Feverfew & Migraines

I looked up feverfew in Medline and would like to report what I found there. If you aren't interested in medical experimentation as it applies to herbs, you will probably not be interested in what follows.

The good news (for migraine sufferers): I found two double blind experiments looking at the effectiveness of feverfew on migraines: The first one used 72 migraine sufferers. Half got a capsule per day of feverfew, the other half got a placebo. There was a significant reduction in the mean number and severity of migraine attacks. The other experiment looked at 17 migraine sufferers who normally ate feverfew to control headaches. They gave placebos to some and continued the feverfew with others. The placebos increased frequency and severity of migraines.

The bad news: Feverfew affects the smooth muscles of the body. These are muscles that control much of your involuntary muscular processes, such as the vascular system (blood vessels), digestive system, internal organs, aorta, etc. From what I can gather from some of the abstracts in Medline, feverfew PERMANENTLY affects the ability of these smooth muscles to contract and relax. Here are some snippets from the abstracts which looked at this:

"(Feverfew)...inhibits smooth muscle contractability in a time- dependent, non-specific, and irreversible manner."

"(Feverfew)...affects smooth muscles...may represent a toxic modification of post-receptor contractile function in the smooth muscle...effects are potentially toxic"

"...inhibition of eicosanoid generation is irreversible"

"...irreversible loss of tone of precontracted aortic rings... inhibited ability of acetylcholine to induce endothelium dependent relaxation of tissue."

What does this all mean for the long term health of those who take feverfew? That does not seem to have been looked at yet; these articles were very recent. However, I think that people who take feverfew should know that they may be permanently affecting the smooth muscles in their bodies and may want to take this into account when deciding whether or not to continue taking it.

From: Jim Heath (heath@iinet.net.au) (in reply to above):

I sent a copy of Julia Moravcsik's Medline findings about feverfew to Reader's Digest (who published an article in their Feb 1995 issue advising that feverfew can help prevent migraines.)

I've had a letter back from Elizabeth Craig, a RD researcher. She confirms that none of their sources when they researched the article (late 1994) showed any side-effects from feverfew. She also said that after she got my letter (dated 21 June 95) she contacted a migraine research scientist who is studying the effects of feverfew. The researcher is familiar with Medline and says that "research has shown the dosage taken by migraine sufferers has no side effects at all."

Jim Heath


Feverfew and migraine

It's not at all unusual for people interested in using herbs to replace over the counter medications with simple herbal counterparts. What has been unusual enough to generate headlines, though, is the conventional medical community's research and acceptance of a traditional European folk remedy, Feverfew, in preventing migraine headaches.

Migraines are believed to be caused by an upset in serotonin metabolism, causing spasms of intracranial blood vessels, which then causes dilation of extracranial blood vessels.

In the 1970s an English research group sought volunteers already using Feverfew before beginning a study of its efficacy. Their advertisement in a London newspaper brought more than 20,000 responses. Since then, several well-documented double-blind, placebo studies in England confirm its value.

An interesting one reported in The Lancet (July 23, 1988; 2(8604):189- 192) followed 72 volunteers. After a one-month trial using only a placebo, half of the group received either one capsule of dried Feverfew leaves a day (or a matching placebo) for four months. Neither the group nor the researchers knew which group was receiving the Feverfew. The group kept diary cards of their migraine frequency and severity. After four months, the groups switched medications, and the trial continued for an additional four months. 60 patients completed the study, and full information was available on all but one.

The study found Feverfew to be associated with reducing the number and severity of attacks (including vomiting), with the researchers concluding that there had been a significant improvement when the patients were taking Feverfew. There were no serious side effects.

Feverfew is currently classified as Tanacetum parthenium, a member of the Asteracea (or Compositae) family, and was formerly named Chrysanthemum parthenium, where you'll still find it listed in some references. Feverfew is a corruption of Febrifuge, based on its tonic and fever-dispelling properties. It's been called Maid's Weed, referring to its emmenagogue qualities, which are also reflected in its Greek name, Parthenion ("girl").

Its primary actions are anti-inflammatory, bitter, emmenagogue and a vasodilator. Aside from migraine relief, long-term users report relief from depression, nausea and inflammatory arthritic pain. Drunk in cold infusion, it can relieve the cold, clammy sweats associated with migraine.

Additionally, it's been used externally as an insect repellant, and topically for insect bites. Perhaps the insect-repelling quality accounts for the tradition of planting it around the house to ward off illnesses and to purify the air.

The tea, drunk cold, has been used for sensitivity to pain, and for relief of face-ache or ear ache (all migraine-like symptoms). The Eclectic physicians of the 19th century called it one of the pleasantest of the tonics, influencing the whole intestinal tract, increasing the appetite, improving digestion, promoting secretion, with a decided action on kidney and skin.

John Gerard's Herbal in 1663, said it to be "...good against summer headaches to inhale crushed Feverfew blossoms. Dried and taken with honey or sweet wine good for those as be melancholic, sad, pensive or without speech." Culpepper used in it poultice form for head ache.

Feverfew in blossom is easily identified by its flat or convex yellow disk and numerous short, broad 2-ribbed white rays. The leaves are alternate, petiolate, flat, bi or tripinnate with ovate, dentate segments. It quickly escapes cultivation, and has become naturalized in many areas of the U.S. and Europe, in some places regarded as a nuisance weed.

Among its constituents are a volatile oil, containing pinene and several pinene derivatives, bornyl acetate and angelate, costic acid, B-farnesine and spiroketal enol ethers; Sesquiterpene lactones, the major one being parthenolide); and Acetylene derivatives.

Pharmacologists say it is likely that the sesquiterpene lactones in Feverfew inhibit prostaglandin and histimine released during the inflammatory process, preventing the vascular spasms that cause migraines. It appears to regulate the serotonin mechanism.

To attain the maximum benefit from Feverfew, it should be taken daily as a preventive. For migraine prevention, parthenolide plays an important role. The parthenolide content in Feverfew is highly variable in different populations grown in different locations or harvested at different times of the year.

Recent Canadian tests of U.S. Feverfew products found all of them to be low in parthenolide. Canada, which has recently recognized Feverfew products as official, over the counter drugs for migraine prevention and relief, will require that they contain a minimum of 0.2% parthenolide.

So, this is one of the few cases where a standardized extract may be more desirable than the whole plant, with a lot to be said for fresh or freeze-dried preparations. If you want to use the fresh plant, the flowers have a higher parthenolide content than do the leaves. If you are picking the leaves, they are best just before flowering.

In one of those magical bits of synergy that herbalists love, the isolated parthenolides used alone don't work on migraines, nor does the whole plant with the parthenolides removed. The parthenolide is bioavailable only in

PRECAUTIONS: I know of nothing, whether allopathic or herbal medicine, that I would feel free in saying to have absolutely no unpleasant side effects. We're all unique individuals when it comes to body chemistry. Some unfortunate people are allergic to chamomile. They may also be allergic to Feverfew.

A few recent studies of parthenolide in vitro point to toxicity involving smooth muscle tissue. However, no side effect resembling this has ever been reported in human use. Feverfew's safety and usefulness are historic.

Pregnant women should never take Feverfew. Its traditional use as an emmenogogue underlines the risk here.

The bitter tonic qualities, so useful for indigestion, can cause gastric pain in people with gall stones or gall-bladder problems, by making the gall bladder try to empty. Likewise, the increased production of stomach acid would make it highly aggravating to anyone with a gastric ulcer or esophogeal reflux.

Some people have developed mouth ulcers from eating the fresh leaves.

DOSAGE: Feverfew is most effective fresh or freeze dried. Take the equivalent of 1 fresh leaf or 125 mg. freeze-dried herb once a day (0.2% parthenolides) 1-3 times daily (don't chew the leaf).

In addition to Feverfew on its own as preventive herbal therapy, one would want to look at one's individual migraine triggers or pattern and add herbs whose actions complement Feverfew's anti-inflammatory, bitter and vasodilator actions to support the affected body systems.

----- Please also check the 'Herbs for migraine' entry (2.2.2) below.

----- From Rene Burrough <100735>:

Eating feverfew leaves I learned this from a nursery woman here who grows herbs commercially & was a nurse during WW2, and has suffered from migraines for years, and it extremely sympathetic to herbal medicine. She swears that the GREEN leaf is far more efficacious than the yellow or golden version. And she takes one leaf a day for months at a time to keep the migraine at bay. What she does is to make a <bread> with the feverfew leaf inside and squished into a tiny ball with a doughy bit of bread around it as a casing. Then the pill can be swallowed without the leaf coming into contact with the lining of the digestive tract.

Galen Starwalker