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What Europeans Are Doing to Limit Migraine Frequency

March 2006

By Russell Martin

Relief for Respiratory, Gastrointestinal Conditions

The ability of butterbur’s active ingredient petasin to quell smooth muscle spasms in vascular walls (which may contribute to migraine) allows it to similarly benefit other parts of the body, thereby mitigating disorders unrelated to migraine.2,30

In Europe, butterbur extract is commonly used to battle allergic rhinitis (hay fever), and studies have confirmed its efficacy, both compared to a commonly used prescription medication and in a double- blind, placebo-controlled study. When butterbur extract was compared with Zyrtec®, the brand name of the anti-allergy prescription medication cetirizine, researchers determined that both compounds were equally effective in limiting sneezing, nasal congestion, runny nose, itchy nose, and itchy eyes. Among the 131 patients studied over two weeks, half took butterbur extract to relieve their symptoms and the other half took cetirizine. The researchers believe that petasin in butterbur extract proved efficacious by limiting histamine and leukotriene, which promote inflammation and mucous secretions, and by dilating constricted airways to ease breathing.30

Butterbur leaves and root have been used for centuries to manage bronchial asthma and whooping cough. A recent Scottish study showed that the anti-inflammatory action of 25 mg of butterbur extract taken twice daily significantly improved out-breath volume in asthma patients who regularly treat their symptoms with inhaled corticosteroids. The investigators noted that butterbur complemented the activity of the corticosteroids and showed a superior effect compared to placebo.31

Furthermore, in a German open trial, 80 asthma sufferers who took 50 mg of butterbur extract three times a day saw the number, duration, and severity of their asthma attacks decrease during an eight-week study period. The study authors speculated that butterbur extract may be effective both as a stand-alone asthma treatment and in combination with other asthma medications.32

Historically, butterbur has been used as a folk medicine for various gastrointestinal disorders, particularly digestive tract spasms associated with colic and bile flow obstruction. A contemporary German study found butterbur extract can block ethanol-induced damage to the stomach and reduce ulcerations in the small intestine.33 German researchers are studying butterbur’s potential applications in controlling spasms of the urogenital tract, which can contribute to urinary urgency and incontinence. They believe that butterbur may prove effective in managing these disorders.34


In recent years, researchers have found that riboflavin, or vitamin B2, shows promise in blocking the onset of migraine headaches. Like other B vitamins, riboflavin facilitates energy production in the body by aiding the metabolism of fats, carbohydrates, and proteins. It is also essential in the production of red blood cells and antibodies.

Although its mechanism of action in preventing migraine remains uncertain, riboflavin may help increase energy production in the cellular power plants known as mitochondria. Scientists speculate that low mitochondrial energy supplies may trigger migraines in many patients.35

In a 1994 open study at Belgium’s University of Liege, 49 migraine sufferers took 400 mg of riboflavin with breakfast every day for three months. At the end of the study, the participants reported an average 68% reduction in the number of headaches they experienced each month, an impressive decrease that warranted a follow-up placebo-controlled study.35

Four years later, the Belgian scientists conducted a randomized trial of 55 migraine patients, half of whom consumed 400 mg of riboflavin daily while the other half received placebo. At the end of the three-month study, nearly 60% of the participants receiving riboflavin reported at least a 50% reduction in the number of monthly headaches, while only 15% of the placebo group reported decreased headache incidence of 50% or more. While two patients taking riboflavin reported diarrhea and increased urine volume as side effects, the high daily dose of riboflavin was otherwise well tolerated. Since the B vitamin cannot be stored in the body, the researchers postulated that the 400-mg daily dosage—250 times the FDA’s recommended minimum daily intake—was required to achieve the therapeutic effect.36

In a 2004 open-label study at Humboldt University in Berlin, 23 people aged 20-65 were given 400 mg of riboflavin daily for six months. At the study’s onset, the participants averaged four headache days a month. By the end of three months, the group’s average number of headache days had been reduced to two; after six months, their average number of monthly headaches remained at two. Patients reported that migraine duration and intensity did not decrease with the riboflavin treatment, yet they reported taking significantly less total pain-relieving medication over the course of each month compared to the amount they consumed at the beginning of the study. Minor diarrhea and abdominal pain were the only side effects reported.37

In a California study in 2004, researchers discovered that a much smaller daily dose of riboflavin similarly reduces the frequency of migraine headaches. In a three-month, controlled, double-blind study at an outpatient clinic, 48 people randomly received either a combination dosage of 400 mg of riboflavin, 300 mg of magnesium, and 100 mg of the herb feverfew (all three of which have been show to have therapeutic benefits in managing migraine) or just 25 mg of riboflavin each day.

The clinical physicians who designed the study defined a positive response to treatment as a reduction of monthly migraine frequency by 50% or more. Forty-two percent of the patients taking the riboflavin-magnesium-feverfew combination successfully responded to the therapy at the end of three months—reducing their number of headaches by 50% or more—while 44% of those taking only the small dose of riboflavin responded successfully. The physicians were surprised by the efficacy of the low dose of riboflavin, and suggested further studies to determine what dosage of vitamin B2 provides the greatest possible reduction in headache incidence.38

Because it is inexpensive, essential to the body, and can be tolerated in high dosages with minimal side effects, riboflavin—together with butterbur, magnesium, and feverfew—will be the subject of much more research in coming years as to its effects and efficacy in preventing migraine.


As more and more research documenting butterbur’s ability to reduce migraine attacks comes to light, thousands of sufferers are turning to this herbal extract as a safe, effective, and natural way to limit the crippling effects of migraine headaches.

Since its clinical use began in Germany in 1985, nearly half a million people have been treated with standardized butterbur extract, with significant success and virtually no side effects.13 Investigators in Europe and North America are testing butterbur’s applications in managing various disorders like hay fever, gastrointestinal conditions, and urogenital disorders. Butterbur thus appears to be a promising natural remedy for many common health complaints.


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