Feverfew and Migraine Headaches

In 1973, at the suggestion of a friend, and apparently based on the advice of a traditional Welsh healer, a Welsh woman Mrs Anne Jenkins tried taking three fresh leaves of feverfew iJanacetum parthenium) each day in an attempt to rid herself of severe and recurrent migraines. After ten months, Mrs Jenkins' headaches had vanished and did not return as long as she kept taking feverfew. Her enthusiasm rapidly led to widespread use of feverfew in the UK. Dr. Stewart Johnson, a London migraine specialist, became interested and initiated a survey that was then followed up by a clinical trial. The survey revealed some interesting findings:' • About 72% of those surveyed (253 suffering from true migraine) found that feverfew was helpful for the prevention of their headaches; 78% of the 23 people suffering from tension headaches also found that feverfew reduced headache frequency and severity. Of 242 patients who recorded the frequency, 33% no longer had attacks, and 76% had fewer migraines each month compared to before taking feverfew. • Associated nausea and vomiting decreased or disappeared. A proportion of patients experienced the migraine aura without the attack. • When attacks did occur, they responded better to conventional painkillers (e.g., aspirin). Feverfew users experienced no adverse interactions with their orthodox medication. • Many patients also suffering from arthritis found their symptoms somewhat relieved by feverfew. • The onset of the effect was slow and gradual, often taking several months, and the average dose used was very low about two-and-a-half fresh leaves (1.5 inches long by 1.25 inches wide) per day. The average duration of treatment was 2.3 and 2.6 years for men and women, respectively. When individuals stopped taking feverfew, their migraines tended to return soon after. • The survey also revealed some side effects in a small percentage of users. Adverse effects included mouth ulcers or inflammation. In contrast, a percentage of users experienced improved digestion, a sense of well-being, and improved sleep. This work was followed up by a double-blind, placebocontrolled, pilot clinical trial involving 17 patients who had been self-medicating with raw feverfew every day for three months. Eight of these patients received two capsules per day containing freeze-dried feverfew leaf powder (25 mg each), and nine received placebo for 24 weeks. Prior to the trial, the reduction in the frequency of migraines during self-treatment with feverfew was significant for both groups. Compared to the migraine frequency while self-medicating, there was no change in the frequency or severity of symptoms in the feverfew group during the trial. The placebo group, however, experienced a significant increase (p < 0.05) in the frequency and severity of headaches when the results of the previous three months were considered. The placebo group also experienced a higher incidence and severity of nausea and vomiting than the feverfew group (p<0.05). The authors claimed a prophylactic benefit for feverfew in preventing migraine attacks. Curiously, fewer adverse events were reported by those taking feverfew (four patients reported none), compared to placebo (all patients taking placebo reported at least one event).^' Apparently, because of ethical reasons (feverfew was considered to have unknown safety by the scientists), the trial had this unusual design. The patients were already using feverfew, so the trial therefore observed the results of patients unknowingly stopping their herbal treatment. Such an abrupt discontinuance led to the recurrence of severe migraines in some patients. Perhaps more importantly, the study showed that long-term feverfew users were normal in terms of a large number of biochemical and hematological parameters.