Can I take butterbur with my allergy medication?

It has been combined with antihistamines in trials without notable issues, but polypharmacy should always be reviewed with a clinician.

Also known as: Petasites hybridus, Petadolex, Purple butterbur

The migraine herb with genuine trial data — provided you buy the PA-free extract that makes it safe.

By IngredientWiki Editorial Team
Fact-checked by IngredientWiki Editorial Team
Updated 2026-09-26
2 min read

In short

Butterbur (Petasites hybridus) is a wetland plant whose extract is one of the few botanicals with randomized-trial evidence for migraine prevention: a standardized 75 mg twice-daily extract reduced migraine frequency by about 45–48% in trials, and it also has data for allergic rhinitis. The critical safety point is pyrrolizidine alkaloids (PAs) — liver-toxic compounds present in the raw plant that must be removed in processing; only PA-free extracts (like Petadolex) are considered safe, and even those carry warnings for mild liver-enzyme changes. Raw butterbur preparations are dangerous and should never be used. The 2012 discontinuation of one marketed extract after liver concerns sharpened the quality debate.

Standardized extract has real migraine-prevention trial data
~45% migraine frequency reduction at 75 mg twice daily
Raw plant contains liver-toxic pyrrolizidine alkaloids
Only certified PA-free extracts are safe — check the label

What is Butterbur?

Butterbur is the migraine herb with two faces. The good one wears a trial record most botanicals envy: a standardized extract cutting migraine frequency nearly in half in randomized studies, with respectable allergic-rhinitis data as a bonus. The dangerous one is the raw plant itself, which contains pyrrolizidine alkaloids that damage the liver. The entire safety story of butterbur is contained in a processing step — the removal of those alkaloids — and every responsible recommendation of this ingredient begins and ends with verifying it.

Where it comes from

Natural sources

Root and leaves of Petasites hybridus, a wetland plant native to Europe and Asia
Traditional use for headache, asthma, and wounds since antiquity
Actives: petasin and isopetasin sesquiterpenes

How it's made

Standardized extracts (e.g., Petadolex: 75 mg tablets, PA-free <0.08 ppm), which are the only acceptable forms.

What it does in products

Benefits

Migraine prevention

strong evidence

Randomized trials of standardized PA-free extract report ~45–48% reductions in migraine frequency versus placebo over 3–4 months.

Allergic rhinitis

moderate evidence

Trials show symptom relief comparable to some antihistamines without sedation, via leukotriene inhibition.

Tension and cluster headache (limited data)

emerging evidence

Preliminary reports exist, but the rigorous evidence is confined to migraine prevention.

Side effects & safety

Mild GI upset and burping (common)The most frequent complaint with standardized extracts.

Liver-enzyme elevations (rare)Reported even with PA-free extracts; monitoring advised for long-term use.

Safety considerations

Avoid — insufficient safety data, and some sources advise against use in pregnancy.
CYP3A4-metabolized drugs — petasin may alter metabolism; data limited
Anticholinergics — additive effects possible
Not for: Liver disease
Not for: Raw or unprocessed butterbur (pyrrolizidine alkaloid toxicity)
Not for: Pregnancy

How it's used

In supplements

50–75 mg of standardized PA-free extract twice daily for migraine prevention; effects assessed at 8–16 weeks.

In skincare

Not a topical ingredient.

Regulatory status

Sold as a dietary supplement; no FDA-approved disease claims. FDA and German regulators require PA-free processing for safety.
Not applicable.

The PA rule

Pyrrolizidine alkaloids cause veno-occlusive liver disease, and butterbur's raw root contains them at dangerous levels. Modern extraction removes PAs to trace levels (<0.08 ppm) — a standard enforced by German regulators and reflected in the clinical trials. The rule is absolute: never use raw, home-prepared, or uncertified butterbur.

The 2012 discontinuation episode

In 2012, the manufacturer of one marketed PA-free butterbur product withdrew it after reports of liver enzyme elevations. Subsequent analysis suggested the issues were product-specific rather than class-wide, but the episode reinforced both the extract's genuine pharmacology and the need for liver monitoring in long-term use.

Frequently asked questions

Is butterbur safe for migraines?