Petadolex for Migraine Prophylaxis: The Facts

Posted by Sonia Jasuja, MSIV Drexel University College of Medicine

As a current student of traditional Western Medicine, I have been trained to turn towards modern pharmacology and away from natural remedies, for the most part.  However, as someone who has suffered from severe skin allergies all my life, I know how desperate patients can get in order to find something that really works! When Western Medicine fails us, where can we turn?

During my clinical Neurology rotation at Monmouth Medical Center, I saw another issue that plagues patients: Migraine.  While there have been great advances in the prevention and treatment of migraine, some patients are still left with debilitating pain. It was during this rotation that I first heard about Petadolex, or Petasites hybridus (aka Butterbur).

What is it? Butterber is an herbal plant that has been used for medicinal purposes, including migraine and headache, allergies, asthma, and many more. Most herbal remedies use the root extract in the form of a pill. It has properties that relieve spasms and decrease inflammation.¹

Is it safe? Yes- studies have determined that Petasites is safe to use for the prophylaxis of migraine. The dose that was cited to have moderate efficacy is 150mg daily.²

Side effects are very mild and include burping, stomach upset, diarrhea, fatigue and itching.³

One important thing to keep in mind- make sure to only buy Petasites hybridus that is certified and labeled, “PA free”. “PA” stands for pyrrolizidine alkaloids, which cause adverse effects in the liver, lungs and circulatory system. PA’s can cause cancer.³

You should not take Petasites if you are pregnant or breast-feeding, have liver disease, or if you are allergic to ragweed, marigolds, daisies or other related herbs. ³

Does it work? Probably, but we still need more information! In 2006, Agosti et al. published “Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: A systematic review”. Of the two studies that were looked at, the systematic review showed that there is only moderate evidence for the effectiveness of Petasites at the dose of 150mg/day for a period of 3-4 months. The review also thoughtfully pointed out that confounding factors still need to be accounted for. These factors would include things like which migraine treatments have been successful or unsuccessful in the past, and any use of addictive or hormonal substances, such as nicotine or estrogens.²

The review article states that the overall effect size of the 150mg extract dose is approximately 15% percent lower migraine frequency rate per month compared to placebo.²

The bottom line.  If you have frequent or debilitating headaches, you should see you doctor for an evaluation.  You may need some diagnostic testing, and there are probably some very effective conventional medications you can try.  However, if you are still having frequent headaches despite that, Petasites might be worth a try.

REFERENCES

1. Brind’Amour, Katie. “Migraine Herbal Home Remedies From Around the World.”Healthlines RSS News. Healtline Editorial Team, 16 Apr. 2013. Web. 16 Nov. 2013.

2. R. Agosti, R.K. Duke, J.E. Chrubasik, S. Chrubasik, Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: A systematic review, Phytomedicine, Volume 13, Issues 9–10, 24 November 2006, Pages 743-746, ISSN 0944-7113, http://dx.doi.org/10.1016/j.phymed.2006.02.008.

3. “Butterbur Information | Evidenced-Based Supplement Guide.” MedicineNet. MedicineNet.com, n.d. Web. 16 Nov. 2013.

Poor migraine control leads to chronic daily headache

Many patients manage their infrequent migraine headaches with triptan medications, such as sumatriptan.

We call these “abortive” medications – you take them as needed whenever you have a headache to make it go away.

These medications set off an “explosion” of chemicals inside the brain, “extinguishing” the migraine just like an explosion of dynamite can put out an uncontrolled oil rig fire:

However, sometimes, that “chemical explosion” doesn’t put the fire out completely, and it comes right back.

We call this “rebound” headache, and we have already blogged about how taking too much abortive medication (including over the counter medications like Excedrin Migraine) for migraines can lead to  headache all the time, chronic daily headache, because of analgesic rebound.

Data from a new study has recently confirmed this:  The large American Migraine Prevalence and Prevention (AMPP) study showed that patients with very poor headache control were 4 times more likely to progress into chronic migraine during the following year than those with better control.

Clearly, poor headache control leads to more and more headaches, presumably because of analgesic rebound.

The solution?  Obtaining more sustained migraine control by starting a daily preventative medication for migraine like topiramate, valproic acid or botulinum toxin.

If your headaches are getting more frequent or out of control, seek the help of a board certified neurologist sooner rather than later!