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.
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.
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.
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.
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.
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 activity, inhibiting Trypanosoma cruzi growth (2). Although much of its activity is attributed to parthenolide, the major active compound in feverfew, a parthenolide-free extract of feverfew has 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).
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).
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)
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.
