How It Works
Bottom Line: Clinical trials suggest feverfew can help to prevent migraine headaches. When people stop taking feverfew, they usually develop headaches, anxiety, nausea and vomiting (post-feverfew withdrawal syndrome).
One or more compounds found in feverfew are thought to have anti-inflammatory activity and may act synergistically 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, several 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.
Research Evidence
Several clinical trials have studied the use of feverfew in the management of rheumatoid arthritis, and have found it to be ineffective. Many clinical trials have been performed using feverfew to prevent migraine headaches, and have had inconsistent results; the following trials did show feverfew to be effective.
Migraine headache 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.
Seventeen patients already chewing raw feverfew leaves for migraine headache prevention were asked to continue to take feverfew in capsule form or take a placebo capsule for 24 weeks. Patients who continued with feverfew reported no change in headache frequency, but those who switched to the placebo pill had a significant increase in the frequency and severity of headaches, nausea, and vomiting. This is good evidence of post-feverfew withdrawal syndrome.
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.
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.
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.
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
(11). Feverfew leaves should be administered via capsules or tablets. Oral ulceration has occurred among those who chew the raw leaves or consume as a tea
(5). Many products are standardized to a 0.2% parthenolide concentration. In vitro studies indicate that this product may interfere with the function of platelets
(4). A few in vitro studies have shown that feverfew exhibits anticancer effects
(8) (9). Results from a Phase I clinical trial with cancer patients indicate that upto 4 mg of parthenolide was well tolerated; however, parthenolide could not be detected in the plasma;
(10). Feverfew should be not be used concomitantly with anticoagulants.
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
(1)
Mechanism of Action
It is suggested that the sesquiterpene lactones, particularly parthenolide, are the active ingredient and are responsible for its anti-inflammatory mechanism of action. A recent study found that parthenolide attenuates activation of the NF-kappa B complex to block transcription of inflammatory proteins
(6). 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
(4) (5).
Contraindications
Patients allergic to ragweed, chrysanthemums, marigolds or other members of the Compositae family may have cross-sensitivity to feverfew.
Adverse Reactions
Common: Minor GI distress. Mouth ulcerations may result from chewing fresh feverfew leaves.
Withdrawal: Muscle stiffness, anxiety and moderate pain usually occur following cessation of long-term feverfew use (post-feverfew syndrome).
(5)
Herb-Drug Interactions
Anticoagulants / Antiplatelets: Theoretically, feverfew may have additive effect.
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.
Johnson ES, et al. Efficacy of feverfew as prophylactic treatment of migraine. BMJ 1985;291:569-73.A study of 17 patients previously taking feverfew, randomized to either placebo or feverfew 50 mg daily for six periods of 4 weeks. The authors reported that the placebo group experienced a significant increase in the frequency and severity of headache. Those given the feverfew had no change. It was later suggested that the placebo group suffered from post-feverfew withdrawal symptoms.
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
- European Scientific Cooperative on Phytotherapy. ESCOP Monographs on the medicinal uses of plant drugs. Exeter, London: March 1996.
- Tyler, V. Herbs of Choice, the Therapeutical Use of Phytomedicinals. Binghamton: Pharmaceutical Press; 1994.
- de Weerdt GJ, et al. Herbal medicines in migraine prevention: Randomized double-blind placebo-controlled crossover trial of a feverfew preparation. Phytomedicine 1996;3:225-30.
- Williams CA, et al . A biologically active lipophilic flavonol from Tanacetum parthenium. Phytochemistry 1995;38:267-70.
- Johnson ES, et al. Efficacy of feverfew as prophylactic treatment of migraine. BMJ 1985;291:183-92.
- Reuter U, et al. Nuclear factor-kappaB as a molecular target for migraine therapy. Ann Neurol 2002;51:507-16.
- Murphy JJ, et al. Randomized, double-blind, placebo-controlled trial of feverfew in migraine prevention. Lancet 1988;23:189-92.
- Yip-Schneider MT, et al. Parthenolide and sulindac cooperate to mediate growth suppression and inhibit the nuclear factors-kappa B pathway in pancreatic carcinoma cells. Mol Cancer Ther 2005;4(4):587-94.
- Zhang S, Ong CN, Shen HM. Involvement of proapoptotic Bcl-2 family members in parthenolide-induced mitochondrial dysfunction and apoptosis. Cancer Lett 2004;211(2):175-88.
- Curry III EA, et al. Phase I dose escalation trial of feverfew with standardized doses of parthenolide in patients with cancer. Investigational New Drugs 2004;22:299-305.
- 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.
