Feverfew for Migraine Prevention

feverfew_feature2

Edited for size and used with permission from creator H Zell through Wikimedia Commons.

When thinking about trying a natural remedy to treat migraines, it’s important to use the same common sense wisdom you would use with any other medication. The key is to recognize that there’s no doctor or pharmacist to blame if things go wrong. It’s your responsibility to make wise choices for yourself and accept the risks and benefits. You need to get answers to these basic questions before you can make an informed choice. Instead of asking a doctor or pharmacist, you will have to find the answers yourself.

Does it work?

The short answer is: “No one knows for sure.”

Like any other preventive, it may work for some and not for others. The research quality is inconsistent and the studies that show no benefit are either literature reviews or used an atypical formulation. It costs money for good quality research. Feverfew can’t be patented. It’s not expensive to grow or convert to useable forms. Unless someone gets a grant to do multiple longitudinal placebo-controlled, double-blind studies with several formulations and doses, we might never know for sure.

How does it work?

A 2005 study published in Cephalalgia reported that parthenolide was identified as the active compound responsible for feverfew’s anti-migraine effects. Parthenolide is a 5-HT (serotonin) agonist. It inhibits platelet aggregation in response to a release of serotonin. We’ve all heard the theory that dramatic fluctuations in serotonin may be responsible for the activation of migraine attacks. Triptans work in a similar way by rapidly counteracting the rise in serotonin that accompanies an attack. No studies support the use of feverfew as an abortive. However, its properties do indicate the potential to stabilize blood vessel reactivity to changes in serotonin in both the brain and the gastrointestinal tract. Some researchers have suggested that its actions are similar to methylsergide (Sansert) which is known to block the effects of serotonin.

Feverfew also decreases smooth muscle spasms in the vascular system. While the vascular theory of migraine has largely been debunked as a potential cause, vasodilation does still occur during migraine. By reducing the spasticity of vascular tissues, feverfew can reduce the pounding and throbbing felt when blood vessels over-dilate in response to chemical changes in the migraine brain.

As if that wasn’t enough, feverfew has also demonstrated the ability to block histamine release and inhibit prostaglandin synthesis to act as a natural NSAID. Good stuff, huh?

How much should I take?

The NIH recommends taking 100-300 mg of a standardized extract (0.2-0.4% Parthenolides) 4 times daily. The dried powdered leaf extract is shown to have the most favorable response. Tinctures (liquid) are also viable options. CO2 extracted supplements have the poorest outcomes.

How long before I know if it works?

As with any preventive medication, you should expect to use it 4-6 weeks before seeing any results. Maximum benefits are typically seen after 90 days of consistent use. No studies have linked the long-term use of feverfew to adverse effects.

Personal Experience:
In 1995 I tried a 0.7% dried leaf extract capsule daily for 6 months and saw significant reduction in frequency and severity of attacks. I had to discontinue use when I became pregnant. When I started taking it again 2 years later, it didn’t have the same effect. I don’t remember the brand I used. I’m sure it was different the second time around. The quality difference may have been the reason it didn’t work for me. I mentioned it to my naturopath who told me that my experience was typical and that if it works, it should be taken continuously to maintain benefit.
.

What are the potential side effects?

Most people do not report any adverse effects from taking feverfew. Those who experience side effects usually do not find them disturbing enough to stop taking feverfew. The most common complaint is stomach upset which can be mitigated by taking it with meals.

People who are allergic to ragweed have a slight risk of a similar allergic reaction when taking feverfew as it is in the same Asteraceae family as daisy and ragweed.

The most significant side effect is an increase in heart rate. If this occurs, check with your doctor about the safety of continuing to use feverfew.

Feverfew has a long history of use. At times raw leaves have been chewed or dried ground leaves have been steeped as a tea. Use of feverfew in this way may result in mouth ulcers, tongue and lip swelling, or loss of taste. If fresh leaves are applied directly to the skin, you may develop dermatitis. These side effects can be avoided by using only capsules, tablets, or tinctures.

Who should not use it?

  • Do not use if pregnant or nursing as feverfew has uterine stimulant properties. It has a risk of inducing abortion, labor, or menstrual bleeding.
  • Do not give to children younger than 2 years.
  • Adjust dose based on weight for children aged 2-18
  • Rapid discontinuation may result in headaches, insomnia, joint pain, irregular sleep patterns, stiffness, tension, tiredness, muscle and joint stiffness. If you must stop, wean off slowly or under medical supervision to reduce these symptoms.
  • Feverfew may inhibit platelet activity and interfere with blood clotting.
  • Check with your doctor first before using if you take any blood thinning medications such as aspirin, Warfarin, Plavix, or Ginkgo
  • Check with your doctor and/or pharmacist if taking any medications metabolized by the liver as feverfew may affect the rate of absorption, half-life, or change the action of these medications.

SOURCES:

  1. Biggs MJ,Johnson ES, Persaud NP, Ratcliffe DM. Platelet aggregation in patients using feverfew for migraine. Lancet.1982;2:776.
  2. Feverfew:Medline Plus Supplements. Natural Medicines Comprehensive Database Consumer Version, Therapeutic Research Center, 1995.
  3. Feverfew – A new drug or an old wives′ remedy? The Lancet
    Volume 325, Issue 8437, 11 May 1985, Pages 1084.
  4. Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J. 1985;291:569–73.
  5. Murphy JJ, Heptinstall S, Mitchell JL. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet. 1988;2:189–92.
  6. Pareek, Anil, Suthar, Manish, Rathore, Garvendra S. , Bansal, Vijay. Feverfew (Tanacetum parthenium L.): A systematic review. Pharmacogn Rev. 2011 Jan-Jun; 5(9): 103–110.
  7. PfaffenrathV, Diener HC, Fischer M, Friede M, Zepelin HH. The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis–a double-blind, multicentre, randomized placebo-controlled dose-response study. Cephalalgia. 2002;22:523–32.

DISCLAIMER: This post is for educational purposes only and not intended to be the definitive source on Feverfew. Please follow the links to do your own research. Choosing to use natural remedies is an individual process that should take into account your preferences, health history, and a thorough analysis of the benefits and risks.

Leave a Reply