Butterbur (Petasites hybridus)

Tier 2 — promising · Migraine prevention · Allergies

One of the few herbal supplements with strong evidence for migraine prevention. AAN and AHS guidelines previously recommended 150 mg per day based on trials showing a 48 percent reduction in migraine frequency. However, raw butterbur contains pyrrolizidine alkaloids that cause liver damage. Only PA-free certified extracts (like Petadolex) are safe. Product was withdrawn from German market in 2009 over quality concerns. Use only PA-free brands.

Dose: 75 mg PA-free extract twice daily for migraine prevention; ONLY use certified PA-free products