- How It Works
- Purported Uses
- Research Evidence
- Patient Warnings
- Do Not Take If
- Side Effects
- Dosage (Inside MSKCC Only)
Scientific Name
Tanacetum parthenium
Common Name
Bachelor's button, featherfew, Santa Maria, wild chamomile, wild quinine
Clinical Summary
Derived from the leaves of the plant, this herb is used primarily to treat migraine headaches. A feverfew extract has been shown to reduce the frequency of migraine attacks (1). In addition, feverfew extracts possess antiprotozoal properties (2). Although much of its activity is attributed to parthenolide, the active compound in feverfew, a parthenolide-free extract of feverfew demonstrated free radical-scavenging properties, protecting against UV-induced sun damage (3).
A few in vitro studies have shown that feverfew exhibits anticancer effects (4) (5) (6). Results from a Phase I clinical trial with cancer patients indicate that up to 4 mg of parthenolide was well tolerated; however, parthenolide could not be detected in the plasma (7).
Feverfew leaves should be administered via capsules or tablets; oral ulceration was reported among those who chewed the raw leaves or when consumed as tea (8).
Many products are standardized to a 0.2% parthenolide concentration. In vitro studies indicate that this product may interfere with the function of platelets (9). Feverfew should be not be used concomitantly with anticoagulants. Cases of airborne contact dermatitis by feverfew have been reported in susceptible individuals, and subsequent analysis has determined that parthenolide may be the allergen (10).
Purported Uses
- Arthritis
- Dysmenorrhea
- Migraine prophylaxis
- Psoriasis
Constituents
- Terpenoids: Chrysantemonin, chrysanthemolide, magnoliolide, parthenolide, santamarine, reynosin
- Volatile oils: Camphor, borneol, farnesene and their esters
- Pyrethrin
- Flavonols
- Tannins
(11)
Mechanism of Action
It is suggested that the sesquiterpene lactones, particularly parthenolide, are the active ingredients and are responsible for feverfew’s anti-inflammatory mechanism of action; parthenolide attenuates activation of the NF-kappa B complex to block transcription of inflammatory proteins (12). In glioblastoma cells, parthenolide induces caspase 3/7-mediated apoptosis independent of NF-kappa B suppression (13). It is believed that all the feverfew constituents have a synergistic effect in preventing migraines. Some researchers believe that the flavonol content has anti-inflammatory action (8) (9).
Contraindications
Patients allergic to ragweed, chrysanthemums, marigolds, or other members of the Compositae family may have cross-sensitivity to feverfew.
Adverse Reactions
Common: Minor gastrointestinal distress. Mouth ulcerations may result from chewing fresh feverfew leaves. Cases of airborne contact dermatitis have also been reported (10).
Withdrawal: Muscle stiffness, anxiety, and moderate pain usually occur following cessation of long-term feverfew use (post-feverfew syndrome). (8)
Herb-Drug Interactions
Anticoagulants / Antiplatelets: Theoretically, feverfew may have additive effects.
Cytochrome P450 enzymes: Feverfew can inhibit CYP1A2/2C8/2C9/2C19/2D6 and 3A4, and can interact with substances metabolized by these enzymes (15).
Herb Lab Interactions
Theoretically may increase PT, PTT, and INR.
Literature Summary and Critique
Murphy JJ, et al. Randomized, double-blind, placebo-controlled trial of feverfew in migraine prevention. Lancet 1988;23:189-92.
A prospective, randomized, double-blind, placebo-controlled trial of feverfew conducted in 72 patients who reported at least two years of a minimum of one migraine per month. Fifty-nine patients finished the study with a 24% reduction in the number of attacks in the feverfew group compared to the placebo group. A significant reduction in associated nausea and vomiting was noted in the feverfew group. An assessment of blinding revealed that 59% of the patients taking feverfew stated efficacy compared to 24% receiving placebo. The authors’ conclusions suggest that feverfew is safe and effective in the prophylaxis of migraine headaches.
Diener HC, et al. 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; 25:1031-1041.
One hundred and seventy patients with migraine were randomized to receive 6.25 mg feverfew CO2-extract or placebo three times a day for 16 weeks following a baseline period of 4 weeks. Results showed that the frequency of migraines decreased by 1.9 attacks in the treatment group and by 1.3 attacks in those on placebo from 4.79 attacks per month. This difference was found to be statistically significant. The feverfew extract was well tolerated with nonspecific adverse effects that were seen in the placebo group as well. Researchers conclude that feverfew is effective in reducing the frequency of migraine attacks in patients.
References
- 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. Nov 2005;25(11):1031-1041.
- Izumi E, Morello LG, Ueda-Nakamura T, et al. Trypanosoma cruzi: antiprotozoal activity of parthenolide obtained from Tanacetum parthenium (L.) Schultz Bip. (Asteraceae, Compositae) against epimastigote and amastigote forms. Exp Parasitol. Mar 2008;118(3):324-330.
- Martin K, Sur R, Liebel F, et al. Parthenolide-depleted Feverfew (Tanacetum parthenium) protects skin from UV irradiation and external aggression. Arch Dermatol Res. Feb 2008;300(2):69-80.
- Yip-Schneider MT, Nakshatri H, Sweeney CJ, Marshall MS, Wiebke EA, Schmidt CM. Parthenolide and sulindac cooperate to mediate growth suppression and inhibit the nuclear factor-kappa B pathway in pancreatic carcinoma cells. Mol Cancer Ther. Apr 2005;4(4):587-594.
- Zhang S, Ong CN, Shen HM. Involvement of proapoptotic Bcl-2 family members in parthenolide-induced mitochondrial dysfunction and apoptosis. Cancer Lett. Aug 10 2004;211(2):175-188.
- Parada-Turska J, Paduch R, Majdan M, Kandefer-Szerszen M, Rzeski W. Antiproliferative activity of parthenolide against three human cancer cell lines and human umbilical vein endothelial cells. Pharmacol Rep. Mar-Apr 2007;59(2):233-237.
- Curry EA, 3rd, Murry DJ, Yoder C, et al. Phase I dose escalation trial of feverfew with standardized doses of parthenolide in patients with cancer.Invest New Drugs. Aug 2004;22(3):299-305.
- Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J (Clin Res Ed). Aug 31 1985;291(6495):569-573.
- Williams CA, Hoult JR, Harborne JB, Greenham J, Eagles J. A biologically active lipophilic flavonol from Tanacetum parthenium. Phytochemistry. Jan 1995;38(1):267-270.
- Paulsen E, Christensen LP, Andersen KE. Compositae dermatitis from airborne parthenolide. Br J Dermatol. Mar 2007;156(3):510-515.
- Phytotherapy ESCo. ESCOP Monographs on the medicinal uses of plant drugs. Exeter, London; March 1996.
- Reuter U, Chiarugi A, Bolay H, Moskowitz MA. Nuclear factor-kappaB as a molecular target for migraine therapy. Ann Neurol. Apr 2002;51(4):507-516.
- Anderson KN, Bejcek BE. Parthenolide induces apoptosis in glioblastomas without affecting NF-kappaB. J Pharmacol Sci. Feb 2008;106(2):318-320.
- Murphy JJ, Heptinstall S, Mitchell JR. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet. Jul 23 1988;2(8604):189-192.
- Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom. 2004;18(19):2273-81.
How It Works
Bottom Line: Feverfew may benefit patients with migraine headaches.
One or more compounds found in feverfew are thought to prevent migraines. One such compound, parthenolide, was found to block the formation of inflammatory proteins in a recent laboratory study. Researchers and physicians have varying theories about what causes migraines. Inflammation is only one possible cause.
Purported Uses
- To prevent migraine headaches
Some clinical trials support this use. Post-feverfew withdrawal syndrome (consisting of muscle stiffness, anxiety, headaches, nausea, and vomiting) can occur after patients discontinue using this herb. - To treat arthritis
Although compounds in feverfew show anti-inflammatory activity in the laboratory, clinical trials do not support this use. - To relieve painful and heavy menstruation
No scientific evidence supports this use. - To treat psoriasis
Although compounds in feverfew show anti-inflammatory activity in the laboratory, there is no proof from clinical trials that this effect occurs in humans. - To treat protozoal diseases
One laboratory study found that feverfew could stop the growth of the protozoa that causes Chagas disease. - To treat sun damage
Feverfew protected against UV-induced sun damage in one laboratory study.
Research Evidence
Migraine prevention:
A randomized, controlled trial studied the use of feverfew in preventing migraine headaches. Seventy-two patients who had experienced at least one migraine per month for two years were given a feverfew or placebo capsule for four months, then switched to the other treatment for another four months. Compared to the period when they took the placebo pill, patients reported a reduction in migraine attacks, nausea, and vomiting while taking feverfew. In addition, patients taking feverfew more often reported that they found it effective. However, this study does not tell us what the long-term effects of feverfew are.
One hundred and seventy patients with migraine were randomized to receive 6.25 mg feverfew CO2-extract or placebo three times a day for 16 weeks following a baseline period of 4 weeks. Results showed that the frequency of migraines decreased by 1.9 attacks in the treatment group and by 1.3 attacks in those on placebo from 4.79 attacks per month. This difference was found to be statistically significant. The feverfew extract was well tolerated with nonspecific adverse effects that were seen in the placebo group as well. Researchers conclude that feverfew is effective in reducing the frequency of migraine attacks in patients.
Patient Warnings
- Because it is not regulated by the F.D.A., this product may be contaminated with other botanicals and/or the concentration listed on the label may be inaccurate.
- Cases of airborne contact dermatitis by feverfew have been reported in susceptible individuals.
Do Not Take If
- You are taking warfarin or other blood thinners (Feverfew may increase the risk of bleeding).
- You are allergic to ragweed, chrysanthemums, marigolds, or other members of the Compositae family.
Side Effects
- Stomach upset
- Mouth ulcerations may result from chewing fresh feverfew leaves.
- Post-feverfew syndrome: Withdrawal symptoms often develop when patients stop taking feverfew after a long period of time. These include muscle stiffness, anxiety, moderate pain, headache, nausea, and vomiting.
Dosage (Inside MSKCC Only)
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Aliases
Tanacetum Parthenium
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