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Limited evidenceBrain & cognition

Feverfew

Feverfew is a long-popular migraine preventive whose best trial produced a difference of only 0.6 attacks per month versus placebo, and whose older positive studies were tiny. Cochrane rates the evidence low quality — the honest summary is that feverfew probably does very little.

What the science says

  • Migraine frequency Limited evidence

    The 2015 Cochrane review covered six trials (561 patients) and could not pool them. The largest rigorous trial (n = 218, MIG-99 CO2 extract) reduced attacks from 4.8 to 2.9 per month versus 4.8 to 3.5 on placebo — a between-group difference of 0.6 attacks per month, rated low quality evidence.

  • Earlier positive trials do not hold up Limited evidence

    Three trials reporting clear benefit had only 17 to 60 participants each, while two more rigorous trials (n = 50 and n = 147) found no significant difference from placebo. This is the classic pattern of an effect that shrinks as study quality rises.

  • Attack severity, duration and nausea Limited evidence

    Across the included trials no statistically significant differences were found for migraine intensity or duration, incidence or severity of nausea and vomiting, or global assessment. Any benefit appears confined to attack count.

Dosage & safety

Studied doseThe best-tested preparation is a stable CO2 extract at 6.25 mg three times daily (MIG-99). Older trials used 50-143 mg/day of dried leaf standardised to at least 0.2% parthenolide. Allow 12 weeks. Parthenolide content varies enormously between commercial products, and some contain almost none.
SafetySide effects in trials were mild and transient: gastrointestinal complaints and mouth ulcers or tongue irritation, the latter mainly with chewed fresh leaves. Abrupt discontinuation after prolonged use can cause 'post-feverfew syndrome' — rebound headache, anxiety, insomnia and joint stiffness — so taper rather than stopping suddenly. Avoid with allergy to Asteraceae plants (ragweed, chamomile, chrysanthemum). Contraindicated in pregnancy because of uterine stimulant activity. Parthenolide has antiplatelet activity in vitro, so use caution with anticoagulants and before surgery. Not banned in sport.

Scientific references

Where to buy

Nature's Answer, Feverfew Extract, Alcohol-Free, 1 fl oz (30 ml)

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