Feverfew (Tanacetum parthenium L. Schultz-Bip.)
Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
6-hydroxykaempferol, alpha-Pinene, altamisa, apigenin, bachelor's button, camomille grande, camphene, camphor, crysanthemum parthenium, (E)-beta-ocimene, (E)-chrysanthenol, (E)-chrysanthenyl acetate, featherfew, featherfoil, febrifuge plant, federfoy, flirtwort, gamma-terpinene, golden feverfew, Leucanthemum parthenium, limonene, linalool, lipophilic flavonoids, luteolin 7-glucuronides, Matricaria capensis, matricaria eximia hort, Matricaria parthenium L., melatonin, midsummer daisy, MIG-99, Mig-RL, monoterpenes, mother herb, mutterkraut, nosebleed, p-cymene, Parthenium hysterophorus, parthenolide, Pyrenthrum parthenium L., quercetagetin, santa maria, sesquiterpene lactones, sesquiterpenes, Tanacetum parthenium, Tanacetum parthenium (L.) Schultz-Bip., tanetin, tannins, wild chamomile, wild quinine.
Feverfew is an herb that has been used traditionally for fevers, as its name denotes, although this effect has not been well studied.
Feverfew is most commonly taken by mouth for the prevention of migraine headache. Several human trials have been conducted with mixed results. Overall, these studies suggest that feverfew taken daily as dried leaf capsules may reduce the incidence of headache attacks in patients who experience chronic migraines. However, this research has been poorly designed and reported.
There is currently inconclusive evidence regarding the use of feverfew for symptoms associated with rheumatoid arthritis.
Feverfew appears to be well tolerated in clinical trials, with a mild and reversible side effects profile. The most common adverse effect appears to be mouth ulceration and inflammation with direct exposure to leaves. In theory, there may be an increased risk of bleeding.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Migraine headache prevention
Feverfew is often taken by mouth for the prevention of migraine headaches. Laboratory studies show that feverfew can reduce inflammation and prevent blood vessel constriction (squeezing) that may lead to headaches. Most of the available human studies are not high quality and report mixed results. However, overall they do suggest that feverfew may reduce the number of headaches that occur in people with frequent migraines. A large, well-designed study comparing feverfew to other migraine treatments is needed before a strong recommendation can be made.
It is not clear if feverfew is helpful for treating rheumatoid arthritis symptoms such as joint stiffness or pain.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
Abdominal pain, anemia, anti-inflammatory, asthma, blood vessel dilation (relaxation), blood vessel disorders (antiangiogenic), breast cancer, cancer, central nervous system diseases, colds, colorectal cancer, constipation, cystic fibrosis, diarrhea, digestion, dizziness, fever, gastrointestinal distress, joint pain, induction of labor/abortion, heart muscle injury, insect bites, insect repellant, leukemia, menstrual cramps, neurological complications of malaria, pancreatic cancer, parasitic infections (leishmaniasis), promotion of menstruation, rash, ringing in the ears, skin cancer, toothache, tranquilizer, uterine disorders.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
2 to 3 dried leaves (approximately 60 milligrams) have been taken daily, or 50 to 250 milligrams of a dried leaf preparation taken daily, standardized to 0.2% parthenolide (a common dose is 125 milligrams daily). Human studies have used 50 to 114 milligrams of feverfew powdered leaves daily, packed into capsules, standardized to 0.2% parthenolide, or 0.50 milligrams of parthenolide daily. Doses of 70 to 86 milligrams of dried chopped feverfew leaves in capsules, taken once daily, have also been used.
Children (younger than 18 years)
There is not enough scientific information to safely recommend feverfew for use in children.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Feverfew may cause allergy in people allergic to chrysanthemums, daisies, marigolds, or other members of the Compositae family, including ragweed. There are multiple reports of allergic skin rashes after contact with feverfew.
Side Effects and Warnings
Few side effects are reported in human studies of feverfew. The side effects that do occur are usually mild and reversible. Mouth inflammation or ulcers, including swelling of the lips, tongue irritation, bleeding of the gums, and loss of taste, have been reported and usually occur after direct contact of the mouth with the leaves, although some people report burning after swallowing a capsule containing dried leaf. Photosensitivity (sensitivity to sunlight or sunlamps) has been reported with other herbs in the Compositae plant family and may be possible with feverfew as well. Indigestion, nausea, flatulence, constipation, diarrhea, abdominal bloating, and heartburn have been reported rarely in human studies. Gardeners may develop skin irritation at sites of contact with feverfew plants. Feverfew can also cause allergic rashes. One small study reported increased heart rate in some patients.
Long-term feverfew users who stop treatment suddenly may experience feverfew withdrawal symptoms, including rebound headaches, anxiety, difficulty sleeping, muscle stiffness, and joint pain.
Laboratory tests suggest that feverfew affects blood platelets and in theory may increase the risk of bleeding. However, this has not been clearly shown in humans. Nonetheless, caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. Use caution prior to some surgeries or dental procedures, due to a theoretical increase in bleeding risk.
Pregnancy and Breastfeeding
There is not enough information about safety to recommend feverfew during pregnancy or breastfeeding. Traditional experience suggests that feverfew may stimulate menstrual flow and induce abortion, and therefore should be avoided.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Based on laboratory research, feverfew theoretically may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. However, this has not been clearly shown in humans. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
Sun sensitivity caused by certain drugs like doxycycline or Retin A® may be increased by feverfew. Feverfew may also alter the way that certain drugs are broken down by the liver.
Feverfew may have an additive effect if taken along with drugs taken for cancer, histamine release, fungal or protozoal infections, and drugs that increase blood flow. Feverfew may also interact with anesthetics and antibiotics.
In theory, feverfew may interact with anti-depressants and should be used with caution in people with a history of depression and/or other mental illness.
Interactions with Herbs and Dietary Supplements
In theory, feverfew may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. This is based on laboratory research, and has not been reported clearly in humans. Multiple cases of bleeding have been reported with the use of Ginkgo biloba and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
Sun sensitivity caused by certain herbs and supplements may be increased by feverfew. Feverfew may alter the way that certain herbs and supplements are broken down by the liver.
Feverfew may theoretically interact with herbs that act as antidepressants, such as St. John's wort.
Feverfew may also interact with herbs taken for cancer, parasitic infection, fungal infection, bacterial infection, protozoal infection, and drugs that increase blood flow.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Curry EA III, 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. View Abstract
DeWeerdt CJ, Bootsman H, Hendricks H. Herbal medicines in migraine prevention. Randomized double-blind placebo-controlled crossover trial of a feverfew preparation. Phytomed 1996;3(3):225-230.
Diener HC, Pfaffenrath V, Schnitker J, et al. 2005 Nov;25(11):1031-41. 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. View Abstract
Ernst E, Pittler MH. The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review. Public Health Nutr 2000;3(4A):509-514. View Abstract
Kuritzky A, Elhacham Y, Yerushalmi Z, et al. Feverfew in the treatment of migraine: its effect on serotonin uptake and platelet activity. Neurology 1994;44(Suppl 2):A201.
Maizels M, Blumenfeld A, Burchette R. A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: a randomized trial. Headache 2004;44(9):885-890. View Abstract
Murphy JJ, Heptinstall S, Mitchell JR. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet 7-23-1988;2(8604):189-192. View Abstract
Palevitch D, Earon G, Carasso R. Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: a double-blind placebo-controlled study. Phytother Res 1997;11(7):508-511.
Pattrick M, Heptinstall S, Doherty M. Feverfew in rheumatoid arthritis: a double blind, placebo controlled study. Ann Rheum Dis 1989;48(7):547-549. View Abstract
Pittler MH, Vogler BK, Ernst E. Feverfew for preventing migraine (Cochrane Review). The Cochrane Library 2000;(4):CD002286. View Abstract
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. View Abstract
Sriramarao P, Rao PV. Allergenic cross-reactivity between Parthenium and ragweed pollen allergens. Int Arch Allergy Immunol 1993;100(1):79-85. View Abstract
Vogler BK, Pittler MH, Ernst E. Feverfew as a preventive treatment for migraine: a systematic review. Cephalalgia 1998;18(10):704-708. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017