Feverfew (Tanacetum Parthenium)

2014

Clinical Uses

Feverfew is used to prevent and treat migraine headaches.

Historical Uses

Traditionally, feverfew was used to manage labor pains, to reduce fevers, and to repel insects.

Growth

Feverfew is a member of the daisy family and may be grown in herb gardens in the spring. The plant prefers dry soil and sun.

Feverfew: Part Used

• Leaves

Major Chemical Compounds

• Sesquiterpene lactones, primarily parthenolide

Feverfew: Clinical Uses

Feverfew is used to prevent migraine headaches and also to treat migraine headaches.

Mechanism of Action

The mechanism by which feverfew works is not fully understood. It may act like non-steroidal anti-inflammatory drugs (NSAIDs) by interfering with the first step of thromboxane synthesis (inhibiting prostaglandin biosynthesis), but it differs from salicylates in that it does not inhibit cyclo-oxygenation by prostaglandin synthase. Feverfew inhibits serotonin release from platelets and polymor-phonuclear leukocyte granules, which benefits patients with migraines or arthritis (The Lawrence Review of Natural Products, 1994). It has shown antinociceptive and anti-inflammatory effects in animals.

Feverfew: Dosage

To be effective at preventing migraines, the parthenolide content of feverfew must be between 0.25 and 0.5 mg. Standardized extract gives 275 mg a day. One study used 100 mg of feverfew leaf (two 50-mg capsules daily). During an acute attack, 1 to 2 grams may be needed. Or two to three leaves may be taken daily with food or juice for migraine or arthritis. It may be 1 to 2 months before an improvement occurs.

Side Effects

Aphthous ulcerations (mouth sores) have been reported in 12 percent of respondents in a study; these ulcerations are more likely with ingestion of fresh leaves. Feverfew may cause GI upset as well, in addition to an elevated international normalized ratio.

Contraindications

• Feverfew is contraindicated during pregnancy and breast-feeding.

Herb-Drug Interactions

Feverfew should not be taken at the same time as NSAIDs because the herbal effect will be inhibited. Feverfew may decrease platelet aggregation and should not be given with aspirin. Feverfew should not be given to patients who are also taking anticoagulant therapy.

Pregnancy and Breast-Feeding

Do not use this herb during pregnancy because it may stimulate the uterus and induce abortion. It should not be used during breast-feeding.

Pediatric Patients

There is no substantial information for children under age 2 (Natural Medicines, 2000).

Summary of Studies

Palevitch et al. (1997). This double-blind, placebo-controlled, crossover study included 57 subjects with severe migraines. The patients took 100 mg of feverfew or placebo daily for 2 months. Results: Feverfew reduced the pain of migraines and improved overall symptoms compared to the placebo; patients in the placebo group experienced increased pain.

Heptinstall et al. (1992). The study of three physicochemical assays and bioassay showed parthenolide content and bioactivity Products varied widely in their parthenolide content, and in some products parthenolide was not detected.

Murphy et al. (1988). This randomized, double-blind, placebo-controlled crossover study looked at feverfew for migraine prophylaxis. It included 72 volunteers. Results: Feverfew reduced the mean number and severity of attacks in each 2-month period. It also reduced the degree of vomiting. VAS scores improved. There were no serious side effects.

Johnson et al. (1985). This double-blind, placebo-controlled study looked at the efficacy of migraine prophylaxis in 72 volunteers. Results: Feverfew prevented migraine attacks.

Heptinstall et al (1985). Results: Inhibition of granule secretion of platelets and polymorphonuclear leucocytes showed that the pattern of effects of feverfew extracts on platelets is different from that of other inhibitors and that the effect on polymorphonuclear leucocytes is more pronounced than that obtained with very high amounts of nonsteroidal anti-inflammatory drugs.

Collier et al. (1980). This study looked at inhibition of prostaglandin biosynthesis by feverfew. Results: Feverfew contains a factor that inhibits prostaglandin biosynthesis, but it differs from that of salicylates in that it does not inhibit cyclo-oxygenation by prostaglandin synthase.

Feverfew: Warnings

• Mouth sores were reported by 12 percent of the people who took part in one study; the sores were more likely among people who used fresh leaves.

• Don’t take feverfew with nonsteroidal anti-inflammatory drugs (such as ibuprofen, acetaminophen, and so forth), aspirin, or blood thinners.

• Don’t take feverfew if you are breastfeeding.

• Feverfew may cause gastrointestinal upset.

• Feverfew may increase the risk of bleeding.

• Don’t take feverfew if you are pregnant because it may stimulate the uterus and induce abortion.

• Don’t give feverfew to children under age 2.