Feverfew vs Butterbur
Which is better for headaches?
Awaiting clinical review. This comparison is built from sourced entries but has not yet been signed off by a pharmacist or clinician.
Short answer
For preventing migraine, feverfew is the more sensible one to try: its benefit is small (Limited, 2; about 0.6 fewer attacks a month than placebo in the best trial) but it was well tolerated in trials. Butterbur has the better-rated evidence (Moderate, 3; 48% fewer attacks versus 26% on placebo in one trial of a special extract), but liver injury has been reported even with PA-free products, the UK regulator advised against unlicensed butterbur in 2012, and the American Academy of Neurology withdrew its endorsement in 2015. Neither is a first-line answer, and migraine should be confirmed by a doctor first.
Well tolerated in trials, with a small benefit: 0.6 fewer attacks a month than placebo
Higher-rated evidence (48% vs 26% fewer attacks), but rare liver injury even with PA-free products
Side by side
| Attribute | Feverfew | Butterbur |
|---|---|---|
| Evidence for headaches | Limited (preventing migraine) | Moderate (migraine prevention) |
| Best for | Preventing migraine | Migraine prevention |
| How fast | 4+ weeks | 4+ weeks |
| Typical form | Leaf powder 100–600 mg/day | PA-free root extract, 75 mg twice daily |
| Main caution | Not for pregnancy; may slow blood clotting | Rare liver injury, even with PA-free products |
| Safe in pregnancy? | No; NCCIH and EU regulator advise against | Avoid; PA-free safety unclear |
| Liver safety | No liver warning in the entry | Rare liver injury, even PA-free; MHRA alert 2012 |
| Blood thinners | May slow clotting; ask first | No interaction recorded |
Which should you pick?
Choose Feverfew if
- you want the lower-risk option and can accept a small, uncertain benefit
- you are an adult who is not pregnant, not on blood thinners and has no daisy-family allergy
- you can give it about 2 months and keep a migraine diary
Choose Butterbur if
- you have talked to a doctor, have no liver problems, and accept the liver risk
- you will use only a product labelled PA-free, for no more than about 16 weeks
- you are not pregnant or breastfeeding and have no ragweed or daisy allergy
Questions people ask
Can I take feverfew and butterbur together?
Neither entry reviews taking them together, and no interaction between them is recorded. Combining adds each one's cautions, and butterbur's liver risk means that decision belongs with a doctor.
Which works better for migraine prevention, feverfew or butterbur?
Butterbur has the stronger trial result: a special root extract at 75 mg twice daily cut attacks by 48% versus 26% on placebo over 4 months in 245 people. Feverfew is weaker, with the Cochrane review calling the evidence low quality and the best trial finding 0.6 fewer attacks a month than placebo. The butterbur figure comes from one manufacturer's extract, and its safety concerns outweigh the difference for most people.
Why did the American Academy of Neurology withdraw butterbur?
A 2012 AAN guideline rated butterbur effective for migraine prevention, but according to NCCIH the Academy withdrew that endorsement in 2015 because of safety concerns. NCCIH says even PA-free butterbur products have been linked to rare liver injury, and the MHRA advised against unlicensed products in January 2012.
How long should I try either for?
Feverfew's EU monograph gives about 2 months to judge an effect and advises seeing a doctor if migraines recur after that. The butterbur migraine trial ran 4 months, and NCCIH says PA-free products appear safe for up to 16 weeks, with long-term safety unknown.
Sources
- Cochrane review Wider B, Pittler MH, Ernst E. Feverfew for preventing migraine. Cochrane Database Syst Rev. 2015.
- Randomised controlled trial Diener HC, Pfaffenrath V, Schnitker J, Friede M, Henneicke-von Zepelin HH. Efficacy and safety of 6.25 mg t.i.d. feverfew CO2-extract (MIG-99) in migraine prevention--a randomized, double-blind, multicentre, placebo-controlled study. Cephalalgia. 2005.
- Regulator/health agency NCCIH. Feverfew. National Center for Complementary and Integrative Health (last updated February 2025).
- Randomised trial Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology. 2004.
- Regulator/health agency NCCIH. Butterbur: Usefulness and Safety. National Center for Complementary and Integrative Health.
- Regulator summary Medsafe (New Zealand). Complementary Corner: Butterbur and Liver Toxicity. Prescriber Update, June 2012.