Feverfew as a preventive treatment for migraine: a systematic review

BK Vogler, MH Pittler, E Ernst

Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, Exeter, UK 

E Ernst, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT, UK. Tel. and fax +44 (0) 1392 424989, email. E.Ernst@exeter.ac.uk.

Background: Feverfew is a popular herbal remedy advocated for the prevention of migraine. Aim: The aim of this systematic review was to look at the evidence for or against the clinical effectiveness of feverfew in migraine prevention. Data sources: Literature searches were performed using the following databases: Medline, Embase, Biosis, CISCOM, and the Cochrane Library (all from their inception to April 1998). Study selection: Only randomized, placebo-controlled, double-blind trials were included. Data extraction: All articles were read by two independent reviewers. Data were extracted in a predefined, standardized fashion. The methodological quality of all trials was evaluated using the Jadad score. Main results: Five trials met the inclusion/exclusion criteria. The majority favor feverfew over placebo. Yet important caveats exist. Conclusion: The clinical effectiveness of feverfew in the prevention of migraine has not been established beyond reasonable doubt.

Randomised double-blind placebo-controlled trial of feverfew in migraine prevention.

Murphy JJ, Heptinstall S, Mitchell JR.

Lancet. 1988 Jul 23;2(8604):189-92.

Department of Medicine, University Hospital, Nottingham.

The use of feverfew (Tanacetum parthenium) for migraine prophylaxis was assessed in a randomised, double-blind, placebo-controlled crossover study. After a one-month single-blind placebo run-in, 72 volunteers were randomly allocated to receive either one capsule of dried feverfew leaves a day or matching placebo for four months and then transferred to the other treatment limb for a further four months. Frequency and severity of attacks were determined from diary cards which were issued every two months; efficacy of each treatment was also assessed by visual analogue scores. 60 patients completed the study and full information was available in 59. Treatment with feverfew was associated with a reduction in the mean number and severity of attacks in each two-month period, and in the degree of vomiting; duration of individual attacks was unaltered. Visual analogue scores also indicated a significant improvement with feverfew. There were no serious side-effects.

Efficacy of feverfew as prophylactic treatment of migraine

Johnson ES, Kadam NP, Hylands DM, Hylands PJ.

Br Med J (Clin Res Ed). 1985 Aug 31;291(6495):569-73

Seventeen patients who ate fresh leaves of feverfew daily as prophylaxis against migraine participated in a double blind placebo controlled trial of the herb: eight patients received capsules containing freeze dried feverfew powder and nine placebo. Those who received placebo had a significant increase in the frequency and severity of headache, nausea, and vomiting with the emergence of untoward effects during the early months of treatment. The group given capsules of feverfew showed no change in the frequency or severity of symptoms of migraine. This provides evidence that feverfew taken prophylactically prevents attacks of migraine, and confirmatory studies are now indicated, preferably with a formulation controlled for sesquiterpene lactone content, in migraine sufferers who have never treated themselves with this herb.

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

HC Diener, V Pfaffenrath²²Leopoldstr. 59/II, München, J Schnitker³³Institut für Angewandte Statistik (IAS), Bielefeld, M Friede⁴⁴Schaper & Brümmer GmbH & Co. KG, Salzgitter, Germany & H-H Henneicke-von Zepelin⁴⁴Schaper & Brümmer GmbH & Co. KG, Salzgitter, Germany on behalf of the Investigators

Neurologische Universitätsklinik, Essen, ²Leopoldstr. 59/II, München, ³Institut für Angewandte Statistik (IAS), Bielefeld, and ⁴Schaper & Brümmer GmbH & Co. KG, Salzgitter, Germany

Hans-Christoph Diener MD, PhD, Professor and Chairman, Department of Neurology, University Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany. Tel. + 49 20 1723 2460, fax + 49 20 1723 5901, e-mail h.diener@uni-essen.de

Diener HC, Pfaffenrath V, Schnitker J, Friede M & Henneicke-von Zepelin H-H on behalf of the Investigators.

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 2005. London. ISSN 0333-1024

The efficacy and tolerability of a CO₂-extract of feverfew (MIG-99, 6.25 mg t.i.d.) for migraine prevention were investigated in a randomized, double-blind, placebo-controlled, multicentre, parallel-group study. Patients (N = 170 intention-to-treat; MIG-99, N = 89; placebo, N = 81) suffering from migraine according to International Headache Society criteria were treated for 16 weeks after a 4-week baseline period. The primary endpoint was the average number of migraine attacks per 28 days during the treatment months 2 and 3 compared with baseline. Safety parameters included adverse events, laboratory parameters, vital signs and physical examination. The migraine frequency decreased from 4.76 by 1.9 attacks per month in the MIG-99 group and by 1.3 attacks in the placebo group (P = 0.0456). Logistic regression of responder rates showed an odds ratio of 3.4 in favour of MIG-99 (P = 0.0049). Adverse events possibly related to study medication were 9/107 (8.4%) with MIG-99 and 11/108 (10.2%) with placebo (P = 0.654). MIG-99 is effective and shows a favourable benefit–risk ratio. 

Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: A double-blind placebo-controlled study

PALEVITCH D. ⁽¹⁾ ; EARON G. ⁽²⁾ ; CARASSO R. ⁽³⁾ ;

⁽¹⁾ Unit of Medicinal and Aromatic Plants, Newe Yaár Research Center, P.O. Box 1021, Ramat Yishay, 30095, ISRAEL. ⁽²⁾ Private Clinic, 125 Rothschild Blvd., Tel Aviv, ISRAEL. ⁽³⁾ Outpatient Pain Clinic, Hillel Yaffe Hospital, Hadera, ISRAEL

To assess the effectiveness of feverfew as a prophylactic therapy for migraine, a double-blind placebo controlled cross-over trial was conducted for a period of 4 months. Fifty seven patients who attended an outpatient pain clinic were selected at random and divided into two groups. Both groups were treated with feverfew in the preliminary phase (phase 1), which lasted 2 months. In the second and third phases, which continued for an additional 2 months, a double-blind placebo-controlled cross-over study was conducted. The results showed that feverfew caused a significant reduction in pain intensity compared with the placebo treatment. Moreover, a profound reduction was recorded concerning the severity of the typical symptoms that are usually linked to migraine attacks, such as vomiting, nausea, sensitivity to noise and sensitivity to light. Transferring the feverfew-treated group to the placebo treatment resulted in an augmentation of the pain intensity as well as an increase in the severity of the linked symptoms. In contrast, shifting the placebo group to feverfew therapy resulted in a reduction of the pain intensity as well as in the severity of the linked symptoms.