Herbs for Headache and Migraine: Feverfew, Butterbur and Others
What trials and official bodies say about feverfew, butterbur and peppermint for headache and migraine, including why butterbur is no longer recommended and when a headache is an emergency.
Content last updated . This page has not been medically reviewed.
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Emergency signs first
A sudden headache that is extremely painful needs emergency care, as do headaches with trouble speaking or remembering, numbness or weakness on one side, a seizure, drowsiness or confusion, or loss of vision. [1][2] MedlinePlus says to get medical help right away for a headache after a blow to the head, or with a stiff neck, fever, confusion, loss of consciousness, or pain in the eye or ear. [3] In the US, call 911. Do not try a herb first. For a migraine, the NHS also advises urgent advice if an attack lasts longer than 72 hours, aura lasts more than an hour, or you are pregnant or just had a baby. [1]What this page covers
Only a few herbs have been studied for migraine prevention. Names follow GBIF: feverfew is Tanacetum parthenium (leaf or herb) [6][7]; butterbur is Petasites hybridus (root extract was studied) [6][4]; peppermint is Mentha × piperita. [6] European feverfew is a different plant from American feverfew (Parthenium integrifolium). [7] See feverfew and butterbur.Traditional use (not proof)
NIH says people have traditionally used feverfew for many purposes, including respiratory, digestive and menstrual disorders, kidney and liver disease, earache and fever. [7] Traditional use does not show that it prevents migraine.What research shows
| Herb | What the source found | Strength of evidence | Form and people studied |
|---|---|---|---|
| Feverfew | A 2015 Cochrane review found six trials (561 people). In the largest, feverfew cut attacks by 0.6 per month more than placebo; the authors call the evidence low quality. [8] NIH describes a 2020 review of 7 studies (634 people) with inconsistent findings. [7] A 2012 guideline rated one feverfew extract "probably effective." [9] | Mixed to promising but limited | Prevention of migraine; extracts, adults [8] |
| Butterbur | NIH: a root extract may reduce migraine frequency in adults and children. [4] A 2012 guideline said it should be offered. [9] | Promising, but safety concerns led to withdrawal of the recommendation | PA-free root extracts, taken by mouth [4] |
| Peppermint oil on the skin | NIH: limited evidence it might relieve tension headaches. [10] The EU committee says skin preparations on the forehead and temples can relieve mild headaches in adults. [11] | Promising but limited | Tension-type headache, not migraine; not for under 18s in the EU [11] |
| Other herbs | Proper evidence not found in the sources we read (NIH, EU, NHS, MedlinePlus pages, a Cochrane review and a US guideline). | Insufficient evidence | Not applicable |
The EU herbal committee accepts feverfew for preventing migraine after a doctor has excluded serious conditions, as "traditional use" because clinical-trial evidence is insufficient; it says use in adults only and that it usually takes about 2 months to have an effect. [12] For other prevention options the NHS lists medicines, acupuncture, relaxation, cognitive behavioral therapy and vitamin B2; see riboflavin and migraine. [1]
Frequently asked questions
Does feverfew prevent migraines?
Evidence is mixed. A Cochrane review called it low-quality evidence, with one larger trial showing a small benefit of 0.6 attacks per month over placebo. [8]
Is butterbur safe for migraine?
NIH says PA-free products seem safe in short studies but rare liver injury has been reported, and the neurology academy stopped recommending it in 2015. [4]
Can peppermint oil help a headache?
Limited evidence suggests skin application might help tension headaches. [10]
When is a headache an emergency?
When it comes on suddenly and is extremely painful, or with confusion, weakness, vision loss or a stiff neck and fever. [2][3]
Can herbs replace my migraine medicine?
Never stop a prescribed medicine on your own; ask the prescriber or pharmacist. The NHS says treatment can manage migraine but not cure it. [1]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Herb warning: butterbur and the liver
Butterbur (Petasites hybridus) contains pyrrolizidine alkaloids (PAs) that can damage the liver and lungs and may cause cancer. [4] Rare liver injury has been linked even to products described as PA-free. [4] Memorial Sloan Kettering says not to take it with liver disease. [5] The American Academy of Neurology recommended butterbur in 2012 but stopped recommending it in 2015 because of serious safety concerns. [4] See pyrrolizidine alkaloids and herbs and liver injury.
Safety
- Feverfew and withdrawal: after long use, stopping can bring muscle stiffness, anxiety, headaches, nausea and vomiting. [13]
- Allergy: people sensitive to ragweed and related plants may react to feverfew; the EU says it must not be used if allergic to the daisy family (Asteraceae). [7][12] Butterbur can also cause reactions in people allergic to ragweed, chrysanthemums, marigolds and daisies. [4] See herbal allergy and cross-reactivity.
- Medicines and bleeding: NIH says feverfew may interact with some medicines, including those used for migraine. [7] Memorial Sloan Kettering says it may have additive effects with anticoagulants and antiplatelets. [13] See herbs and blood thinners and medicine interactions.
- Surgery: NIH says feverfew may slow blood clotting and should be stopped at least 2 weeks before scheduled surgery. [7] Ask the surgical team; see herbs before and after surgery.
- Pregnancy and breastfeeding: NIH says not to take feverfew while pregnant because it may affect uterine contractions. [7] Butterbur products containing PAs should not be used in pregnancy or breastfeeding, and little is known about PA-free ones. [4]
- Everyday effects: feverfew can cause mouth sores if fresh leaves are chewed; no serious side effects were reported by NIH. [7] Peppermint oil should not go on the face of infants or young children. [10]
- Pain medicine overuse: the NHS says to try not to take painkillers for more than 2 days a week because it can cause more headaches. [1]
- Children, older adults, kidney: not described in the sources we read, except as noted above.
- Quality: see quality testing.
References
- NHS (UK). Migraine. Page last reviewed 10 March 2026. Read 2026-10-23.
- NHS (UK). Headaches. Read 2026-10-23.
- MedlinePlus (U.S. National Library of Medicine). Headache. Read 2026-10-23.
- NCCIH, NIH. Butterbur. Last updated November 2024. Read 2026-10-23.
- Memorial Sloan Kettering Cancer Center. Butterbur. Read 2026-10-23.
- GBIF Backbone Taxonomy, species match service (api.gbif.org/v1/species/match), queried for each scientific name used on this page. Read 2026-10-23.
- NCCIH, NIH. Feverfew. Last updated February 2025. Read 2026-10-23.
- Wider B, Pittler MH, Ernst E. Feverfew for preventing migraine. Cochrane Database of Systematic Reviews. 2015. Read 2026-10-23.
- Holland S, et al. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults. Neurology. 2012. Read 2026-10-23.
- NCCIH, NIH. Peppermint Oil. Last updated May 2025. Read 2026-10-23.
- European Medicines Agency (EMA), Committee on Herbal Medicinal Products (HMPC). Peppermint oil: summary for the public. Read 2026-10-23.
- EMA, HMPC. Feverfew herb: summary for the public. Read 2026-10-23.
- Memorial Sloan Kettering Cancer Center. Feverfew. Read 2026-10-23.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.