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StackTerminal.Health

Butterbur (Petasites hybridus)

Butterbur is an herbal extract used primarily for migraine prevention and treatment of allergic rhinitis. It is important to use PA-free extracts to avoid potential liver toxicity.

painanti inflammatoryrespiratoryneurological

Evidence last reviewed: 20 Apr 2026

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Who should avoid this
  • •pregnant or breastfeeding individuals
  • •those with liver conditions
  • •children under 18 years
Evidence
5 records
5 recordsBest grade:High

The evidence supports Butterbur's effectiveness in reducing migraine frequency and alleviating allergic rhinitis symptoms, with multiple high-quality RCTs backing these claims. However, it's crucial to ensure the extract is PA-free to mitigate risks.

Allergic rhinitis treatment
Adults with allergic rhinitis · RCT
Moderate

Petasites extract showed superiority over placebo for rhinosinusitis and allergic rhinitis.

Dose: 150 mgDuration: 12 weeksForm: PA-free extract
Citation: Rajapakse et al. (2019). Phytomedicines in the Treatment of Migraine.
Allergic rhinitis treatment
Adults with allergic rhinitis · RCT
Moderate

Petasites extract was effective in reducing symptoms of allergic rhinitis compared to placebo.

Dose: 150 mgDuration: 12 weeksForm: PA-free extract
Citation: Guo et al. (2007). Herbal medicines for the treatment of allergic rhinitis: a systematic review.
Migraine prevention
Adults with migraine · RCT
High

Petasites extract significantly reduced migraine attack frequency compared to placebo.

Dose: 150 mgDuration: 4 monthsForm: PA-free extract
Citation: Lipton et al. (2004). Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology.
Migraine prevention
Adults with migraine · RCT
High

Petasites extract 75 mg bid was more effective than placebo and well tolerated.

Dose: 150 mgDuration: 4 monthsForm: PA-free extract
Citation: Grossman et al. (2001). An extract of Petasites hybridus is effective in the prophylaxis of migraine.
Migraine prevention
Adults with migraine · RCT
High

Petasites extract 75 mg bid reduced migraine frequency by 48% compared to placebo.

Dose: 150 mgDuration: 4 monthsForm: PA-free extract
Citation: Laccourreye et al. (2017). Benefits, pitfalls and risks of phytotherapy in clinical practice in otorhinolaryngology.
Mild gastrointestinal events were reported.
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How to take it

Take 75 mg of PA-free extract twice daily.

PA-free extract
Standardized to contain petasin and isopetasin, free of pyrrolizidine alkaloids to avoid hepatotoxicity.
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