Spreading butterbur
It started with a headache.
I was in that space where nothing was helping. Not the Neurontin my Neuro prescribed, not the large doses of Vicodin and especially not the Butalbital that I'd relied on for so many years. The headaches and nausea have been among the worst I have had in my life.
So I started Googling. Among the herbal remedies I found was an herb called Butterbur. When looking into why it may work, I found a passage indicating that it was thought that chemicals called petasites, found in large quantities in the rhyzome of Butterbur, may lower the the reactivity of smooth muscles around the arteries in the head that spasm when a migraine occurs. As a life-long asthmatic, I know all about smooth muscles; it is the smooth muscles around the bronchi that spasm during an asthma attack. Sure enough, Butterbur was also indicated in the treatment of allergies and asthma. Looking further, I found that the mechanism of action is leukotriene inhibition like the asthma drugs Accolate and Singulair.
Something else clicked then. If an herb that acts on the smooth muscles works for both conditions, then there should be a correlation between asthma and migraine. Once again, I started Googling. A search of migraine asthma relationship turns up about 150 different studies showing comorbidity between the conditions. In one case review study of over 60,000 pairs in the UK it was found that it was 1.6 times more likely that a person with asthma would have migraines. The study managers factored out circumstances such as higher frequency of office visits (they found a lower correlation between, say, migraines and diabetes despite the similar high rate of office visits among diabetics. The smaller increase in frequency among diabetics was thought due to a higher incidence of proper diagnosis of migraine) and differences in age.
While the petasites in Butterbur are likely to aid in treatment of asthma and migraines, another group of chemicals known as unsaturated pyrrolizidine alkaloids (PAs) also occur in the raw herb and they can be deadly. If you think you may have seen pyrrolizidine before, you may have encountered it on the label of an ecologically-friendly pesticide or flea treatment. PAs are found in members of the Asteraceae (Daisy) and Boraginaceae (Borage) families, and Butterbur belongs to the latter group. Other members are chrysanthemums, daisies, marigolds, borage, coltsfoot (tussilago) and comfrey, and varying amounts of petasites and PAs are found in all of them. They have all been used at one time or another for the treatment of asthma for some 3000 years. PAs, however, are highly toxic to the liver (for all my chemistry geek buddies: they are broken down by CYP3A4 and glutathione into toxic pyrrole intermediates. The reactive pyrrole intermediates form covalent bonds with nucleic acids and disrupt cellular protein synthesis and cell replication).
I started using purified Butterbur extract, and have found is does help my asthma. I haven't had a migraine since starting it though the literature suggests that migraine prevention typically occurs after one month of regular use. A dose of 50-75 mg per day is recommended. If the Butterbur extract does not say that it is PA-free, don't use it. Further, a standard Chinese herb, kuan dong hua, is a coltsfoot or butterbur extract and some brands have been found to contain PAs. The Japanese often use Fuki, or Japanese Butterbur, in fried form or as Fuki-miso and these may also contain PAs if not properly prepared.
Butterbur may interact with drugs that are also broken down by CYP3A4, so check with your doctor or pharmacist before taking it.
I was in that space where nothing was helping. Not the Neurontin my Neuro prescribed, not the large doses of Vicodin and especially not the Butalbital that I'd relied on for so many years. The headaches and nausea have been among the worst I have had in my life.
So I started Googling. Among the herbal remedies I found was an herb called Butterbur. When looking into why it may work, I found a passage indicating that it was thought that chemicals called petasites, found in large quantities in the rhyzome of Butterbur, may lower the the reactivity of smooth muscles around the arteries in the head that spasm when a migraine occurs. As a life-long asthmatic, I know all about smooth muscles; it is the smooth muscles around the bronchi that spasm during an asthma attack. Sure enough, Butterbur was also indicated in the treatment of allergies and asthma. Looking further, I found that the mechanism of action is leukotriene inhibition like the asthma drugs Accolate and Singulair.
Something else clicked then. If an herb that acts on the smooth muscles works for both conditions, then there should be a correlation between asthma and migraine. Once again, I started Googling. A search of migraine asthma relationship turns up about 150 different studies showing comorbidity between the conditions. In one case review study of over 60,000 pairs in the UK it was found that it was 1.6 times more likely that a person with asthma would have migraines. The study managers factored out circumstances such as higher frequency of office visits (they found a lower correlation between, say, migraines and diabetes despite the similar high rate of office visits among diabetics. The smaller increase in frequency among diabetics was thought due to a higher incidence of proper diagnosis of migraine) and differences in age.
While the petasites in Butterbur are likely to aid in treatment of asthma and migraines, another group of chemicals known as unsaturated pyrrolizidine alkaloids (PAs) also occur in the raw herb and they can be deadly. If you think you may have seen pyrrolizidine before, you may have encountered it on the label of an ecologically-friendly pesticide or flea treatment. PAs are found in members of the Asteraceae (Daisy) and Boraginaceae (Borage) families, and Butterbur belongs to the latter group. Other members are chrysanthemums, daisies, marigolds, borage, coltsfoot (tussilago) and comfrey, and varying amounts of petasites and PAs are found in all of them. They have all been used at one time or another for the treatment of asthma for some 3000 years. PAs, however, are highly toxic to the liver (for all my chemistry geek buddies: they are broken down by CYP3A4 and glutathione into toxic pyrrole intermediates. The reactive pyrrole intermediates form covalent bonds with nucleic acids and disrupt cellular protein synthesis and cell replication).
I started using purified Butterbur extract, and have found is does help my asthma. I haven't had a migraine since starting it though the literature suggests that migraine prevention typically occurs after one month of regular use. A dose of 50-75 mg per day is recommended. If the Butterbur extract does not say that it is PA-free, don't use it. Further, a standard Chinese herb, kuan dong hua, is a coltsfoot or butterbur extract and some brands have been found to contain PAs. The Japanese often use Fuki, or Japanese Butterbur, in fried form or as Fuki-miso and these may also contain PAs if not properly prepared.
Butterbur may interact with drugs that are also broken down by CYP3A4, so check with your doctor or pharmacist before taking it.