What Europeans Are Doing to Limit Migraine FrequencyMarch 2006
By Russell Martin
For more than three decades, migraine sufferers in Germany have been prescribed an extract derived from a perennial herb known as butterbur. Now medical practitioners in the United States are paying close attention to this herbal extract’s remarkable ability to reduce the number of headaches that migraine sufferers experience each month by almost 50%.1
Butterbur’s principal active constituent is petasin, which reduces smooth muscle spasms and appears to be particularly valuable in relaxing the constriction of cerebral blood vessels.2 The petasin in butterbur also makes this herb useful in managing upper respiratory inflammation, asthma attacks, urinary disorders, menstrual cramps, kidney stones, and various gastrointestinal disorders associated with smooth muscle spasm.2 However, it is butterbur’s ability to markedly reduce the frequency of migraine headaches that has recently excited researchers and migraine sufferers alike.1
Butterbur’s Success in Europe
Migraine treatment in the United States has focused on pharmaceuticals. In Germany, however, where nutraceutical companies have long been recognized as world leaders in herbal medication research conducted under stringent government regulation, butterbur is a popular and proven prophylactic alternative to prescription drugs. Conventional migraine medications are expensive, can have serious side effects, and often are not effective in preventing migraine attacks.
In a study published in 2000 in the International Journal of Clinical Pharmacology and Therapeutics, German neurologist Dr. Werner Grossmann set out to determine whether a standardized butterbur extract could limit migraine attacks as successfully as conventional prescription medications, and whether it, too, posed a risk of dangerous side effects. Drugs most often prescribed to reduce migraine frequency include beta-blockers such as propranolol and metoprolol, whose common side effects are lowered blood pressure, muscle weakness, and depression. Also frequently prescribed are calcium antagonists such as flunarizine and serotonin antagonists such as methysergide and pizotifen, whose shared side effects include tiredness, weight increase, Parkinson-like symptoms, and concentration disturbances. In placebo-controlled, double-blind studies, these medications have reduced migraine frequency by 50-70%.9
Dr. Grossmann and his colleagues studied 60 migraine outpatients at the Munich-Harlaching Municipal Hospital. The 28 males and 32 females averaged 29 years of age. Each subject had experienced at least three migraine attacks a month for the previous three months and had taken no prophylactic migraine medication for four weeks before beginning the study. Thirty-three of the subjects took 50 mg of standardized butterbur extract twice a day, while 27 took placebo. Fifty-eight participants completed the study.10
Following one month of treatment, the butterbur-supplemented group’s average of 3.3 migraine attacks a month before taking medication dropped to 1.8 attacks a month. After eight weeks on the supplement, they averaged 1.3 attacks a month. At the study’s 12-week conclusion, the group averaged 1.7 attacks a month. Thus, the migraine sufferers experienced a 61% decrease in headaches after eight weeks and a 49% decrease after 12 weeks while taking the butterbur extract. By contrast, the number of monthly headaches in the placebo group dropped from 2.9 attacks per month without medication to 2.2 attacks after four weeks, 2.4 attacks after eight weeks, and 2.6 attacks at the end of 12 weeks—a statistically insignificant reduction in total headaches.10
Among the butterbur group, the number of headache days per month fell from 3.4 to 1.7 by the end of the study period. The intensity of migraine pain and its duration (as reported by the study participants) did not decrease significantly for either the butterbur or placebo group. However, when asked whether they had benefited from the treatment, 23 subjects who received butterbur said yes, while eight responded no. By contrast, only seven people in the placebo group said they had benefited, while 20 said they had not.10
Moreover, not one participant in either the butterbur or placebo group reported any side effects during the three-month trial. According to Dr. Grossmann:
“The results of this study demonstrate that the special extract of Petasites hydrides [butterbur] is effective in the prophylactic treatment of migraine. The significant reduction in the frequency of attacks and number of migraine days is comparable to other agents considered effective for migraine prophylaxis, such as beta-blockers, calcium antagonists, e.g. flunarizine, cyclandelate, as well as serotonin antagonists.”10
New Studies Confirm German Findings
Four years after the German study was published, Dr. Richard Lipton, a neurologist at the Montefiore Medical Center in New York City, published the results of a similar study of 245 migraine sufferers. This trial likewise demonstrated that a standardized butterbur formulation significantly limited migraine frequency.
The participants averaged 42 years of age and had experienced two to six migraine headaches a month for the three months before the trial. Unlike the German study in which participants were evenly divided between males and females, females made up an average of 81% of the subjects in the three trial groups.1 In Dr. Lipton’s four-month study, approximately one third of the subjects were given placebo, one third received 50 mg of butterbur extract twice daily, and another third took 75 mg of butterbur twice daily.
After four months of treatment, those receiving placebo reported a 26% reduction in headache frequency. The group taking 50 mg of butterbur extract reported a 36% drop and the 75-mg group had a 48% reduction. In the 75-mg group, 68% of the subjects had a greater than 50% reduction in frequency of attacks after four months; in the placebo group, 49% reported a comparable reduction. Like the German researchers, Lipton and his colleagues found no reduction in the intensity of pain or duration of headaches that could be attributed to butterbur. The only statistically significant side effect was that roughly 10% of those taking both doses of butterbur experienced increased burping.1
Speaking with reporters following the study’s publication in the journal Neurology, Dr. Lipton cautioned:
“Before [they] take a medicine to prevent migraines, consumers should be pretty sure that they have migraines, and the best way to ensure that you have migraines is to get a diagnosis from a health care professional. Once migraine is diagnosed, [butterbur extract] is intended as a self-treatment. It is available over the counter without a prescription, and it’s a treatment that many people initiate on their own. For people who are taking prescription medications, it is worth checking with a doctor, though, before starting a natural product, and it’s important to remember that even though it is a natural product, it is a real drug, with real benefits but also the potential for real interactions with other medications.”11
On the heels of the Lipton study, German researchers published the results of a trial conducted at five pediatric clinics and 13 medical practices in that country. The study’s 108 participants included 29 children aged 6-9 years and 79 adolescents aged 10-17 years, each of whom had suffered from migraines for at least one year. Depending on their age and weight, the subjects were treated with 50-150 mg of standardized butterbur extract daily for four months. Treatment progression was recorded in migraine journals designed especially for children and adolescents.12
At the study’s conclusion, the number of migraine attacks in both groups was substantially reduced: from 9.4 attacks during the three months preceding the study to 4.0 attacks over the four-month study in the younger group, and from 9.7 to 5.8 attacks among the adolescents. Seventy-seven percent of the participants reported a reduction of at least 50% in headache frequency, and 91% reported that they felt substantially or slightly improved after taking butterbur for the length of the study. The butterbur was well tolerated, with no serious adverse side effects reported. As in the Lipton study, a few participants reported experiencing belching in association with the butterbur extract.12
Study authors Raymond Pothmann and Ulrich Danesch cautioned that because of the trial’s uncontrolled nature, its positive results could not be regarded as definitive proof of butterbur’s effectiveness in children and adolescents suffering migraine. However, when combined with data from the Grossman and Lipton studies, the German researchers said their findings suggest that standardized butterbur extract is a safe, effective prophylactic migraine treatment in children and adolescents as well as adults. Furthermore, they noted that the results warranted a placebo-controlled trial to further document butterbur’s efficacy in young migraine sufferers.12
Danesch also sought to determine the overall safety of the standardized German butterbur formulation, particularly because the plant is known to contain small quantities of pyrrolizidine alkaloids that are carcinogenic and potentially toxic to the liver. The German manufacturer of standardized butterbur extracts reports that these harmful substances are successfully removed using a high-pressure liquid carbon dioxide extraction process. This claim has been certified by the German government in its regulation of all nutraceuticals produced and distributed in that country. In repeated studies, Danesch and colleagues fed standardized butterbur extract to laboratory rats in dosages correlated to 333-1,250 times the recommended human daily dosage. They failed to detect any adverse effects on the animals, even after 26 weeks of study, a period representing roughly one quarter of the rats’ average life span.13