By Marcello Cherchi, MD PhD
For patients
Feverfew is an herb. Feverfew is safe to take, though you should not take feverfew if you are pregnant or nursing. Feverfew helps some people with migraines.
For clinicians
Overview
Several extracts of the herb feverfew have been used in medicine for various purposes. Feverfew is generally well tolerated and no major safety concerns have been reported. In otoneurology feverfew is sometimes used for migraine prophylaxis, though the evidence for its efficacy is modest.
Introduction
Feverfew is an herb (Tanacetum parthenium) that has been used for putative medicinal purposes for centuries.
Pharmacology
Feverfew appears to have several biological effects, including anti-inflammatory activity, relaxation of smooth muscle in vasculature, inhibition of platelet aggregation, and anti-histaminic activity (Pareek et al. 2011).
Adverse effects
Systematic reviews have found no major safety concerns associated with feverfew (Ernst and Pittler 2000; Wider et al. 2015).
Cautions and contraindications
Feverfew should not be taken during pregnancy and nursing.
Relevance in otoneurology
Feverfew has been studied as a migraine prophylactic. There may be more than one mechanism of action (Pareek et al. 2011).
There are several different extracts of feverfew (Pareek et al. 2011). The most commonly used extract of feverfew, called parthenolides, is taken at a dose of 100 – 300 mg four times per day. Another extract of feverfew, called MIG‑99, is taken at a dose of 6.25 mg three times per day (Diener et al. 2005).
Several Cochrane reviews found insufficient evidence to support the use of feverfew for migraine prophylaxis (Pittler and Ernst 2004; Pittler et al. 2000), though the most recent Cochrane review concluded, “Since the last version of this review, one larger rigorous study has been included, reporting a difference in effect between feverfew and placebo of 0.6 attacks per month. This adds some positive evidence to the mixed and inconclusive findings of the previous review. However, this constitutes low quality evidence, which needs to be confirmed in larger rigorous trials with stable feverfew extracts and clearly defined migraine populations before firm conclusions can be drawn” (Wider et al. 2015).
If feverfew is effective for migraine prophylaxis, this usually becomes apparent around 16 weeks (Diener et al. 2005).
Some patients take feverfew in combination with other non-pharmacologic migraine prophylaxis (Guilbot et al. 2017; Maizels et al. 2004).
Other notes
Feverfew is available over-the-counter.
References
Diener HC, Pfaffenrath V, Schnitker J, Friede M, Henneicke-von Zepelin HH (2005) 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 25: 1031-41. doi: 10.1111/j.1468-2982.2005.00950.x
Ernst E, Pittler MH (2000) The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review. Public Health Nutr 3: 509-14. doi: 10.1017/s1368980000000598
Guilbot A, Bangratz M, Ait Abdellah S, Lucas C (2017) A combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study. BMC Complement Altern Med 17: 433. doi: 10.1186/s12906-017-1933-7
Maizels M, Blumenfeld A, Burchette R (2004) A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: a randomized trial. Headache 44: 885-90.
Pareek A, Suthar M, Rathore GS, Bansal V (2011) Feverfew (Tanacetum parthenium L.): A systematic review. Pharmacogn Rev 5: 103-10. doi: 10.4103/0973-7847.79105
Pittler MH, Ernst E (2004) Feverfew for preventing migraine. Cochrane Database Syst Rev: CD002286.
Pittler MH, Vogler BK, Ernst E (2000) Feverfew for preventing migraine. Cochrane Database Syst Rev: CD002286. doi: 10.1002/14651858.CD002286
Wider B, Pittler MH, Ernst E (2015) Feverfew for preventing migraine. Cochrane Database Syst Rev 4: CD002286. doi: 10.1002/14651858.CD002286.pub3
