A 2020 review looked at 19 randomized studies of single herbs for migraine and used 2 different words. Feverfew was mixed and butterbur was positive.
That sounds like a clear winner until you read the second half. Butterbur carries a liver-safety concern that feverfew does not.
Quick Answer: Feverfew or Butterbur?
A systematic review of 19 randomized studies described feverfew findings as mixed and butterbur as positive but limited. Butterbur has the better efficacy signal and a serious catch: unpurified preparations carry a hepatotoxicity concern. Neither has a large effect size, and feverfew's best trial produced a difference of 0.6 attacks a month against placebo.
Key Takeaways
- A 2020 review of 19 studies called feverfew findings mixed overall.
- It described butterbur as positive, albeit limited across those 19 studies.
- Unpurified butterbur carries 1 liver concern that feverfew does not.
- The best feverfew trial produced a 0.6-attack difference every month.
- Risk of bias was high for many of those 19 studies.
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What the Review Actually Said
The wording in a systematic review carries a lot of information, and this one chose its words carefully.
| Herb | How the review described it |
|---|---|
| Feverfew | Findings on efficacy were mixed |
| Butterbur | Positive, albeit limited evidence |
| Curcumin, citron, coriander | Positive preliminary findings, prophylaxis |
| Menthol and chamomile | Positive preliminary findings, acute use |
| Overall | Risk of bias high for many of the 19 studies |
Positive but limited is not the same as proven, and mixed is not the same as useless.[1]Herbal treatments for migraine: A systematic review of randomised-controlled studies — Phytotherapy Research (2020) View source What feverfew is comes first, in our guide to the herb itself.
The Butterbur Catch
Anyone comparing these 2 needs the safety half of the comparison, not just the efficacy half.
- The concern: Hepatotoxicity with unpurified preparations.
- Why: Naturally occurring pyrrolizidine alkaloids in the plant.
- What matters: Whether a product is certified free of them.
- Feverfew equivalent: No comparable liver concern.
That is why we do not stock butterbur and why a straight swap is the wrong way to read the evidence. Feverfew safety is set out in the safety cautions.
The Effect Sizes, Side by Side
What actually matters is how much either one moves the attack count.
| Measure | Feverfew |
|---|---|
| Best single trial, feverfew arm | 4.8 down to 2.9 attacks a month |
| Best single trial, placebo arm | 4.8 down to 3.5 attacks a month |
| Difference between arms | 0.6 attacks a month |
| 2025 pooling, 9 trials, 899 people | Frequency down 1.11 |
| 2025 pooling, pain severity | Down 0.63, not significant |
Cochrane could not pool its 6 trials at all, which limits how confidently any comparison can be made.[2]Feverfew for preventing migraine — Cochrane Database of Systematic Reviews (2015) View source The full reading is in the 0.6-attack difference.
What Else People Compare
Three other options come up constantly, and they sit outside the herbal comparison.
- Magnesium: A nutrient with its own separate migraine literature.
- Riboflavin: Vitamin B2, also studied for prevention.
- CoQ10: Another commonly used option.
- Prescription prevention: Larger effect sizes than any of these 3.
None of those is a herb, which is why the 2020 review did not cover them, and the last line is the one worth acting on for frequent migraines.
How to Choose
A short decision list, given what the evidence supports.
| Situation | The reasonable step |
|---|---|
| Frequent or worsening migraines | A clinician, for prescription prevention |
| Occasional, wanting to try something | Feverfew, at under 1 fewer attack a month |
| Considering butterbur | Only a preparation certified free of alkaloids |
| Already on anticoagulants | Ask before starting either of the 2 |
| Pregnant | Neither |
Adverse events in the largest feverfew trial were 8.4% against 10.2% on placebo, which is where the well-tolerated description comes from.[3]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) View source If the second line describes you, a 1000 mg feverfew capsule is the cheap option.
Seek Urgent Assessment Rather Than Comparing Supplements If
- A sudden severe headache unlike any before, or a headache with fever, neck stiffness, confusion, weakness, vision loss or after a head injury
- Any change in the pattern, frequency or character of long-standing migraines
- Pregnancy, or planning a pregnancy
- Taking warfarin, another anticoagulant, or an antiplatelet medicine
- A known allergy to ragweed, chrysanthemums, marigolds or daisies
Frequently Asked Questions
Is feverfew or butterbur better for migraines? +
A 2020 review of 19 studies called feverfew mixed and butterbur positive but limited. Butterbur also carries a liver concern that feverfew does not.
Is butterbur safe to use for migraines? +
Only if the preparation is certified free of pyrrolizidine alkaloids. That is the 1 detail that decides the safety question.
Who should not take butterbur? +
Anyone using an unpurified preparation, and anyone with liver disease. Those 2 reasons are why we do not stock it.
What is the best herb for migraine headaches? +
On that 2020 review, butterbur had the better signal of the 2 and feverfew the cleaner safety record. Neither has a large effect size.
Can I take feverfew and butterbur together? +
There is no trial of the combination. Stacking 2 herbs multiplies the unknowns rather than the benefit.
What about magnesium for migraines? +
Magnesium is a nutrient with its own separate literature, so it was not among the 19 herbal studies reviewed here.
Is a combination formula better? +
No trial has compared a combined formula against feverfew alone. The 6 Cochrane trials all tested feverfew monopreparations.
Does feverfew work as well as prescription prevention? +
No. Prescription options have far larger effect sizes than the 0.6-attack difference feverfew produced in its best trial.
What not to take with butterbur? +
Anything else affecting the liver, and it is a conversation for a clinician rather than a shelf. We stock feverfew instead of the 2.
Which is cheaper? +
Feverfew is usually the cheaper of the 2 per month, at 1 capsule daily. Cost is a poor tie-breaker when both effect sizes are small.
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