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. In fact, 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. Today, professional herbalists primarily use feverfew to treat and
prevent certain headaches, arthritis, and other painful disorders. Studies
evaluating the scientific validity of these uses of feverfew, however, have
elicited some debate. See the discussions that follow about migraines and
Migraine Headaches Feverfew gained popularity in Great Britain
in the 1980s as an alternative to conventional medications for migraine
headaches. In fact, 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. Since then, several
well-designed studies have been conducted to evaluate the safety and
effectiveness of feverfew for the prevention and treatment of migraine
headaches. Most of these studies have found beneficial results. For example, in
a study of 76 migraine sufferers, those who ingested feverfew capsules (70 to
114 mg) daily for 4 months experienced a 24% reduction in attacks and a
substantial drop in symptoms that often accompany migraines, such as nausea and
vomiting, compared to those who received placebo.
Despite such positive findings, some experts have questioned the quality of
these studies. Two recent critical reviews of studies on feverfew for migraine
headaches conducted to date draw slightly different conclusions. One group of
experts concluded that feverfew appears to be beneficial for the prevention of
migraine headaches, but that scientific studies on this topic have been poorly
designed to date, making it difficult to draw any firm conclusions until
better-designed studies are conducted. The other team of experts states, upon
"feverfew is likely to be effective in the prevention of migraine."
Again, many individuals have had success working with an herbal specialist to
control their migraines by using feverfew. It is particularly important when
using feverfew to do so with guidance from a specialist because there is wide
variability in the formulations of this herb sold over the counter. This may
explain why some studies show improvement in migraines while others do not.
For now, some suggest that feverfew may be most appropriate for migraine
sufferers who have not gotten better using conventional therapies or cannot
tolerate standard medications due to side effects. Other specialists point out
that many prescription medications used for headaches do not have the strongest
data to support their use either. They go on to say that given that feverfew has
fewer side effects and greater tolerability, this herb is definitely an
important option for people with migraines.
Arthritis Although many laboratory tests demonstrate
anti-inflammatory properties of feverfew and many professional herbalists
recommend feverfew for the treatment of arthritis, a study conducted in 1989
concluded that feverfew was no more effective than placebo in improving symptoms
of rheumatoid arthritis. Some experts argue that this study was poorly designed,
particularly because some patients continued, throughout the study, to use
non-steroidal anti-inflammatory drugs (NSAIDs), which can interfere with
feverfew and reduce its effectiveness. (NSAIDs, such as ibuprofen, are commonly
prescribed or recommended for arthritis.) Until further studies are conducted,
it appears that the safety and effectiveness of feverfew in people with
rheumatoid arthritis has yet to be scientifically proven.
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 (which means that 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
What's It Made Of?
Feverfew products usually consist of dried feverfew leaves, but the aerial
parts of the plant (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
Feverfew is available fresh or dried (for use in teas), or can be purchased
in capsule, tablet, and liquid extract forms. Parthenolide (the active compound
in feverfew) content varies tremendously from product to product and usually
depends on its geographical origin. (The variability in the amount of
parthenolide may explain why some studies show relief of pain from migraines or
arthritis while others do not.) For this reason, feverfew preparations should be
standardized to contain at least 0.2% parthenolide.
How to Take It
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 to 25
kg), the appropriate dose of feverfew for this child would be 1/3 of the adult
Prevention of migraine headaches: Standardized feverfew extract
(minimum 250 micrograms [mcg] parthenolide) two times daily.
Treatment of migraine headaches: 1 to 2 grams parthenolide daily.
Other conditions (such as arthritis): 20 to 60 drops twice a day of
1:1 fluid extract; or 60 to 120 drops twice a day of 1:5 tincture (solution made
from herb and alcohol, or herb, alcohol, and water).
The use of herbs is a time-honored approach to strengthening the body and
treating disease. Herbs, however, contain active substances 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 practitioner knowledgeable 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 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 your propensity to bleed; therefore, it should be
avoided around the time of surgery.
Pregnant and nursing women as well as children under 2 years of age should
not take feverfew.
Feverfew can alter the menstrual cycle, so women with a regular menstrual
cycle should use with caution.
If you are currently being treated with any of the following medications, you
should not use feverfew without first talking to your healthcare provider.
Blood-thinning medications Feverfew can 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 healthcare practitioner before taking this herb.
NSAIDs Although specific interactions between feverfew and
conventional medications have not been adequately researched, a potential
interaction with non-steroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, has been identified and may result in decreased effectiveness of
these medications. The opposite may be true as well -
namely, that NSAIDs can render feverfew ineffective.
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.
Blumenthal M, ed. The Complete German Commission E Monographs. Therapeutic
Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
Brinker F. Herb Contraindications and Drug Interactions. 2nd ed.
Sandy, OR: Eclectic Medical Publications; 1998:71.
De Weerdt CJ, Bootsma HPR, Hendriks H. Herbal Medicines in migraine
prevention. Randomized double-blind placebo controlled crossover trial of a
feverfew preparation. Phytomedicine.
Ernst E, Pittler MH. The efficacy and safety of feverfew (Tanacetum
parthenium L.): an update of a systematic review. [Review] Public Health
Foster S, Tyler VE. Tyler's Honest Herbal. 4th ed. New York: The
Haworth Herbal Press; 1999:161-162.
Gruenwald J, Brendler T, Jaenicke C et al, eds. PDR for Herbal
Medicines. 2nd ed. Montvale, NJ: Medical Economics Company;
Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative
therapies and warfarin. Am J Health Syst Pharm.
Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as
prophylactic treatment of migraine. Br Med J.
Klepser TB, Klepser
ME. Unsafe and potentially safe herbal therapies. Am J Health Syst Pharm.
1999;56(2):125-138; quiz 139-141.
Larkin M. Surgery patients at risk for herb-anaesthesia interactions.
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.
Murphy JJ, Heptinstall S, Mitchell JR. Randomised double-blind
placebo-controlled trial of feverfew in migraine prevention. Lancet.
O'Hara M, Kiefer D, Farrell K, Kemper K. A review of 12 commonly used
medicinal herbs. Arch Fam Med. 1998;7:523-536.
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.
Pittler MH, Vogler BK, Ernst E. Feverfew for preventing migraine. [Review]
Cochrane Database Syst Rev. 2000;(3):CD002286.
Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia,
PA: Hanley & Belfus, Inc; 2002:188-192.
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.
White L, Mavor S. Kids, Herbs, Health. Loveland, Colo: Interweave
Press; 1998:22, 31.
Review Date: April 2002
Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD,
Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University
and Senior Medical Editor Integrative Medicine, Boston, MA; Gary Kracoff, RPh
(Pediatric Dosing section February 2001), Johnson Drugs, Natick, MA; Steven
Ottariono, RPh, Veteran's Administrative Hospital, Londonderry, NH; R. Lynn
Shumake, PD (March 1999), Director, Alternative Medicine Apothecary, Blue
Mountain Apothecary & Healing Arts, University of Maryland Medical Center,
Glenwood, MD; David Winston, Herbalist (April 1999), Herbalist and Alchemist,
Inc., Washington, NJ; Tom Wolfe, P.AHG (April 1999), Smile Herb Shop, College
Park, MD. All interaction sections have also been reviewed by a team of experts
including Joseph Lamb, MD (July 2000), The Integrative Medicine Works,
Alexandria, VA;Enrico Liva, ND, RPh (August 2000), Vital Nutrients, Middletown,
CT; Brian T Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant
Professor, University of Maryland School of Pharmacy; President, Your
Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000),
President and Chairman, Hawaii State Consortium for Integrative Medicine,
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