Feverfew

Tanacetum parthenium

Common & Folk Names

• Featherfew
• Febrifuge Plant (fever reducer)
• Bachelor’s Buttons
• Wild Chamomile
• Mutterkraut (German – “mother’s herb”)
• Medieval Aspirin

Plant Family

Asteraceae (Compositae) – The Daisy/Composite Family

Geographic Location

Feverfew is native to the Balkan Peninsula and Asia Minor (southeastern Europe and Turkey). It has naturalised extensively throughout temperate regions worldwide including Europe, North America, Australia, and New Zealand. Originally a cultivated garden plant, it has escaped cultivation and now grows wild in many areas. In New Zealand, feverfew is naturalised throughout both islands, particularly in cooler regions, though not considered invasive.

Habitat

Feverfew grows readily in disturbed areas including roadsides, waste ground, old walls, hedgerows, and field margins. It thrives in sunny, well-drained locations and is commonly found near human habitation. In its naturalised range, it often grows as a garden escapee or volunteer plant. Feverfew tolerates a wide range of soil conditions but prefers slightly alkaline, well-drained sites with moderate fertility.

Growing Conditions

Sun: Full sun preferred. Tolerates partial shade but flowering and parthenolide content may be reduced in shade.

Soil: Well-drained, moderately fertile soil with neutral to slightly alkaline pH (6.5-7.5). Tolerates poor, rocky, or sandy soil. Does NOT tolerate waterlogged conditions. Drought-tolerant once established.

Propagation: Easily grown from seed sown in spring (September-October in NZ) or autumn (March-April). Seeds need light to germinate – press onto soil surface, do not cover. Germination in 10-21 days at 15-20°C. Can also propagate by division in spring or autumn, or from basal cuttings in spring. Self-seeds prolifically – can become weedy if not deadheaded.

Care: Low maintenance perennial. Water regularly during establishment, then drought-tolerant. Benefits from occasional trimming to encourage bushiness. Deadhead spent flowers to prevent excessive self-seeding and prolong blooming season (unless collecting seed). Cut back to ground level in late autumn/winter. May die back in severe frost but usually regenerates from roots in spring. Hardy in USDA zones 5-9 (equivalent to most NZ regions). Plant grows 30-60 cm tall with deeply divided, yellow-green, aromatic leaves and clusters of small white daisy-like flowers with yellow centres.

NZ Planting Calendar

Sowing/Planting: September–October (spring) or March–April (autumn)

Division: Spring or autumn

Flowering: December–February (summer)

Harvest (Leaves): December–February (just before or during early flowering for maximum parthenolide)

Harvesting Guidelines

Leaves (Primary Medicinal Part):

Optimal harvest timing: Harvest leaves just before or during early flowering (December-February in NZ), when parthenolide content is typically highest

Method:

• Cut fresh, unblemished leaves in morning after dew has dried but before midday heat
• Use clean, sharp scissors or pruners
• Harvest from healthy, vigorous plants (at least 6 months old for good parthenolide content)
• Can harvest throughout growing season but pre-flowering/early flowering stage preferred for maximum potency

Drying:

• Dry quickly in warm (not hot), shaded, well-ventilated area to preserve volatile parthenolide
• Temperature: 30-40°C maximum (higher temperatures degrade parthenolide)
• Spread leaves in single layer on screens or hang small bunches
• Dry until crisp and crumbly (7-14 days depending on conditions)

CRITICAL: Parthenolide is volatile and heat-sensitive – slow drying or high heat significantly reduces potency

Freeze-drying preserves maximum parthenolide (commercial products often freeze-dried)

• Store dried leaves in airtight containers away from light and heat
• Properly dried and stored leaves retain potency for 6-12 months

Flowers (Secondary Use):

• Harvest flowers when fully open
• Dry as for leaves
• Flowers have lower parthenolide content than leaves
• Used primarily in combination preparations

Seeds:

• Allow flower heads to fully dry on plant
• Collect seeds when brown and dry
• Store in cool, dry place for propagation

Harvesting Caution:

• Feverfew sap can cause contact dermatitis in sensitive individuals (approximately 5-10% of people)
• Members of Asteraceae family (ragweed, chrysanthemum, daisy) commonly cause allergic reactions
• Wear gloves if skin sensitivity is a concern
• Wash hands thoroughly after handling fresh plant

Parts Used

• Leaves – primary medicinal part (highest parthenolide content, 0.1-0.7%)
• Aerial parts (leaves and flowers combined) – used in some preparations
• Flowers – secondary use (lower parthenolide than leaves)

Constituents & their Actions

Feverfew’s therapeutic activity comes from a complex mixture of compounds, with the sesquiterpene lactone parthenolide receiving the most research attention as the primary active constituent (though this is now debated).

Sesquiterpene Lactones (0.2-0.9% of Dried Leaf):

These are the most pharmacologically significant constituents. Feverfew contains multiple sesquiterpene lactones of the germacranolide type. The most abundant and well-studied is:

• Parthenolide (0.1-0.7% of dried leaf – accounts for 85-90% of total sesquiterpene lactone content)
• Additional sesquiterpene lactones: 3β-hydroxyparthenolide, canin, artecanin, reynosin, santamarin, and others

The main actions of parthenolide are:

• Potent anti-inflammatory (inhibits NF-κB signaling pathway)
• Inhibits serotonin release from platelets
• Inhibits prostaglandin synthesis
• Blocks CGRP (Calcitonin Gene-Related Peptide) release from trigeminal nerves
• Inhibits nitric oxide synthesis
• Antispasmodic (smooth muscle relaxation)

Volatile Oils (0.2-0.5%):

These contribute to feverfew’s aromatic properties and may have therapeutic effects. Main volatile compounds include:

• Camphor
• Camphene
• Borneol
• α-pinene
• β-pinene
• Terpinene

The main actions are:

• Mild anti-inflammatory
• Antimicrobial

Flavonoids:

Polyphenolic compounds with antioxidant and anti-inflammatory properties:

• Apigenin
• Luteolin
• Quercetin
• Tanetin

The main actions are:

• Antioxidant (free radical scavenging)
• Anti-inflammatory
• Mild antispasmodic

Polyacetylenes:

Unique compounds found in feverfew and other Asteraceae:

These contribute to:

• Antimicrobial effects
• Possible anti-inflammatory activity

Melatonin:

Interestingly, feverfew contains measurable amounts of melatonin (identified by Murch et al., 1997 in The Lancet). This is unusual for a non-seed plant part.

May contribute to:

• Regulation of circadian rhythms
• Possible role in migraine prophylaxis (migraines often have circadian/sleep components)

Actions with Mechanisms

Migraine Prophylaxis (Primary Modern Use – PREVENTIVE, Not Acute Treatment):

This is feverfew’s most clinically validated and widely-used action. CRITICAL DISTINCTION: Feverfew works PROPHYLACTICALLY (preventively) to reduce frequency and severity of migraine attacks when taken daily over weeks to months. It does NOT treat acute migraine attacks in progress and should NOT be taken as an abortive medication. The mechanism of migraine prevention appears to involve multiple pathways. Parthenolide inhibits the transcription factor NF-κB (nuclear factor kappa B), which in turn reduces expression of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6) and inflammatory mediators implicated in migraine pathogenesis. This occurs because parthenolide directly binds to and inhibits IκB kinase (IKK), which in turn prevents NF-κB activation and translocation to the nucleus. Feverfew inhibits serotonin (5-HT) release from blood platelets, which in turn may reduce the serotonergic component of migraine initiation. However, the role of platelet serotonin in migraine is now debated and may not be the primary mechanism. More importantly, parthenolide inhibits release of CGRP (Calcitonin Gene-Related Peptide) from trigeminal sensory neurons, which in turn prevents neurogenic inflammation and vasodilation that characterize migraine attacks. CGRP is now recognised as a central mediator of migraine – modern migraine drugs (gepants, CGRP monoclonal antibodies) target this pathway. Feverfew blocks CGRP via inhibition of TRPA1 (transient receptor potential ankyrin 1) channels in sensory neurons, which in turn prevents the pain signaling cascade. Additionally, feverfew inhibits nitric oxide (NO) synthesis via down-regulation of inducible nitric oxide synthase (iNOS), which in turn reduces NO-mediated vasodilation and neurogenic inflammation associated with migraines. The mechanism is complex and multifactorial – feverfew acts at multiple points in the migraine cascade rather than a single target. Onset of effect is cumulative and delayed: Feverfew must be taken daily for 4-6 weeks minimum to assess effectiveness, with maximal benefit often requiring 2-3 months of continuous use. This reflects the need for sustained anti-inflammatory effects and neurochemical modulation.

Anti-inflammatory (Systemic):

Feverfew provides broad anti-inflammatory effects beyond migraine prevention. Parthenolide’s inhibition of NF-κB is a central mechanism, which in turn suppresses transcription of multiple inflammatory genes including those encoding COX-2, iNOS, and pro-inflammatory cytokines. This represents a “upstream” anti-inflammatory mechanism – blocking the master regulator rather than individual downstream mediators. Additionally, feverfew inhibits prostaglandin synthesis via direct inhibition of phospholipase A2, which in turn reduces arachidonic acid release and subsequent prostaglandin production. The flavonoids provide additional anti-inflammatory effects via antioxidant mechanisms, scavenging free radicals that perpetuate inflammation. These anti-inflammatory properties have led to traditional and some modern use of feverfew for arthritis, though clinical evidence for this indication is limited compared to migraine prophylaxis.

Antiplatelet/Antithrombotic:

Feverfew inhibits platelet aggregation through multiple mechanisms. Parthenolide inhibits granule secretion from platelets, which in turn prevents release of platelet-activating substances including serotonin, ADP, and thromboxane A2. This occurs via inhibition of sulfhydryl groups in platelet proteins. Additionally, feverfew extracts inhibit thromboxane synthetase and reduce thromboxane B2 production, which in turn reduces platelet activation and aggregation. These antiplatelet effects are CLINICALLY SIGNIFICANT and create drug interaction concerns with anticoagulant/antiplatelet medications (see Safety section). The antiplatelet action may contribute to cardiovascular protective effects but also increases bleeding risk.

Smooth Muscle Relaxation/Antispasmodic:

Feverfew causes relaxation of smooth muscle in blood vessels and potentially other tissues. This occurs via multiple mechanisms including calcium channel blockade and modulation of prostaglandin synthesis, which in turn reduces smooth muscle tone. This antispasmodic action contributes to feverfew’s use for menstrual cramps and digestive spasms in traditional medicine, though clinical evidence is limited. The vascular smooth muscle effects may contribute to migraine prophylaxis by reducing vascular reactivity.

Emmenagogue (Stimulates Menstruation – Traditional Use):

Traditional use includes bringing on menstruation and aiding childbirth (hence the name “mutterkraut” or “mother’s herb” in German). The mechanism likely involves uterine smooth muscle stimulation via prostaglandin-mediated pathways and/or direct uterine contractile effects.

Mild Febrifuge (Fever Reducer – Historical Use):

Despite the common name “febrifuge plant,” feverfew’s fever-reducing properties are not particularly strong and this is no longer a primary clinical use. The mechanism would involve anti-inflammatory prostaglandin inhibition affecting hypothalamic thermoregulation. The name “feverfew” may actually be a corruption of “featherfew” (referring to feathery leaves) rather than “fever few.”

Main Use

Feverfew’s primary modern use is as a PROPHYLACTIC (PREVENTIVE) treatment for MIGRAINE headaches, taken daily to reduce the frequency, severity, and duration of migraine attacks. This is an evidence-based application supported by multiple clinical trials. Feverfew is NOT effective for treating acute migraines already in progress – it must be taken continuously as prevention.

Primary Clinical Indication:

Migraine Prophylaxis (Prevention):

• For patients with frequent migraines (≥2-4 attacks per month) seeking to reduce attack frequency
• Particularly useful for patients who:
• Cannot tolerate pharmaceutical migraine prophylaxis drugs (beta-blockers, anticonvulsants, antidepressants)
• Prefer natural/herbal approaches
• Have contraindications to pharmaceutical prophylaxis
• Want to try reducing pharmaceutical medication doses (under medical supervision)

Evidence Base:

Murphy et al. (1988), The Lancet: Landmark double-blind placebo-controlled crossover trial of 72 patients. Feverfew (one capsule dried leaf daily) significantly reduced mean number and severity of attacks, reduced vomiting, compared to placebo. Visual analog scores showed significant improvement.

Johnson et al. (1985), British Medical Journal: Double-blind placebo-controlled trial of 17 patients who previously used fresh feverfew leaves. When switched to placebo, patients had significant increase in frequency and severity of headache, nausea, vomiting. Feverfew group maintained stable migraine control. “Provides evidence that feverfew taken prophylactically prevents attacks of migraine.”

Pfaffenrath et al. (2002), Cephalalgia: Double-blind, multicenter, placebo-controlled dose-response study (n=147). Tested MIG-99 (CO2 extract) at three doses. 6.25 mg TID (equivalent to 0.5 mg parthenolide) showed best efficacy. Results showed modest but significant reduction in migraine frequency in subset of patients with ≥2-4 attacks per month.

2015 Cochrane Review (Wider et al.): Systematic review concluded feverfew is “likely to be effective in the prevention of migraine” though noted quality of evidence varies and more research needed. Most trials favor feverfew over placebo.

1999 Systematic Review (Ernst & Pittler): Reviewed 6 RCTs. Majority favored feverfew over placebo. Concluded “feverfew is likely to be effective in the prevention of migraine.”

Realistic Expectations:

• Effect is modest to moderate, not dramatic
• Reduces migraine frequency by approximately 20-40% in responders
• Reduces severity and associated symptoms (nausea, vomiting, light sensitivity)
• Does NOT eliminate migraines completely in most patients
• Individual variation – works well for some, minimally or not at all for others
• Requires 4-6 weeks minimum trial to assess effectiveness, often 2-3 months for full benefit
• Should be combined with lifestyle modifications (sleep, stress management, trigger avoidance)

Comparison to Pharmaceutical Prophylaxis:

• Generally less effective than prescription prophylactic medications (beta-blockers, topiramate, valproate, CGRP antibodies)
• But potentially fewer side effects than pharmaceuticals
• Reasonable option for mild-moderate migraine, first-line natural approach, or adjunct to medications

Often combined with:

• Magnesium (400-600 mg daily) – reduces migraine frequency via multiple mechanisms
• Riboflavin/Vitamin B2 (400 mg daily) – mitochondrial support
• Coenzyme Q10 (100-300 mg daily) – energy metabolism support
• This “triplet” combination has good evidence for migraine prophylaxis

Secondary/Traditional Uses (Limited Clinical Evidence):

• Arthritis/Rheumatism: Traditional use for inflammatory joint conditions. Anti-inflammatory mechanisms support rationale but clinical trials lacking.
• Menstrual disorders: Traditional emmenagogue for scanty/irregular periods, dysmenorrhea (painful periods). Limited evidence.
• Fever: Historical use (name “febrifuge”) but not a primary modern application.
• Headaches generally: May help tension headaches via anti-inflammatory/antispasmodic effects but specific evidence for non-migraine headaches limited.

Preparations

CRITICAL PREPARATION NOTE: Parthenolide is volatile, heat-sensitive, and poorly water-soluble. Heat (including hot water infusion) significantly degrades parthenolide. Freeze-drying preserves maximum parthenolide content. For migraine prophylaxis, freeze-dried capsules standardised to parthenolide content are most reliable.

Freeze-Dried Leaf Capsules (PREFERRED for Migraine Prophylaxis):

• Most reliable preparation – preserves volatile parthenolide
• Use products standardised to minimum 0.2% parthenolide (preferably 0.2-0.7%)
• Typical dose: 50-150 mg standardised extract daily
• OR: 100-250 mg freeze-dried whole leaf (if standardised)
• Take with food to minimize GI upset
• Available from health food stores, online retailers
• Look for: “Standardised to 0.2% (or higher) parthenolide” on label
• Split dose (morning and evening) may improve tolerance

Commercial CO₂ Supercritical Extract (MIG-99 Type):

• Special CO₂ extraction process preserves parthenolide
• Well-studied in clinical trials
• Dose: 6.25 mg extract, 3 times daily (equivalent to 0.5 mg parthenolide total daily)
• More expensive but good quality control
• May be labeled as “MIG-99” or similar

Fresh Leaf (Traditional Method – NOT RECOMMENDED for Most Users):

Traditional approach: Chew 1-3 fresh leaves daily

PROBLEMS:

• Causes mouth ulcers (aphthous ulcers) in approximately 10-18% of users – painful, can lead to discontinuation
• Loss of taste sensation
• Tongue inflammation and swelling
• Unpleasant bitter taste
• Parthenolide content varies enormously between plants (genetic variation)
• Difficult to standardise dose

If using fresh leaves: Sandwich between bread to minimize mouth contact, or swallow whole leaves without chewing (though absorption may be reduced)

Only consider if growing your own feverfew and cannot access standardised products

Tincture (1:5, 40-50% Alcohol):

• 2-4 mL, 1-2 times daily
• Less reliable for migraine prophylaxis than freeze-dried capsules
• Alcohol extracts parthenolide reasonably well but storage stability concerns (parthenolide degrades over time)
• May be useful if capsules not tolerated
• Take diluted in water

Tea/Infusion (NOT RECOMMENDED for Migraine Prophylaxis):

• 1-2 teaspoons dried leaf per cup boiling water, steep 10-15 minutes
• PROBLEM: Parthenolide is poorly water-soluble and heat-sensitive – hot water infusion destroys much of the parthenolide
• Tea may provide some anti-inflammatory effects from flavonoids but unlikely to be effective for migraine prevention
• Traditional use for fever, general anti-inflammatory, but not optimal for migraines

Dried Leaf Powder (Non-Freeze-Dried):

• 50-200 mg dried powdered leaf in capsules or mixed in food
• Less reliable than freeze-dried – conventional drying (heat) reduces parthenolide
• If using, ensure product specifies parthenolide content
• Start low dose and increase gradually

Combination Products:

• Feverfew + Magnesium + Riboflavin (B2) + Coenzyme Q10 – popular combination for migraine prophylaxis
• Example: Products like “MigreLief,” “Migraine Defense,” etc.
• May offer synergistic benefits
• Follow manufacturer’s instructions

Dosage

CRITICAL DOSING NOTES:

• Feverfew must be taken DAILY for PROPHYLAXIS – not “as needed”
• Minimum 4-6 week trial required to assess effectiveness
• Maximal benefit often takes 2-3 months
• If no improvement after 3 months, unlikely to be effective
• Do not stop abruptly after long-term use (see “Post-Feverfew Syndrome” in Safety section)

Migraine Prophylaxis:

• Freeze-Dried Leaf (Standardised to 0.2-0.7% Parthenolide): 50-150 mg daily, typically divided into 2 doses
• OR: 100-250 mg freeze-dried whole leaf daily (if standardised)
• CO2 Extract (MIG-99 Type): 6.25 mg, 3 times daily (18.75 mg total daily) – this provides approximately 0.5 mg parthenolide daily
• Parthenolide Dose: Target 0.2-0.6 mg parthenolide daily (most clinical trials used this range)
• Fresh Leaves (if used): 1-3 fresh leaves daily – highly variable parthenolide content, mouth ulcer risk
• Tincture (1:5, 40-50% Alcohol): 2-4 mL, 1-2 times daily
• Duration: Continuous use for months to years while migraines are problematic. Can attempt gradual taper after 6-12 months of good control to see if migraines return.

General Anti-Inflammatory/Other Uses:

• Tincture: 2-3 mL, 2-3 times daily
• Tea: 1 cup, 1-3 times daily (though not ideal for parthenolide delivery)

Children:

• Limited safety data in children
• Not typically recommended under age 12
• If used in adolescents (12-18 years), use reduced adult dose under professional supervision

Elderly:

• Standard adult doses generally safe
• Monitor for drug interactions (often on anticoagulants)

Safety & Drug Interactions

Scientific Evidence

Migraine Prophylaxis – Clinical Trials (Chronological):

Johnson et al. (1985), British Medical Journal: Double-blind placebo-controlled study of 17 patients who were chronic feverfew users (eating fresh leaves). Patients randomized to continue feverfew (capsules of freeze-dried leaf) or placebo for 6 months, then crossed over. Results: Placebo group had significant increases in migraine frequency and severity, nausea, and vomiting. Feverfew group maintained stable migraine control. Conclusion: “Feverfew taken prophylactically prevents attacks of migraine.”

Murphy et al. (1988), The Lancet: Randomized, double-blind, placebo-controlled crossover study. 72 volunteers (60 completed) with migraine (IHS criteria). One capsule dried feverfew leaf daily or placebo for 4 months, then crossed over for 4 months (after 1-month washout). Results: Feverfew associated with significant reduction in mean number of attacks (24% reduction), severity of attacks, and degree of vomiting. Duration of attacks unchanged. Visual analog scores showed significant improvement. Side effects: 18% developed mouth ulcers (using fresh leaves in preliminary phase). Conclusion: Feverfew effective for migraine prophylaxis.

Pfaffenrath et al. (2002), Cephalalgia: Double-blind, multicenter, randomized placebo-controlled dose-response study. 147 patients with migraine (with or without aura). Tested three doses of MIG-99 (CO2 extract): 2.08 mg, 6.25 mg, 18.75 mg TID vs placebo for 12 weeks after 4-week baseline. Primary outcome: number of migraine attacks in last 28 days of treatment vs baseline. Results: Overall population showed modest non-significant trends. However, subgroup with ≥4 attacks/month showed significant benefit with 6.25 mg TID dose. Conclusion: Moderate evidence for efficacy in high-frequency migraine sufferers. Dose-response relationship demonstrated (6.25 mg TID optimal).

1998 Study (Palevitch et al.): Double-blind placebo-controlled crossover trial (n=57). Feverfew significantly reduced pain intensity compared to placebo. Profound reduction in typical migraine symptoms (vomiting, nausea, photophobia, phonophobia). Transferring from feverfew to placebo caused augmentation of pain intensity and symptom severity.

Systematic Reviews & Meta-Analyses:

Ernst & Pittler (1999), Public Health Nutrition: Systematic review and update of RCTs. Searched multiple databases through December 1999. 6 RCTs met inclusion criteria (feverfew mono-preparations for migraine prevention). Quality assessment: Jadad scores 1-5 (moderate quality). Results: Majority of trials favor feverfew over placebo. Data suggest feverfew associated with only mild and transient adverse effects. Conclusion: “Feverfew is likely to be effective in the prevention of migraine.”

Pittler & Ernst (2004), Cochrane Database: Systematic review for Cochrane Library. Included 5 RCTs (n=343 patients total). Results: Mixed evidence – 3 trials showed benefit, 2 did not. Heterogeneity in study designs, feverfew preparations, and quality. Conclusion: Evidence suggests feverfew may have efficacy beyond placebo but more rigorous studies needed. Updated in 2015.

Wider et al. (2015), Cochrane Database: Updated Cochrane systematic review. 6 RCTs included. Results: Evidence remains mixed but overall suggests potential benefit. Significant heterogeneity in studies (preparations, doses, outcome measures). Conclusion: “Feverfew is likely to be effective in the prevention of migraine” but quality and consistency of evidence could be improved.

Mechanism Studies (Selected):

Heptinstall et al. (1985), The Lancet: In vitro study. Feverfew extracts inhibited granule secretion in blood platelets and polymorphonuclear leukocytes. Inhibited serotonin release from platelets induced by multiple aggregating agents (ADP, adrenaline, collagen). Proposed platelet serotonin release inhibition as mechanism for migraine prophylaxis.

Kwok et al. (2001), Chemistry & Biology: Parthenolide directly binds to and inhibits IκB kinase (IKK), which in turn blocks NF-κB pathway activation. This provides molecular mechanism for parthenolide’s anti-inflammatory effects at transcriptional level.

Murch et al. (1997), The Lancet: Identified melatonin in feverfew and other medicinal plants. Suggested melatonin content may contribute to feverfew’s effects in conditions with circadian/sleep components (like migraine).

Multiple studies (2000s-2010s): Demonstrated parthenolide inhibits CGRP release from trigeminal neurons via TRPA1 channel blockade, inhibits nitric oxide synthesis, modulates inflammatory cytokines. Modern understanding: feverfew works via multiple anti-inflammatory and neuro-modulatory pathways relevant to migraine pathophysiology.

Controversies & Ongoing Debates:

Is parthenolide the active principle? Initially assumed yes, but some feverfew preparations with low/no parthenolide show efficacy. Debate ongoing. Likely multiple constituents contribute.

Why variable clinical trial results? Variability in feverfew preparations (parthenolide content), patient populations, outcome measures, trial duration. Standardization issues.

Optimal dose unclear: Trials used different doses. 6.25 mg MIG-99 TID performed best in dose-response study but many trials used whole leaf preparations.

Other Research Areas:

• Cancer research: Parthenolide shows anti-cancer activity in vitro and animal models (leukemia, solid tumors). Inhibits NF-κB and targets cancer stem cells. Early research stage – not clinical use.
• Rheumatoid arthritis: Traditional use. Some in vitro and animal data support anti-inflammatory effects. Clinical trials limited.

Evidence Quality Summary:

• Migraine prophylaxis: Moderate evidence (multiple RCTs, systematic reviews favor efficacy but heterogeneity exists)
• Anti-inflammatory: Good mechanistic evidence (in vitro, animal), limited human trials outside migraine
• Antiplatelet: Good in vitro and ex vivo evidence, case reports of bleeding
• Other uses: Insufficient evidence

Western Energetics

Temperature: Cooling to Neutral. Feverfew has anti-inflammatory, fever-reducing properties that clear heat, though not as strongly cooling as some herbs. The bitter taste indicates cooling/clearing action.

Moisture: Drying. The bitter quality and anti-inflammatory effects are generally drying in nature, though feverfew is not intensely drying like some bitter herbs.

Tissue State:

Primary: Heat/Excitation (inflammation, acute pain, throbbing headaches, fever, hot conditions)

Secondary: Tension/Constriction (vascular spasm component of migraines, smooth muscle tension)

Feverfew’s primary affinity is for hot, inflamed, excited conditions particularly affecting the head and nervous system. The bitter, cooling nature addresses heat and inflammation while antispasmodic effects address vascular and smooth muscle tension.

Taste

Bitter:

• Dominant taste
• Indicates anti-inflammatory, cooling, digestive stimulant actions
• Stimulates digestive secretions
• Quite pronounced bitterness – makes fresh leaves unpleasant to chew

Aromatic:

• Secondary characteristic
• From volatile oils (camphor, pinenes)
• Slightly pungent, herbal aroma
• Contributes to antispasmodic properties

The strong bitter taste is characteristic of anti-inflammatory herbs with cooling properties. The bitterness makes feverfew unpalatable for many users, supporting use of capsules over fresh leaves.

Plant Lore

Etymology:

• Common name “feverfew” likely derived from Latin febrifugia (“fever reducer”) – medieval corruption through Old English feferfuge
• Alternative theory: Corruption of “featherfew” referring to feathery, finely divided leaves
• Scientific name Tanacetum from Greek athanasia (“immortality”) – shared with tansy
• Parthenium from Greek parthenos (“virgin”) – Plutarch records feverfew saved life of worker who fell from Parthenon (Temple of Athena Parthenos, Virgin Athena) during its construction

Ancient & Medieval Use:

• Greek physician Dioscorides (1st century CE) recommended feverfew for “all hot inflammations”
• Mentioned in medieval Anglo-Saxon herbals for various ailments
• Gerard’s Herball (1597) states feverfew is “very good for them that are giddie in the head” and “for such as are melancholicke, sad, pensive, and without speech”
• Culpeper’s Complete Herbal (1653) recommended feverfew for “all pains in the head” and “to warm and dry up the moisture” – noted it “wonderfully easeth pains of the head”
• Medieval Welsh Physicians of Myddfai recommended feverfew for headaches and “purifying”

Traditional Uses Across Cultures:

• European folk medicine: Headaches, fever, women’s complaints (menstrual irregularities, difficult childbirth), arthritis, toothache, insect bites, general digestive tonic
• British tradition: Particularly associated with women’s health – hence German name Mutterkraut (“mother’s herb”) – used to aid childbirth and bring on menstruation
• Planted in cottage gardens both for medicinal use and to repel insects
• Strewn on floors and in bedding in medieval times to purify air and repel insects (aromatic)

1970s Revival & Modern Popularity:

• Feverfew largely fell out of mainstream herbal use by mid-20th century
• 1970s Britain: Migraine sufferers sharing fresh feverfew leaves among themselves as folk remedy
• This grassroots use caught attention of researchers
• Mrs. Anne Jenkins (1978): British migraine sufferer who promoted feverfew through media after it helped her condition – sparked public interest
• Led to first modern clinical trials in 1980s (Johnson, Murphy)
• Feverfew became one of the few herbs to gain evidence-based validation for specific condition (migraine) during 1980s-1990s “phytomedicine revolution”
• Now one of the most popular and well-researched herbal migraine remedies worldwide

Cultural Symbolism:

• Connection to Athena (wisdom, protection) through Parthenon etymology
• Medieval “cure for sadness and melancholy” – predecessor to modern understanding of mood/nervous system effects
• Victorian language of flowers: Protection, warmth

Agricultural/Garden Use:

• Grown ornamentally for daisy-like flowers and ferny foliage
• Cultivated in herb gardens for medicinal harvest
• Self-seeds readily – can become weedy
• Aromatic foliage may deter some insect pests (though this is debated)
• Attractive to beneficial insects when flowering

Additional Information

Parthenolide Standardisation – Why It Matters:

• Parthenolide content in feverfew is extremely variable (0-0.7%)
• Depends on:
• Genetics: Some cultivars/strains have very low parthenolide (“parthenolide-free” feverfew exists)
• Growing conditions: Soil, climate, stress affect production
• Harvest timing: Pre-flowering/early flowering highest
• Plant part: Leaves highest, flowers lower, stems lowest
• Drying method: Heat destroys parthenolide – freeze-drying preserves maximum
• Storage: Parthenolide degrades over time with heat, light, air exposure
• Clinical implication: Unstandardised feverfew products may contain little or no parthenolide – ineffective for migraine prophylaxis
• Recommendation: Always choose products standardised to minimum 0.2% parthenolide for medicinal use

“Parthenolide-Free” Ornamental Feverfew:

• Some cultivars bred for ornamental use with double flowers (e.g., ‘Snowball’, ‘White Wonder’)
• These often have very low or zero parthenolide
• Useless for medicinal purposes
• If growing feverfew, choose single-flowered forms marketed for medicinal use

Fresh Leaves vs. Capsules – The Mouth Ulcer Problem:

• Traditional British use involved chewing 1-3 fresh leaves daily
• Approximately 10-18% of users developed painful mouth ulcers
• This side effect nearly derailed feverfew’s modern acceptance
• Solution: Freeze-dried capsules eliminate mouth ulcer problem while preserving parthenolide
• Modern recommendation: Use capsules, not fresh leaves (unless you’re willing to risk mouth ulcers)

The Post-Feverfew Syndrome Phenomenon:

• Not widely known but clinically important
• Similar to “rebound headache” seen with discontinuation of some migraine medications
• Possibly more common than reported (many users don’t connect symptoms to feverfew discontinuation)
• Prevention is simple: Taper gradually over 2-4 weeks when stopping long-term use

Feverfew in Integrative Migraine Management:

• Often used as part of “triplet” or “quartet” combination:
• Feverfew (anti-inflammatory, CGRP modulation)
• Magnesium 400-600 mg (NMDA receptor antagonist, neuronal stabilization)
• Riboflavin (Vitamin B2) 400 mg (mitochondrial energy metabolism)
• +/- Coenzyme Q10 100-300 mg (mitochondrial support)
• This combination addresses multiple migraine mechanisms
• Several commercial combination products available (e.g., MigreLief, Migraine Defense)
• Good evidence base for this integrative approach

NZ Context & Availability:

• Feverfew naturalised throughout NZ, particularly in cooler regions (South Island, hill country)
• Easy to grow in home gardens
• Where to buy:
• Health food stores: Standardised capsules, combination products available in various sizes
• Pharmacies: Some stock feverfew products
• Online retailers: iHerb, Amazon, etc. ship to NZ – often cheaper but shipping costs
• Bulk herb suppliers: Dried leaf (usually unstandardised) available – not recommended for migraine use unless standardised
• Garden centres: Live plants (spring/summer) for home cultivation
• Recommended brands: Look for products clearly stating parthenolide content (0.2% minimum)
• Storage: Store feverfew products in cool, dark place. Refrigeration extends shelf life.

Growing Your Own – Considerations:

• Easy to grow in NZ gardens
• Choose medicinal varieties (single flowers), not double-flowered ornamentals
• Harvest pre-flowering for maximum parthenolide
• Freeze-dry if possible (home freeze-dryers available but expensive)
• Otherwise, dry quickly at low temperature (<40°C)
• Test dried leaves for potency before relying on them (expensive – parthenolide analysis)
• Fresh leaf use risks mouth ulcers – not recommended
• Growing your own is economical but quality control challenging

Sources

Murphy, J. J., Heptinstall, S., & Mitchell, J. R. A. (1988). Randomized double-blind placebo-controlled trial of feverfew in migraine prevention. The Lancet, 2(8604), 189-192.

Johnson, E. S., Kadam, N. P., Hylands, D. M., & Hylands, P. J. (1985). Efficacy of feverfew as prophylactic treatment of migraine. British Medical Journal, 291(6495), 569-573.

Pfaffenrath, V., Diener, H. C., Fischer, M., Friede, M., & Henneicke-von Zepelin, H. H. (2002). The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis—a double-blind, multicentre, randomized placebo-controlled dose-response study. Cephalalgia, 22(7), 523-532.

Wider, B., Pittler, M. H., & Ernst, E. (2015). Feverfew for preventing migraine. Cochrane Database of Systematic Reviews, 4, CD002286.

Ernst, E., & Pittler, M. H. (2000). The efficacy and safety of feverfew (Tanacetum parthenium L.): An update of a systematic review. Public Health Nutrition, 3(4a), 509-514.

Kwok, B. H., Koh, B., Ndubuisi, M. I., Elofsson, M., & Crews, C. M. (2001). The anti-inflammatory natural product parthenolide from the medicinal herb feverfew directly binds to and inhibits IκB kinase. Chemistry & Biology, 8(8), 759-766.

Heptinstall, S., White, A., Williamson, L., & Mitchell, J. R. A. (1985). Extracts of feverfew inhibit granule secretion in blood platelets and polymorphonuclear leucocytes. The Lancet, 325(8437), 1071-1074.

Groenewegen, W. A., & Heptinstall, S. (1990). A comparison of the effects of an extract of feverfew and parthenolide, a component of feverfew, on human platelet activity in-vitro. Journal of Pharmacy and Pharmacology, 42(8), 553-557.

Murch, S. J., Simmons, C. B., & Saxena, P. K. (1997). Melatonin in feverfew and other medicinal plants. The Lancet, 350(9091), 1598-1599.

Pareek, A., Suthar, M., Rathore, G. S., & Bansal, V. (2011). Feverfew (Tanacetum parthenium L.): A systematic review. Pharmacognosy Reviews, 5(9), 103-110.

Palevitch, D., Earon, G., & Carasso, R. (1997). Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: A double-blind placebo-controlled study. Phytotherapy Research, 11(7), 508-511.

Pittler, M. H., & Ernst, E. (2004). Feverfew for preventing migraine. Cochrane Database of Systematic Reviews, 1, CD002286.

Alenzi, F. Q. (2020). Alteration of coagulation test results and vaginal bleeding associated with the use of feverfew (Tanacetum parthenium). Journal of Medical Cases, 11(11), 351-354.

Awang, D. V. C. (2009). The quest for the anti-migraine principle(s) of feverfew, Tanacetum parthenium (L.) Schultz Bip. Journal of Herbs, Spices & Medicinal Plants, 15(1), 1-18.

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