Tanacetum parthenium · herb
Evidence tier: weak
Prevents and reduces migraine frequency and intensity by inhibiting platelet aggregation and inflammatory pathways that trigger migraines
Parthenolide, the principal sesquiterpene lactone, inhibits platelet aggregation and serotonin release from platelets, and inhibits NF kB driven inflammatory signalling; the resulting account is that feverfew damps the neurogenic inflammation and vascular changes implicated in migraine. This is a laboratory hypothesis, and given that Cochrane cannot even confirm the clinical effect, the mechanism cannot be described as established. It is also the source of the bleeding interaction, which is the more actionable half of it.
Weak. Feverfew's reputation for migraine prevention is far larger than its evidence, and the Cochrane review is the reason. Wider, Pittler and Ernst (2015, CD002286, 6 trials, 561 participants) found the studies heterogeneous and the results MIXED, and graded what they found as LOW QUALITY EVIDENCE that needs to be confirmed in larger rigorous trials with stable feverfew extracts and clearly defined migraine populations before firm conclusions can be drawn. That is Cochrane declining to endorse it. The one genuinely positive signal is worth stating precisely because its size is the argument: the single largest and best conducted trial added to the review found feverfew reduced migraine frequency by a little more than HALF A MIGRAINE (0.6) per month versus placebo, with NO difference in pain severity and NO difference in attack duration. Half an attack a month, in one trial, with no effect on how bad or how long the attacks were, is not a strong result, and Cochrane says it must be viewed with caution until replicated. The instability of the extracts is a genuine methodological problem, not a footnote: parthenolide content varies enormously between products, so trials are not testing the same thing. The evidence supports PREVENTION only, taken daily, and has nothing to say about aborting an attack in progress. Europe's regulator went the traditional route rather than the evidence route, which is itself the tell: the EMA HMPC monograph registers feverfew herb for the prevention of migraine on the basis of TRADITIONAL USE, explicitly because the clinical studies had shortcomings that prevented firm conclusions. Safety: Cochrane reports no major safety concerns from the trial data.
50 to 100 mg daily of dried leaf extract standardised to about 0.2 percent parthenolide, for prevention, taken daily. Not for an attack in progress. The EMA notes feverfew medicines are for adults only and usually need to be taken for about two months before an effect can be judged.
Take 50 to 150mg of standardised extract (containing 0.2% parthenolide) daily for migraine prevention. Must be used consistently, do not stop abruptly. Allow 6 to 8 weeks to assess prevention benefit. Not for acute migraine relief.
Onset: ~60 days
Avoid in pregnancy, uterotonic effects documented; may stimulate uterine contractions. Avoid with blood thinners (warfarin, aspirin, DOACs), parthenolide inhibits platelet aggregation, increasing bleeding risk. 'Post feverfew syndrome' documented on abrupt withdrawal: rebound headache, anxiety, insomnia, taper rather than stop abruptly. Mouth ulcers in 5 to 15% of users of raw leaf preparations.
Pregnancy: avoid
Breastfeeding: avoid
Active compounds: parthenolide, tanetin, chrysanthenyl acetate, camphor
Remedies using Feverfew · Browse by body system · Check it against what you take
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.