Migräneprophylaxe mit Petasites (Pestwurz)

H. Göbel; R. Pothmann; R. Bauer; U. Danesch

doi:10.1055/s-0038-1629954

Nervenheilkunde, Table of Contents

Nervenheilkunde 2005; 24(03): 211-216
DOI: 10.1055/s-0038-1629954

Deutsche MigrÄne- Und Kopfschmerz-Gexellschaft

Schattauer GmbH

Migräneprophylaxe mit Petasites (Pestwurz)

Klinik und Pharmakologie eines SpezialextraktsMigraine prevention with Petasites (Butterbur)Clinic and pharmacology of a special root extract

Authors

H. Göbel

¹Neurologisch-verhaltensmedizinische Schmerzklinik Kiel
R. Pothmann

²Klinikum Heidberg, Zentrum für Kinderschmerztherapie, Hamburg
R. Bauer

³Institut für pharmazeutische Wissenschaften, Pharmakognosie, Karl-Franzens-Universität Graz
U. Danesch

³Institut für pharmazeutische Wissenschaften, Pharmakognosie, Karl-Franzens-Universität Graz

Abstract

Zusammenfassung

Seit vielen Jahrhunderten wird die Pestwurz (Petasites hybridus) traditionell bei Schmerzen, Fieber und krampfartigen Zuständen eingesetzt. Pharmakologisch handelt es sich bei dem Pestwurz-Spezialextrakt um einen Lipoxygenase- und selektiven Zyklooxygenase-2-Hemmer. In der heutigen Medizin dient die Pestwurz hauptsächlich zur Prophylaxe von Migräneanfällen. Die Wirksamkeit und Sicherheit eines Pestwurz-Spezialextrakts aus dem Rhizom wurde in zwei randomisierten, doppelblinden und Plazebo-kontrollierten Studien mit mehr als 300 Patienten belegt. Die Zahl der Migräneanfälle konnte deutlich reduziert werden, bei mehr als zwei Drittel aller Patienten um mindestens 50%. Eine vergleichbare Wirkung wurde auch bei 108 Kindern und Jugendlichen in einer offenen Studie gezeigt. Nebenwirkungen sind selten und von milder Natur; überwiegend wurden Magenstörungen wie Ruktus berichtet.

Summary

For many centuries butterbur (Petasites hybridus) was traditionally used for conditions like pain, fever and spasms. Pharmacologically, the special butterbur root extract is a lipoxygenase and specific cyclooxygenase-2 inhibitor. Today, butterbur is mainly prescribed for migraine prevention. Efficacy and tolerability of a special butterbur root extract was demonstrated in two randomised, double-blind and placebo-controlled clinical trials with more than 300 patients. Migraine attacks could be significantly reduced. Also, more than two thirds of all patients experienced a reduction of migraine attacks of 50% or greater. A comparable efficacy was also demonstrated in an open trial with 108 children and adolescents. Side effects are rare and of mild nature, gastrointestinal discomfort like eructation is mostly reported.

Schlüsselwörter

Pestwurz - Migräneprophylaxe - Petasine - Lipoxygenase - Zyklooxygenase

Keywords

Butterbur - migraine prevention - petasins - lipoxygenase - cyclooxygenase

Full Text

References

Literatur
1 Barsom S. Behandlung von Koliken und Spasmen in der Urologie mit einem pflanzlichen Spasmolytikum. Erfahrungsheilkunde 1986; 35: 1-11.
2 Bickel D, Roder T, Bestmann HJ, Brune K. Identification and characterization of inhibitors of peptido-leukotriene-synthesis from Petasites hybridus. Planta Med 1994; 60: 318-22.
3 Danesch U. Petasites hybridus (Butterbur root) extract in the treatment of asthma – an open trial. Altern Med Rev 2004; 9: 54-62.
4 Danesch U, Rittinghausen R. Safety of a patented special butterbur root extract for migraine prevention. Headache 2003; 43: 76-8.
5 Diener HC, Hartung E, Chrubasik J, Evers S, Schoenen J, Eikermann A, Latta G, Hauke W. Study Group. A comparative study of oral acetylsalicyclic acid and metoprolol for the prophylactic treatment of migraine. A randomized, controlled, double-blind, parallel group phase III study. Cephalalgia 2001; 21: 120-8.
6 Diener HC, Matias-Guiu J, Hartung E, Pfaffenrath V, Ludin HP, Nappi G, De Beukelaar F. Efficacy and tolerability in migraine prophylaxis of flunarizine in reduced doses: a comparison with propranolol 160 mg daily. Cephalalgia 2002; 22: 209-21.
7 Diener HC, Rahlfs VW, Danesch U. The First Placebo-Controlled Trial of a Special Butterbur Root Extract for the Prevention of Migraine: Reanalysis of Efficacy Criteria. Eur Neurol 2004; 51: 89-97.
8 Esberg LB, Wang GJ, Lin YL, Ren J. Iso-S-petasin, a hypotensive sesquiterpene from Petasites formosanus, depresses cardiac contraction and intracellular Ca2+ transients in adult rat ventricular myocytes. J Pharm Pharmacol 2003; 55: 103-7.
9 Evers S. Drug treatment of migraine in children: a comparative review. Paediatr Drugs 1999; 1: 7-18.
10 Ferriere G. Flunarizine in the prophylactic treatment of paediatric migraine. Cephalalgia 1985; 5 (Suppl. 03) 176-7.
11 Fiebich BL, Grozdeval M, Hess S, Hüll M, Danesch U, Bodensieck A, Bauer R. Petasites hybridus extracts inhibit COX-2 and PGE2 release by direct interaction with the enzyme and by preventing p42/44 MAP kinase activation in rat primary microglial cells. Planta Med. 2004 accepted for publication.
12 Garcia Rodriguez LA, Perez Gutthann S, Walker AM, Lueck L. The role of non-steroidal anti-inflammatory drugs in acute liver injury. BMJ 1992; 305: 865-8.
13 Gillies D, Sills M, Forsythe I. Pizotifen (Sanomigran) in childhood migraine. A double-blind controlled trial. Eur Neurol 1986; 25: 32-5.
14 Gruia FS. Zur biologischen Schmerzbekämpfung. Ergebnisse einer Praxisstudie am Beispiel eines Phytotherapeutikums. Erfahrungsheilkunde 1986; 35: 396-401.
15 Guidetti V, Moscato D, Ottaviano S, Fiorentino D, Fornara R. Flunarizine and migraine in childhood. An evaluation of endocrine function. Cephalalgia 1987; 7: 263-6.
16 Hershey AD, Tang Y, Powers SW, Kabbouche MA, Gilbert DL, Glauser TA, Sharp FR. Genomic abnormalities in patients with migraine and chronic migraine: preliminary blood gene expression suggests platelet abnormalities. Headache 2004; 44: 994-1004.
17 Klapper J. Divalproex sodium in migraine prophylaxis: a dose-controlled study. Cephalalgia 1997; 17: 103-8.
18 Ko W, Lei C, Lin Y, Chen C. Mechanisms of relaxant action of S-petasine and S-Isopetasin, sesquiterpenes of Petasites formosanus, in isolated guinea pig trachea. Planta Med 2001; 67: 224-9.
19 Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology 2004; 63: 2240-4.
20 Luo SF, Wang CC, Chien CS, Hsiao LD, Yang CM. Induction of cyclooxygenase-2 by lipopolysaccharide in canine tracheal smooth muscle cells: involvement of p42/p44 and p38 mitogen-activated protein kinases and nuclear factorkappaB pathways. Cell Signal 2003; 15: 497-509.
21 Pérez Gutthann S, García Rodríguez LA. The increased risk of hospitalizations for acute liver injury in a population with exposure to multiple drugs. Epidemiology 1993; 4: 496-501.
22 Pothmann R, Danesch U. Migraine Prevention in Children and Adolescents. Results of an Open Study With a Special Butterbur Root Extract. Headache. accepted for March 2005.
23 Teschke R. Arzneimittelbedingte Lebererkrankungen. In: Toxische Lebererkrankungen. Stuttgart, New York: Thieme; 2001
24 Salmon MA. Pizotifen (BC.105. Sandomigran) in the prophylaxis of childhood migraine. Cephalalgia 1985; 5 (Suppl. 03) 178.
25 Scheidegger C, Dahinden C, Wiesmann U. Effects of extracts and of individual components from Petasites on prostaglandin synthesis in cultured skin fibroblasts and on leucotriene synthesis in isolated human peripheral leucocytes. Pharm Acta Helv 1998; 72: 376-8.
26 Sheftell F, Rapoport A, Weeks R, Walker B, Gammerman I, Baskin S. Montelukast in the prophylaxis of migraine: a potential role for leukotriene modifiers. Headache 2000; 40: 158-63.
27 Silberstein SD, Neto W, Schmitt J, Jacobs D. MIGR-001 Study Group. Topiramate in migraine prevention: results of a large controlled trial. Arch Neurol 2004; 61: 490-5.
28 Sorge F, De Simone R, Marano E, Nolano M, Orefice G, Carrieri P. Flunarizine in prophylaxis of childhood migraine. A double-blind, placebo-controlled, crossover study. Cephalalgia 1988; 8: 1-6.
29 Sorge F, Marano E, Flunarizine V. Placebo in childhood migraine. A double-blind study. Cephalalgia 1985; 5 (Suppl. 02) 145-8.
30 Symon DNK, Russell G. The general paediatricians view of migraine: a review of 250 cases. In: Lanzi G, Balottin U, Cernibori A. (eds). Headache in children and adolescents. Amsterdam: Elsevier; 1989: 61-6.
31 Thomet OA, Wiesmann UN, Blaser K, Simon HU. Differential inhibition of inflammatory effector functions by petasin, isopetasin and neopetasin in human eosinophils. Clin Exp Allergy 2001; 31: 1310-20.
32 Van der Kuy P, Lohman J. A quantification of the placebo response in migraine prophylaxis. Cephalalgia 2002; 22: 265-70.
33 Wang G-J, Shum AY-C, Lin Y-L. et al. Calcium channel blockade in vascular smooth muscle cells: major hypotensive mechanism of S-petasine, a hypotensive sesquiterpene from Petasites formosanus. J Pharm Exp Ther 2001; 297: 240-6.
34 Ziolo G, Samochewiec L. Study on clinical properties and mechanism of action of Petasites in bronchial asthma and chronic obstructive bronchitis. Pharm Acta Helv 1998; 72: 359-80.