Butterbur for migraine -- a cautionary story

Timothy C. Hain, MD, Chicago IL.• Page last modified: March 27, 2021

When Dr. Hain was practicing neurology in the early 2000's, a drug representative appeared at his door, with samples of a new butterbur preparation. This is how it went:

Drug rep: I have a wonderful new product for you -- this herbal preparation is great for vestibular migraine.

Dr. Hain: OK, what is it ?

Drug rep: Petadolex -- this study shows that it issafe and effective in vestibular migraine.

The drug rep then gave me a reprint, funded by the company that developed this drug. I am not sure if was "Grossmann et al, 2000) or another one, but this would be abot the right time. I said -- great, I will be happy to give it a try.

Drug rep: But wait, it does more !

Dr. Hain: OK what else ?

Drug rep: It also works for asthma.

The drug rep then gave me another reprint, similar to the first. I am not sure if it was Danesch (2004).

Dr. Hain: OK, sounds good.

Drug rep: But wait, it also works for gastic reflux. A third paper was provided (possibly the one by Brune).

Dr. Hain -- OK, a triple threat !

I tried it in 5 migraine patients. One felt better, four couldn't tell any difference. I stopped recommending butterbur products as some of them contain pyrrolizidine alkaloids, that have been linked to liver injury (Aydin et al, 2013).