Teri and I are often asked what patients can use for Migraine prevention. The answer isn't simple because there are so many different preventive medications - over 100 in fact. This list includes FDA approved Migraine preventive medications such as Inderal, Blocadren, Depakote, Topamax and Botox for chronic Migraine. Lifestyle changes and trigger identification and management play an important role here too. In addition, Magnesium, Coenzyme Q10, riboflavin, Petasites hybridus (butterbur) and feverfew (Tanacetum parthenium) are dietary supplements sometimes used for Migraine prevention. Feverfew - in combination with ginger - may abort a Migraine attack. It is found in products like Gelstat and LipiGesic.
Feverfew has been around for hundreds of years as an herbal treatment to reduce fever, help with joint pain and relieve headaches. It can be found growing along the road and near wooded areas in North America, Europe and South America. Resembling the daisy, the active ingredient in feverfew is thought to be parthenolide. Parthenolide is a chemical found in the plant that "inhibits the release of serotonin from platelets. [Researchers] also found that parthenolide and feverfew extract prevented platelet aggregation induced by several chemicals in vitro." ¹
A 2002 study attempted to "show a dose-response of a new stable extract (MIG-99) reproducibly manufactured with supercritical CO 2 from feverfew (T. parthenium)." The study aimed to provide data on the safety and tolerability of MIG-99.² Participants in the study either had Migraine with aura or Migraine without aura, as described by the first International Headache Society's International Classification of Headache Disorders (ICHD). The patients received treatment of MIG-99 or placebo for 12 weeks. The results showed feverfew:
- "seemed to be safe and effective with at least 6.25 mg t.i.d. (three times a day) only in a small subgroup of patients with a minimum of four attacks per month."
- "...the efficacy revealed a difference between MIG-99 (feverfew) 6.25 mg and placebo in the confirmatory intension to treat sample. A good or very good efficacy was reported in 63 percent vs. eight percent of these patients when assessed by the investigator and in 53 percent vs. 23 percent when assessed by the patients." ²
I recently spoke with two Migraine specialists, Dr. Elizabeth Loder and Dr. Peter Goadsby, regarding their thoughts on feverfew for Migraine prevention.
- Dr. Loder said: "I don't have objections to my patients trying feverfew, but I don't actively recommend it for two reasons: the first is that I am quite influenced by a meta-analysis that showed it is probably ineffective. The second is because feverfew and other herbs are not subject to FDA regulation, so that it is hard to know what patients are getting when they buy it. That worries me."
- Dr. Peter Goadsby added, "On balance, it seems to have limited effects as a Migraine preventive." There has been some conversation that feverfew may increase our risk of medication headache (MOH) and that stopping it suddenly on may cause MOH. But Dr. Goadsby replied, "I have not seen clear evidence of medication overuse headache with its use."
Feverfew may be an option for Migraineurs who don't have clotting or blood disorder issues, are not allergic to any member of the daisy family and who are not pregnant or plan on becoming pregnant. According to the 2012 American Headache Society/American Academy of Neurology Guidelines for Migraine Prevention, feverfew is listed as a Level B medication, meaning, it's most likely effective and ought to be thought of for Migraine prevention. Dietary supplements, though often thought of as harmless, do act as drugs in our system and can interact with other medications and existing conditions we may have. That's why it is so important to have a conversation with your doctor before starting a new dietary supplement like feverfew, as one would do with any other medication.
¹ Nelson, M., Cobb, S.E., Shelton, J. "Variations in parthenolide content and daily dose of feverfew products." American Journal of Health-System Pharmacy. vol. 59. August 15, 2002.
² Pfafenrath, V., Diener, H.C., Fischer, M., Friede, M., Henneicke-von Zepelin, H.H. "The efficacy and safety of Tanacetum parthenium (feverfew) in migriane prophylaxis - a double-blind, multicentre, fandoized placebo-controlled dose-response study." Cephalagia 2002; 22:523-532.
³ Erlich, Steven D., NMD. "Feverfew." University of Maryland Medical Center. Medical Reference. Complementary Medicine. Last reviewed: December 13, 2010.
⁴ National Center for Complementary and Alternative Medicine (NCCAM) "Fevervew." Herbs at a Glance. Last updated July, 2010.
⁵ Email interview with Dr. Peter Goadsby. April 29, 2012,
6 Email interview with Dr. Elizabeth Loder. May 5, 2012.
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© HealthCentral Network, 2012.
Last updated May 8, 2012.
Published On: May 09, 2012