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June 30, 2000 -- Herbs continue to make inroads in health care. A drug made from the root of the butterbur plant may be effective at reducing the frequency of migraine attacks and may also help to relieve the intensity and duration of the throbbing, head-crushing pain migraine sufferers feel, according to a New York-based headache researcher speaking at a scientific meeting of the American Headache Society.
But before you rush out to the natural-foods store or dial up your herbal medicine provider on the Internet, you should be aware that butterbur plant extracts normally contain high levels of cancer-causing chemicals. And even though one company says it has come up with a way to remove these substances from the plant extract, some doctors who specialize in the treatment of headache and severe pain question whether the safety of even a modified form of the drug has been established.
In a study of the purified form of butterbur root extract, called Petadolex, in patients with migraines, the drug appeared to be effective at reducing the frequency of migraine attacks. Patients who took the drug in a pill form twice a day for up to 12 weeks had a 50% reduction in migraine frequency after 12 weeks. By comparison, patients taking a dummy pill experienced reductions in the frequency of their migraines by only 10%. Patients in the treatment group also reported shorter duration and intensity of pain, but these effects were less obvious and therefore less conclusive, reported Alexander Mauskop, MD, director of the New York Headache Center in New York City.
The butterbur plant is found in Northern Asia, Europe, and parts of North America, and goes by a variety of monikers, including blatterdock, bog rhubarb, flapperdock, and langwort. Mauskop says that the plant has been used for centuries as a folk remedy to treat spasms of the digestive tract, bronchial asthma, and whooping cough. Modern studies have suggested that the plant works by quieting spasms in some muscle tissues, including the walls of blood vessels, and by reducing inflammation.
The bad news is that despite the seemingly harmless name, butterbur contains high levels of cancer causing compounds. But a German maker of plant-derived drugs has reputedly, through a patented, highly complex process, been able to isolate and purify the beneficial parts of butterbur.
According to Mauskop, there were no reported side effects among patients who took the purified butterbur root extract, an assertion that raises eyebrows among many of his colleagues.
"I was intrigued by the relatively high response rate [of patients to butterbur root extract], and particularly if it's side effect-free, I think it's great. The problem is that the devil is always in the details, and I didn't see enough data," Fahid H. Bajwa, MD, tells WebMD. Bajwa is assistant professor of anesthesia and neurology at Harvard Medical School and a staff member of the pain management and comprehensive headache centers at Beth Israel Deaconess Medical Center in Boston.
Bajwa tells WebMD that drugs that affect the immune system, as butterbur is reported to do, usually cause side effects, and that when the goal of drug therapy is to prevent a disabling condition such as severe migraines, it's important to make sure that the drug itself does not have disabling side effects.
Mauskop doesn't dispute that the jury is still out on the promise of butterbur. "The second study that's underway now will give us more solid data," he tells WebMD. "I agree that you cannot make a conclusion that the extract is effective in the treatment of migraines yet. But the suggestive evidence is that it is ... and this is a first step."
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