2.9 Feverfew and migraine.

Botanical name: 

Photo: Tanacetum parthenium 16. by Eugenia Provence, Eprovence.aol.com

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 the whole plant.

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 entry 3.2, Herbs for migraine.

From Rene Burrough <rburrough.dial.pipex.com>:

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 from 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 pill> 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.

Feverfew dangers, in the best of the herbal forums: http://www.henriettes-herb.com/archives/best/1995/feverfew-3.html