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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.

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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.

How to take it

TimingTiming does not matter; take it daily for at least 12 weeks before judging.
With food?With food, which reduces the stomach upset and mouth irritation.
Worth knowingDo not stop abruptly after months of use — taper it, or you risk 'post-feverfew syndrome': rebound headache, anxiety, insomnia and joint stiffness.

Interactions

With medications

  • warfarin, DOACs, aspirin and antiplatelet drugs

    Parthenolide has antiplatelet activity in laboratory work and may add to bleeding risk. use caution, and stop before surgery

With other supplements

  • fish oil, ginkgo and garlic

    Additive antiplatelet effect. avoid stacking before a procedure

Well-established interactions only — this is not a complete list. Always tell your doctor and pharmacist what you take.

Frequently asked questions

Does feverfew prevent migraines?

Feverfew probably does very little: the Cochrane review rated the evidence low quality, and the largest rigorous trial found only 0.6 fewer attacks per month than placebo. Earlier positive feverfew trials were tiny.

How much feverfew should I take for migraine?

The best-tested feverfew preparation is a CO2 extract at 6.25 mg three times daily; older trials used 50-143 mg/day of leaf standardised to at least 0.2% parthenolide. Allow 12 weeks, and note some products contain almost no parthenolide.

Can you stop feverfew suddenly?

Taper feverfew rather than stopping abruptly after months of use, or you risk 'post-feverfew syndrome': rebound headache, anxiety, insomnia and joint stiffness.

Who should avoid feverfew?

Avoid feverfew in pregnancy because of uterine stimulant activity, and if you are allergic to ragweed, chamomile or chrysanthemum. Feverfew's parthenolide has antiplatelet activity, so use caution with blood thinners and stop before surgery.

Scientific references

Where to buy

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

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