A wealth of scientific evidence shows that feverfew is an effective treatment and prophylactic for migraine headaches. Used for centuries in European folk medicine, feverfew was traditionally utilized for headache, arthritis, and fever. The word feverfew is a corruption of the Latin febrifuge, which literally means fever-reducing.

In a survey conducted in Britain in the 1980s, 70% of migraine sufferers who ate two to three fresh feverfew leaves daily experienced considerable relief from their headaches. A clinical study later revealed that feverfew significantly reduced the symptoms of migraine when compared with placebo. Feverfew also lessened accompanying symptoms of nausea and vomiting. In 1997, this medicinal herb ranked #19 on a list of the top herbs sold at health food stores in the United States.

Feverfew's antimigraine activity comes from parthenolide, a sesquiterpene lactone. Parthenolide is a spasmolytic that makes smooth muscle in the walls of cerebral blood vessels less reactive to vasoconstrictors. Parthenolide helps prevent migraines and lessen the severity of existing migraines by acting as an antagonist to vasoconstrictors such as serotonin, prostaglandins, and norepinephrine.

Parthenolide and standardized extracts of feverfew containing parthenolide block the release of serotonin from blood vessels and prevent platelets from over-aggregating. Parthenolide also inhibits the actions of compounds released from cells that cause inflammation.

Native to southeastern Europe, feverfew is now widespread throughout Europe, North America, and Australia. It is a short, herbaceous, composite perennial. It is a member of the daisy family, and it blooms between July and October. This aromatic plant gives off a strong and bitter odor. Its yellow-green leaves are alternate and bipinnatifid. The small, daisy-like yellow flowers are arranged in a dense corymb.

• Leaves (dried leaves)
• Dried aerial parts

Flavonoids, polyenes, volatile oil (camphor, borneol, terpenes, various esters); sesquiterpene lactones (85% is parthenolide) (0.1% to 0.9% of plant); sesquiterpenes, monoterpenes, spiroketal enol ether polyenes.

Parthenolide content varies tremendously and depends on geographical origin. Nearly 50% of feverfew products from Canada lacked parthenolide. And no parthenolide could be detected in samples from Mexico and Eastern Serbia. It is for this reason that feverfew preparations should be standardized for at least 0.2% parthenolide.

Traditional actions: relaxant, anti-inflammatory, vasodilator, digestive bitter, emmenagogue. Historically, feverfew was used for intestinal parasites, anemia, insect bites, irregular menses, stomachaches, and as an abortifacient, although it is rarely used this way now.

Clinical applications: preventing and treating migraine, initial inflammatory stages of arthritis, rheumatic diseases, allergies, congestive dysmenorrhea, vertigo, and tinnitus.

Conditions: migraine, arthritis, rheumatic diseases, allergies

In vitro and in vivo studies show that feverfew has anti-inflammatory activity and prophylactic action against migraines. The underlying cause of migraine headaches presumably involves two primary mechanisms: (1) over-aggregation of platelets; and (2) release of serotonin and inflammatory compounds from platelets. In vivo and in vitro studies show unequivocally that parthenolide disrupts both mechanisms.

Parthenolide apparently neutralizes sulfhydryl groups on enzymes crucial for platelet aggregation. And it probably achieves its prophylactic effects by suppressing the release of serotonin from platelets. In in vivo studies, extracts of feverfew blocked the synthesis of prostaglandin, thromboxane, and leukotriene.

In vitro findings indicate that feverfew may be beneficial for arthritis. The anti-arthritic effects may be due to the ability of feverfew to destroy peripheral blood mononuclear cells in the synovium.

The first human clinical study of feverfew involved a small sample of only 17 patients, but the results were dramatic. All patients enrolled in this study had taken feverfew for several years. Nine patients were given a placebo and eight were given 50 mg of feverfew daily. During the six-month study period, the patients remaining on feverfew experienced continued relief. Migraines increased almost threefold in the patients taking placebo. However, the increase in symptoms in the placebo group may have actually been part of a feverfew-withdrawal syndrome.

In a double-blind, placebo-controlled, crossover study of 72 migraine sufferers, the treatment group received 70 to 114 mg of feverfew. They had a 24% reduction in the number of migraines when compared with the placebo group. The treatment group had fewer symptoms, although the length of each individual migraine episode did not change.

In another investigation, feverfew showed no clear-cut clinical benefits for rheumatoid arthritis. However, a low dosage of powdered leaf product was used and the parthenolide content was not determined in this trial. Because of the limitations of this study, the efficacy of feverfew for arthritis is inconclusive.

Recommended dosage:

• Treatment and prevention of migraine: standardized feverfew extract (minimum 0.25 mcg parthenolide) bid
• Acute migraine attack: 1 to 2 g parthenolide daily
• For other conditions: 1 to 2 ml bid of 1:1 fluid extract; 2 to 4 ml bid of 1:5 tincture

There are no long-term studies on feverfew toxicology. Minor side effects of nervousness and mild gastrointestinal irritation have been reported with use of standardized feverfew tablets. Adverse side effects of abdominal pain, indigestion, flatulence, diarrhea, nausea, and vomiting have also been observed. Mouth ulcerations, loss of taste, and swelling of the lips, tongue, and mouth occur in about 10% of individuals who chew the leaves.

In vivo studies revealed little evidence of negative reactions to feverfew in daily doses 100 times the dose given to humans. A histological examination of human lymphocytes showed that feverfew does not cause chromosomal abnormalities.

Feverfew is indicated for migraine sufferers who do not respond to conventional treatment. Because this herb can alter the menstrual cycle, menstruating women should use it with caution. Pregnant and lactating women and children under 2 years of age should not take feverfew.

No specific interactions between feverfew and conventional medications have been adequately researched to draw conclusions. However, a potential interaction with non-steroidal anti-inflammatory drugs (NSAIDs) has been raised, because of prostaglandin inhibition by NSAIDs, which may reduce the effectiveness of feverfew (Miller 1998). Additionally, because of the platelet inhibitory effects of feverfew, patients taking anticoagulants with feverfew should be monitored closely for clinical signs of bleeding abnormalities.

The U.S. FDA classifies feverfew as a dietary supplement. Feverfew is used as a nonprescription drug for migraine headache in Britain and Germany.

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