Herbal treatment of headache.

Herbal (botanical) therapy has been used as treatment for headache disorders for millennia. Botanical therapy can be divided into 3 categories: oral, topical, and "aromatherapy." In this article, the options in these categories and the evidence supporting their use are discussed. Unfortunately, evidence is sparse for most herbal treatments, in large part due to a paucity of funding for the type of studies needed to assess their efficacy. Butterbur and feverfew are the 2 herbal oral preparations best studied, and they seem to have real potential to help many patients with migraine and perhaps other headache types. Patients most appropriate for trials of herbal therapy include those who have been refractory to pharmaceutical and other modes of therapy, patients who have had intolerable side effects from pharmaceutical medications, and patients willing to participate in controlled comparative studies. As for mechanisms behind botanical treatments, the lack of funding for studying these agents will continue to retard progress in this area as well, but hopefully the future will bring more concentrated efforts in this field.