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Feverfew

Also listed as: Tanacetum parthenium

• Overview
• Plant Description
• What's It Made Of?
• Medicinal Uses and Indications
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Feverfew ( Tanacetum parthenium ), a member of the sunflower family, has been used for centuries in European folk medicine as a remedy for headaches, arthritis, and fevers. The term feverfew is adapted from the Latin word febrifugia or "fever reducer."

Feverfew has also been traditionally used to treat menstrual irregularities, labor difficulties, skin conditions, stomach aches, and asthma.

Plant Description

Native to southeastern Europe, feverfew is now widespread throughout Europe, North America, and Australia. Feverfew is a short perennial that blooms between July and October. This aromatic plant gives off a strong and bitter odor. Its yellow-green leaves are alternate (in other words the leaves grow on both sides of the stem at alternating levels), and turn downward with short hairs. The small, daisy-like yellow flowers are arranged in a dense flat-topped cluster.

What's It Made Of?

Feverfew products usually consist of dried feverfew leaves, but all parts of the plant that grow above ground may also be used for medicinal purposes. The migraine-relieving activity of feverfew is believed to be due to parthenolide, an active compound that helps relieve smooth muscle spasms. In particular, it helps prevent the constriction of blood vessels in the brain (one of the leading causes of migraine headaches). Parthenolide also inhibits the actions of compounds that cause inflammation.

Medicinal Uses and Indications

Today, health care providers primarily use feverfew to treat and prevent certain headaches, arthritis, and other painful disorders.

Migraine Headaches

Feverfew gained popularity in Great Britain in the 1980s as an alternative to conventional medications for migraine headaches. A survey of 270 migraine sufferers in Great Britain revealed that more than 70% of individuals felt substantially better after ingesting an average of two to three fresh feverfew leaves daily. Several controlled human trials have been conducted using feverfew for migraine prevention and treatment. Overall, these studies suggest that feverfew taken daily as dried leaf capsules may reduce the incidence of attacks in patients who experience long-term migraine headaches.

• A clinical study used a combination of feverfew with Salix alba (white willow). White willow contains components similar to aspirin. The product was given twice daily for 12 weeks. The frequency of migraine attacks and the pain intensity and duration was significantly decreased in the patients taking the combination.
• Another study found that a carbon dioxide extract of feverfew decreased the frequency of migraine attacks from 4.76 per month to 1.9 per month. A 3 month study in 49 subjects found that a combination of feverfew with magnesium and vitamin B2 provided a 50% decrease in migraine attacks.
• Some studies in humans have not been positive. The choice which feverfew supplement to take plays a major role in whether feverfew will help in migraine headaches. Ask your health care provider.

Arthritis

Although many laboratory tests and case reports demonstrate anti-inflammatory properties of feverfew, a human study conducted in 1989 concluded that feverfew was no more effective than placebo in improving symptoms of rheumatoid arthritis. Until further studies are conducted, it appears that the safety and effectiveness of feverfew in people with osteoarthritis or rheumatoid arthritis has yet to be scientifically proven.

Available Forms

Feverfew supplements are available fresh, freeze-dried, or dried and can be purchased in capsule, tablet, or liquid extract forms. Feverfew supplements with clinical studies contain a standardized dose of parthenolide (the active compound in feverfew). Feverfew supplements should be standardized to contain at least 0.2% parthenolide.

How to Take It

Pediatric

Feverfew should not be used in children under 2 years of age.

In older children, adjust the recommended adult dose to account for the child's weight. Most herbal dosages for adults are calculated on the basis of an average of 150 lb (70 kg) adult. Therefore, if the child weighs 50 lb (20 - 25 kg), the appropriate dose of feverfew for this child would be 1/3 of the adult dosage.

Adult

For migraine headaches: Take 100 - 300 mg, up to four times daily, standardized to contain 0.2 - 0.4% parthenolides. Feverfew may be used to prevent or to stop a migraine headache. Feverfew supplements may also be carbon dioxide extracted. For these, take 6.25 mg, 3 times daily, for up to 16 weeks.

For inflammatory conditions (such as arthritis): 120 - 60 drops, 2 times daily of a 1:1 w/v fluid extract, or 60 - 120 drops twice a day of 1:5 w/v tincture.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and that can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Side effects from feverfew can include abdominal pain, indigestion, flatulence, diarrhea, nausea, vomiting, and nervousness. Mouth ulcers, loss of taste, and swelling of the lips, tongue, and mouth may occur in some individuals who chew raw feverfew leaves. Allergic reactions to feverfew, although rare, have also been reported. In fact, people with allergies to chamomile, ragweed, or yarrow will likely be allergic to feverfew and, therefore, should not take it.

Feverfew may increase the tendency to bleed, especially in individuals with bleeding disorders or taking blood-thinning medications, such as aspirin or warfarin. Do not use feverfew if you have bleeding disorders or are taking blood-thinning medications unless you are under the supervision of a doctor.

Pregnant and nursing women as well as children under 2 years of age should not take feverfew.

Do not abruptly stop taking feverfew if you have used it for more than 1 week. A withdrawal syndrome characterized by rebound headache, anxiety, fatigue, muscle stiffness, and joint pain may occur.

Possible Interactions

Feverfew may alter the effects of some prescription and non-prescription medications. If you are currently being treated with any of the following medications, you should not use feverfew without first talking to your health care provider.

Blood-thinning medications -- Feverfew may inhibit the activity of platelets (a substance that plays a role in blood clotting), so individuals taking blood-thinning medications (such as aspirin and warfarin) should consult a health care provider before taking this herb.

Supporting Research

Barsby RW, Salan U, Knight DW, Hoult JR. Feverfew and vascular smooth muscle: extracts from fresh and dried plants show opposing pharmacological profiles, dependent upon sesquiterpene lactone content. Planta Med . 1993;59(1):20-25.

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 . 2004;22(3):299-305.

De Weerdt CJ, Bootsma HPR, Hendriks H. Herbal Medicines in migraine prevention. Randomized double-blind placebo controlled crossover trial of a feverfew preparation. Phytomedicine . 1996;3:225–230.

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 . 2005;25(11):1031-41.

Ernst E, Pittler MH. The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review. [Review] Public Health Nutr . 2000;3(4A):509-514.

Evans RW, Taylor FR. "Natural" or alternative medications for migraine prevention. Headache . 2006;46(6):1012-8.

Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm . 2000;57(13):1221-1227.

Henneicke-von Zepelin HH. Feverfew for migraine prophylaxis. Headache . 2006;46(3):531

Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J . 1985;291:569–573.

Klepser TB, Klepser ME. Unsafe and potentially safe herbal therapies. Am J Health Syst Pharm . 1999;56(2):125-138; quiz 139-141.

Maizels M, Blumenfeld A, Burchette R. A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: a randomized trial. Headache . 2004;44(9):885-90.

Mauskop A. Alternative therapies in headache. Is there a role? [Review] Med Clin North Am . 2001;85(4):1077-1084.

Miller L. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med . 1998;158(20):2200–2211.

Murphy JJ, Heptinstall S, Mitchell JR. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet . 1988;2:189–192.

Palevitch D, Earon G, Carasso R. Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: a double-blind controlled study. Phytotherapy Res . 1997;11:508–511.

Pattrick M, Heptinstall S, Doherty M. Feverfew in rheumatoid arthritis: a double-blind, placebo controlled study. Ann Rheum Dis . 1989;48:547–549.

Pfaffenrath V, Diener HC, Fischer M, et al. The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis--a double-blind, multicentre, randomized placebo-controlled dose-response study. Cephalalgia. 2002;22(7):523-532.

Pittler MH, Vogler BK, Ernst E. Feverfew for preventing migraine. [Review] Cochrane Database Syst Rev . 2000;(3):CD002286.

Shrivastava R, Pechadre JC, John GW. Tanacetum parthenium and Salix alba (Mig-RL) combination in migraine prophylaxis: a prospective, open-label study. Clin Drug Investig . 2006;26(5):287-96.

Silberstein SD. Preventive treatment of headaches. Curr Opin Neurol . 2005;18(3):289-92.

Sumner H, Salan U, Knight DW, Hoult JR. Inhibition of 5-lipoxygenase and cyclo-oxygenase in leukocytes by feverfew. Involvement of sesquiterpene lactones and other components. Biochem Pharmacol . 1992;43(11):2313-2320.

Vogler BK, Pittler MH, Ernst E. Feverfew as a preventive treatment for migraine: a systematic review. Cephalalgia . 1998;18(10):704-708.

Won YK, Ong CN, Shi X, Shen HM. Chemopreventive activity of parthenolide against UVB-induced skin cancer and its mechanisms. Carcinogenesis . 2004;25(8):1449-58.

Wu C, Chen F, Rushing JW, Wang X, Kim HJ, Huang G, Haley-Zitlin V, He G. Antiproliferative activities of parthenolide and golden feverfew extract against three human cancer cell lines. J Med Food. 2006;9(1):55-61.

Zhang S, Lin ZN, Yang CF, Shi X, Ong CN, Shen HM. Suppressed NF-kappaB and sustained JNK activation contribute to the sensitization effect of parthenolide to TNF-alpha-induced apoptosis in human cancer cells. Carcinogenesis . 2004;25(11):2191-9.

• Review Date: 1/31/2007
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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