Migraine affects approximately 12â15% of the Irish population, with a significant female predominance, and represents one of the leading causes of disability in people of working age. Feverfew (Tanacetum parthenium) has been investigated as a herbal migraine preventive for over four decades, making it one of the most specifically studied herbal remedies for a single neurological condition.
Feverfew is a perennial herb, originally native to the Balkans but naturalised across Britain, Ireland, and much of Europe, commonly found growing on walls, roadsides, and waste ground. Its popular name reflects its historical use for fevers, though migraine prevention is the use that has attracted modern clinical investigation.
Interest in feverfew for migraine was substantially boosted by a 1988 survey published in the Lancet reporting that a significant proportion of UK migraine sufferers who had taken feverfew regularly reported fewer and less severe attacks. This prompted funding for controlled clinical trials.
The most studied active compound in feverfew is parthenolide, a sesquiterpene lactone present in the leaves. Proposed mechanisms of action for migraine prevention include:
The clinical trial history of feverfew for migraine is interesting. Several early positive RCTs established the basis for its widespread use, but subsequent trials have produced mixed results.
Johnson et al. (1988, Lancet) conducted a double-blind crossover trial in 72 patients who had been taking feverfew regularly and were either maintained on it or switched to placebo. Patients withdrawn from feverfew experienced significantly more migraines and increased symptoms. This was a withdrawal design rather than a new-start trial, which has important implications for interpreting the results.
Murphy et al. (1988, Lancet) randomised 76 patients to 82 mg dried feverfew leaf or placebo for four months and found significant reductions in migraine frequency and severity. A subsequent trial by De Weerdt et al. (1996) using a CO2 extract (low parthenolide content) found no benefit, which was attributed to the low active compound content.
A Cochrane review by Pittler and Ernst (2004), subsequently updated by Wider et al. (2015), examined six double-blind RCTs and concluded there was "promising evidence" for feverfew in migraine prevention but that the evidence was insufficient to definitively confirm efficacy. The studies were limited by small sample sizes and methodological heterogeneity. The Cochrane reviewers noted that the evidence is more positive when higher-parthenolide preparations are used.
| Claim | Evidence Level | Source |
|---|---|---|
| Feverfew reduces migraine frequency | Limited / Moderate | Cochrane 2015 â "promising but not definitive"; positive RCTs |
| Feverfew reduces migraine severity | Limited | Murphy 1988 RCT; inconsistent across trials |
| Parthenolide inhibits platelet aggregation | Strong (pharmacological) | Multiple in vitro studies |
| Feverfew for acute migraine treatment | Limited | Insufficient evidence; designed for prevention not acute use |
| Low-parthenolide extracts are ineffective | Moderate | De Weerdt 1996 negative trial attributed to low parthenolide |
An important point that is frequently misunderstood: feverfew is a migraine preventive, not an acute treatment. It must be taken daily on a consistent basis to potentially reduce migraine frequency â taking it when a migraine starts will not abort or meaningfully reduce that attack. Clinical trials typically ran for four to six months before final assessment.
The typical dose used in trials is 50â150 mg of dried feverfew leaf per day, standardised to contain at least 0.2% parthenolide. Fresh leaves (two to three leaves daily chewed or in a sandwich) were used in early studies. Standardised capsules are more convenient and allow for consistent dosing. Allow two to three months of consistent daily use before assessing effectiveness.
An important safety phenomenon: people who stop feverfew abruptly after regular use may experience a rebound effect including increased headaches, anxiety, insomnia, and musculoskeletal stiffness â sometimes called "post-feverfew syndrome." This is analogous to caffeine withdrawal headache. Taper the dose gradually rather than stopping abruptly.
Anticoagulants: Feverfew's antiplatelet activity may enhance the effect of warfarin, aspirin, and other anticoagulants. People on blood thinners should discuss with their GP before starting feverfew.
Oral ulcers: Chewing fresh feverfew leaves can cause aphthous mouth ulcers and oral sensitisation in some people. This is much less common with capsule preparations.
Pregnancy: Feverfew is contraindicated in pregnancy. It has been associated with uterine stimulant activity and premature labour in animal studies. Do not use feverfew if pregnant or trying to conceive.
Allergy: As an Asteraceae member, feverfew may cross-react with ragweed, chamomile, and other composite plant allergies. Contact dermatitis can occur with handling fresh leaves.
Surgery: Discontinue two weeks before planned surgery due to antiplatelet effects.
Migraine management: Regular, severe, or disabling migraines should be assessed by a GP or neurologist. Effective prescription preventive treatments (topiramate, propranolol, valproate, newer CGRP-targeted therapies) are available on medical card for eligible patients. Feverfew may be a reasonable complement to or starting point before prescription preventives, but severe migraine burden warrants professional assessment.
Feverfew has a longer and more specific clinical trial history than most herbal remedies for any single condition. The evidence points toward a modest but real preventive effect in some migraine sufferers, particularly with standardised high-parthenolide preparations. It is not as effective as prescription preventive medications in head-to-head comparisons, but for people with mild-to-moderate migraine frequency who prefer a natural first-line option, feverfew is the most evidence-grounded herbal choice available. The key commitments are: daily use, adequate trial period (three months), and standardised preparations.
For feverfew and headache relief supplements, shop at our partner
Shop at The Honey Pot â