We Will No Longer be Recommending Butterbur (Petasitidis hybridus)

We just returned from an annual meeting with the American Headache Society. This is a very large meeting that draws about 400 headache specialists and researchers from around the world.  I will be back with more breaking news of headache research over the subsequent days. For now I just wanted to share one important point.

In this present time in western culture there is a belief system that “natural” is better than “unnatural.”  I will not get into a long discussion about the philosophy and marketing of these terms. But to a real scientist, these terms make no sense. Everything originates in nature and these terms were coined by marketing people.  What we know as prescription medications started in nature but was purified and tested for safety and effectiveness.  The so-called “natural” things are less processed and less tested for either safety or effectiveness.

According to this belief system of natural is better, the more processed something is by humans, the more dangerous (or toxic) it is. These ideas are based on the philosophies of people like  Jean Jacques Rousseau and others but not on science or modern medicine that is practiced around the world. But I digress.

Everyone would love to have something that is “natural” and as the marketing line goes, “Teats the cause and not just covers up the symptoms with medications.”  But that is not reality and such misleading statements comes from business marketing strategies and not from honest understanding of the real causes of headaches and the safest and most effective way to treat them.

His ideology of  “natural is better than unnatural” is nowhere more prevalent that in the Pacific Northwest.  To accommodate the interest of our patients here, we try very hard to find “natural” things that are effective and safe.  Virtually all of the so-called natural remedies for headaches, when studied honestly, are no more effective than a placebo.  There are a few exceptions.

There are behavioral things such as relaxation, biofeedback, exercise, weight loss and acupuncture that seem to be helpful. Some people may turly be benefited by avoiding triggers in their diets. There is no scientific evidence to support fad-diets that claim magic cures for headaches, such as gluten free or paleo diets. These things come and go every few years and their advocates always claim miraculous cures for about everything but are almost always proven wrong when the fad ends.

There are a few supplements including magnesium, riboflavin, Co Enzyeme Q 10 and butterbur have had studies that show some modest benefit when taken daily for long periods of time. Makers of products of butterbur have done the best studies to show effectiveness in headache prevention.  Because of this, we have often recommended butterbur first.

It may be surprising to many patients but so-called “natural” products are not regulated, especially in the United States and are not tested for safety.  In real science, we know that the most harmful toxins are found in nature.  Most of the processing that turns these things into medications are the processing that makes them non-toxic.  It has always been our concern that patients that use natural products that may hurt them in the end.

We have know from the beginning that butterbur has a natural toxin (read more here).  The one company that makes the brand “Pedadolex®” argued that they were the only ones who effectively removed this natural toxin.  However, now 40 cases of liver toxicity have been reported in Europe from patients taken butterbur. It has now been banned there.  It cannot be banned here because the powerful supplement lobby has taken the regulation of supplements out of the hands of the FDA.

So, we will no longer recommend butterbur or Migravent® because it contains butterbur.  We still recommend the other supplements and behavioral approaches. The scientists who study headache (real scientists, not people who make up things and try to market them as cures) are working tirelessly to find things that work to stop and prevent headaches including things that the public will consider “natural.”  So far, most of these studies have been disappointing at best.

I will add in closing that we have come home to 48 messages from patients and an overbooked schedule. We are working as hard as any body can work, but it will take time to get through the messages. Please be patient.