Herbal Monograph
Feverfew
Tanacetum parthenium (L.) Sch.Bip.
Asteraceae (Daisy family)
The premier herbal migraine prophylactic, backed by clinical trials and centuries of European use for headache, fever, and inflammation.
Overview
Plant Description
Strongly aromatic, short-lived perennial herb, 30–80 cm tall. Stems erect, branching, finely furrowed, pubescent. Leaves alternate, bright yellowish-green, pinnately to bipinnately divided into 3–7 segments with crenate-serrate margins, 3–8 cm long; upper leaves becoming sessile and less divided. The fresh leaf has a characteristically pungent, bitter taste and strong chrysanthemum-like odor from the volatile oil. Flower heads numerous, borne in loose terminal corymbs; each capitulum 1–2 cm diameter with a flat yellow central disc of tubular florets surrounded by 10–20 short white ray florets. Involucral bracts in 2–3 overlapping rows, pale green with scarious margins. Fruit a small achene (cypsela) with 5–8 ribs and a short crown. Root system fibrous, shallow.
Habitat
Rocky, disturbed, and waste ground, along walls, roadsides, hedgerows, and field margins. Prefers well-drained, neutral to slightly alkaline soils. Tolerates poor soils but produces higher parthenolide content in moderate-fertility conditions with full sun. Altitude range: sea level to approximately 800 m.
Distribution
Native to the Balkan Peninsula and Anatolia (southeastern Europe and western Asia). Widely naturalized throughout Europe, the British Isles, North and South America, Australia, and New Zealand following centuries of cultivation as a medicinal and ornamental garden plant. Long established in cottage and monastery gardens across temperate regions.
Parts Used
Leaf (fresh or freeze-dried)
Preferred: Freeze-dried leaf capsules standardized to parthenolide content (minimum 0.2% parthenolide); fresh leaf (2–3 leaves daily, chewed or in sandwich); tincture from fresh flowering tops
The leaf is the primary medicinal part, especially for migraine prophylaxis. Fresh leaf chewing was the traditional British method. Freeze-dried leaf retains higher parthenolide levels than conventionally dried material. Most clinical research has used fresh leaf or freeze-dried leaf capsules. Parthenolide content varies significantly by cultivar, growing conditions, and processing method — this variability has been a major challenge in clinical research and commercial product quality.
Flowering aerial parts
Preferred: Tincture of fresh flowering herb; dried herb for infusion
Whole flowering tops used in traditional European herbalism for fever, inflammation, and digestive complaints. The flower heads contain parthenolide and other sesquiterpene lactones but at variable concentrations compared to the leaf. Tinctures and infusions are typically prepared from the flowering herb.
Key Constituents
Sesquiterpene lactones (germacranolides)
Sesquiterpene lactones, particularly parthenolide, are the primary bioactive constituents of feverfew and the basis for its anti-migraine, anti-inflammatory, and antiplatelet properties. Over 30 sesquiterpene lactones have been identified in T. parthenium. Parthenolide is the major sesquiterpene lactone in most cultivars and serves as the standard quality marker (pharmacopeial minimum: 0.2% in dried leaf). The mechanism of migraine prophylaxis is thought to involve inhibition of serotonin release from platelets (preventing the vasospasm-vasodilation cascade), inhibition of prostaglandin synthesis, and anti-inflammatory activity via NF-κB inhibition. CRITICAL NOTE: Parthenolide content varies enormously between cultivars, growing conditions, harvest timing, and processing methods. Many commercial products have been found to contain little or no parthenolide. Freeze-drying is essential for preserving parthenolide; air-drying can cause losses exceeding 50%.
Volatile oils (essential oil)
The essential oil of feverfew (0.02–0.07% in dried herb) consists primarily of monoterpenes, with camphor as the dominant component in most chemotypes. The volatile oil contributes to the aromatic quality and may have mild anti-inflammatory and analgesic properties, but it is not considered the primary mediator of feverfew's anti-migraine activity. The essential oil composition shows considerable chemotypic variation. Different chemotypes may be dominated by camphor, chrysanthenyl acetate, or other monoterpenes.
Flavonoids
Feverfew contains a notable lipophilic flavonoid fraction including tanetin, santin, and other methylated flavones. Williams et al. (1999) proposed that tanetin may contribute to feverfew's anti-inflammatory activity through prostaglandin synthesis inhibition independently of the sesquiterpene lactones. The flavonoid fraction may partially explain why some clinical efficacy has been observed even in products with low parthenolide content, and why whole-plant preparations may have efficacy beyond what would be predicted from parthenolide content alone.
Other constituents
Minor constituents including melatonin, polyacetylenes, and tannins contribute to the overall phytochemical complexity. The detection of melatonin is pharmacologically interesting given melatonin's independent evidence base for migraine prophylaxis, but the amounts present in typical feverfew doses are likely subtherapeutic for this mechanism alone.
Herbal Actions
Reduces inflammation
Broad anti-inflammatory activity mediated primarily through parthenolide's inhibition of NF-κB signaling (by alkylating IKKβ cysteine-179), suppression of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6), inhibition of prostaglandin synthesis via phospholipase A2 inhibition, and reduction of COX-2 expression. The lipophilic flavonoid tanetin may provide additional prostaglandin synthesis inhibition. This multimechanistic anti-inflammatory profile underlies the traditional use for fever, arthritis, and inflammatory conditions.
[6, 11, 12]Relieves pain
Mild to moderate analgesic effect secondary to anti-inflammatory and antiplatelet mechanisms. Most relevant in the context of migraine headache prevention and musculoskeletal inflammation. Not a direct central analgesic — the pain-relieving effect derives primarily from upstream inhibition of inflammatory and vascular mediators.
[13]Relieves smooth muscle spasm
Inhibits smooth muscle contraction, particularly in vascular tissue. Parthenolide and other sesquiterpene lactones inhibit vascular smooth muscle contraction, which may contribute to anti-migraine activity by preventing cerebral vasospasm. Also demonstrated inhibition of uterine smooth muscle in preclinical studies, consistent with the traditional emmenagogue use.
[11]Stimulates or increases menstrual flow
Traditional use to promote menstrual flow and relieve menstrual cramping. The mechanism likely involves prostaglandin modulation and smooth muscle relaxation. This action is the basis for the pregnancy contraindication — uterine stimulation at higher doses is a theoretical risk.
[1]Stimulates digestive secretions via bitter taste receptors
Feverfew leaf has a notably bitter and pungent taste that stimulates digestive secretions. Traditional use as a digestive bitter and for appetite stimulation, though this is secondary to the primary anti-migraine application in modern herbalism.
[10]Promotes perspiration
Mild promotion of perspiration, particularly when taken as a hot infusion. Traditional use in febrile conditions — the common name 'feverfew' derives from the Latin 'febrifugia' (fever-reducer). The febrifuge action is mild and likely involves both the diaphoretic quality and the anti-inflammatory/antiprostaglandin mechanisms.
[10]Therapeutic Indications
Nervous System
Migraine prophylaxis (preventive treatment)
The most extensively studied indication for feverfew. Multiple RCTs have evaluated fresh or freeze-dried leaf for migraine prevention. Murphy et al. (1988): landmark double-blind, placebo-controlled crossover trial in 72 migraine sufferers already using feverfew; those switched to placebo had a significant increase in migraine frequency and severity, while the feverfew group maintained benefit, demonstrating prophylactic efficacy. Pfaffenrath et al. (2002): RCT of a CO2 extract (MIG-99, standardized to parthenolide) showed significant reduction in migraine frequency at higher doses. The Cochrane review by Pittler & Ernst (2004) found the evidence suggests feverfew is effective for migraine prophylaxis but noted study heterogeneity and variable product quality as limitations. The European Medicines Agency (EMA) has a traditional use registration for migraine prophylaxis. Mechanism: inhibition of platelet serotonin release (preventing the serotonin surge and subsequent depletion cycle in migraine), prostaglandin synthesis inhibition, NF-κB-mediated anti-inflammatory effects, and vascular smooth muscle relaxation. IMPORTANT: feverfew is a prophylactic (preventive), not an acute migraine treatment — benefit requires consistent daily use for 4–12 weeks before full effect.
[4, 5, 6, 7]Headache (general)
Traditional use for various headache types beyond classical migraine. The anti-inflammatory, antiplatelet, and antispasmodic actions provide a pharmacological rationale for broader headache applications. Less well-studied than the specific migraine prophylaxis indication. Most applicable for vascular-type and tension headaches with an inflammatory component.
[10]Musculoskeletal System
Rheumatoid arthritis and inflammatory joint conditions
The potent NF-κB inhibitory activity of parthenolide provides a strong pharmacological rationale for use in inflammatory arthritis. Traditional use for 'aches and pains' in joints. Preclinical studies demonstrate suppression of TNF-α, IL-1β, and other inflammatory mediators relevant to rheumatoid arthritis pathophysiology. Clinical evidence is limited — one small clinical study suggested benefit in rheumatoid arthritis but was not of sufficient quality to be conclusive. The anti-inflammatory mechanism is well-established pharmacologically, but robust clinical trials for arthritis are lacking.
[11]Cardiovascular System
Platelet hyperaggregation and thromboembolic risk (adjunctive)
Parthenolide and other sesquiterpene lactones inhibit platelet aggregation through multiple mechanisms: inhibition of thromboxane A2 synthesis, suppression of platelet serotonin release, and interference with platelet phospholipase A2. Heptinstall et al. (1985, 1992) demonstrated significant antiplatelet activity in vitro and ex vivo. This antiplatelet action is relevant to migraine pathophysiology and also has implications for cardiovascular risk, though clinical cardiovascular endpoint studies have not been conducted.
[12]Reproductive System
Dysmenorrhea and menstrual irregularity
Traditional European herbal use as an emmenagogue — to promote and regulate menstrual flow and relieve menstrual cramping. The antispasmodic action on uterine smooth muscle and prostaglandin synthesis inhibition provide a pharmacological rationale. Used historically for delayed or scanty menses and painful periods. No clinical trials specifically for dysmenorrhea.
[1, 10]Digestive System
Digestive sluggishness and poor appetite
The strong bitter taste stimulates digestive secretions including gastric acid, bile, and pancreatic enzymes. Traditional use as a digestive bitter for poor appetite and sluggish digestion. Secondary indication overshadowed by the migraine prophylaxis application in modern practice.
[10]Energetics
Temperature
warm
Moisture
dry
Taste
Tissue States
heat/excitation, wind/tension
Feverfew is energetically warm and dry, with a strongly bitter and somewhat pungent taste. In the Galenic/humoral tradition: warm in the second degree, dry in the first. The warming, dispersing quality drives the diaphoretic and emmenagogue actions. The bitter quality supports digestive function and liver clearance. In Western vitalist terms, feverfew addresses conditions of wind/tension (spasm, migraine, menstrual cramping) and has a moving, dispersive quality appropriate for stagnant and constricted patterns. Despite its warming quality, the strong anti-inflammatory action makes it useful in conditions with an inflammatory component. Best suited to individuals with cold, tense constitutions who are prone to vascular spasm and tension-type pain patterns.
Traditional Uses
British and European folk herbalism
- Prevention and treatment of headaches and migraine — chewing 2–3 fresh leaves daily was the classic British folk remedy that sparked modern clinical research
- Febrifuge for fevers (origin of the common name: Latin 'febrifugia')
- Relief of arthritis, joint pain, and rheumatic complaints
- Emmenagogue for delayed or painful menstruation
- Treatment of toothache (fresh leaf held against the gum)
- Vermifuge for intestinal parasites
- Digestive bitter for sluggish appetite and indigestion
- Poultice of fresh leaves applied to insect bites and stings
- Planted around houses as an insect repellent (the strong odor repels moths and other insects)
"Feverfew has been used in European folk medicine for at least 2,000 years. The name 'feverfew' is a corruption of the Latin 'febrifugia' (fever-reducer), reflecting its primary traditional reputation. John Gerard's Herball (1597) recommended it for 'all inflammations and hot swellings' and as a remedy for headache. Nicholas Culpeper (1652) described it as 'effectual for all pains in the head' and as a warming herb for cold constitutions. The modern resurgence of interest began in the 1970s–1980s when Dr. E. Stewart Johnson at the City of London Migraine Clinic investigated reports from migraine sufferers in Wales who obtained dramatic relief from chewing fresh feverfew leaves. This led to the first clinical trials."
Classical Greek and Roman medicine
- Dioscorides (De Materia Medica, 1st century CE) described it as 'Parthenion' and recommended it for inflammations, particularly hot swellings and as an emmenagogue
- Used for melancholia and 'vertigo' (possibly migraine equivalent)
- Applied externally for inflammation and skin conditions
- Used as a general anti-inflammatory and analgesic herb
"The species name 'parthenium' is thought to derive from the Greek 'parthenos' (virgin), possibly referring to its traditional use in treating menstrual complaints in young women, or from its use at the Parthenon — legend holds that feverfew was used to save the life of a worker who fell during the Parthenon's construction. Dioscorides described its use for inflammation and as an emmenagogue. Pliny the Elder also described the plant and its medicinal applications."
[11]
Traditional Chinese medicine (limited use)
- Not a traditional Chinese materia medica herb, but T. parthenium has been introduced in some TCM-adjacent practices for headache and inflammatory conditions
- Categorized by some modern integrative TCM practitioners as clearing wind-heat and moving blood stasis in the head
"Feverfew is not part of the classical Chinese materia medica but has been adopted by some modern TCM practitioners familiar with Western herbal research, particularly for migraine patterns involving wind-heat or blood stasis. Its bitter, warm, moving energetic profile aligns with herbs that dispel wind and move stagnation in TCM framework."
Eclectic and Physiomedicalist traditions (North America)
- Used by Eclectic physicians in the 19th–early 20th century for nervous headache, migraine, and neuralgia
- Emmenagogue for suppressed menses with associated headache and irritability
- Febrifuge in intermittent and low-grade fevers
- Tonic for 'hysteria' and nervous irritability (conditions now recognized as anxiety and tension states)
- Digestive tonic for atonic dyspepsia
"The Eclectic physicians of North America (19th century) recognized feverfew primarily for nervous headache, neuralgia, and as an emmenagogue. King's American Dispensatory (1898) describes Pyrethrum parthenium as a tonic, carminative, and emmenagogue, useful in 'hysterical complaints, nervous headaches, and as a remedy in suppressed menstruation.' The Physiomedicalists used it similarly for tension and spasm patterns."
[10]
Modern Research
Migraine prophylaxis — landmark crossover trial
Double-blind, placebo-controlled crossover study in 72 migraine sufferers who had been using raw feverfew leaves for migraine prevention. Patients were randomized to continue feverfew (freeze-dried capsules, 82 mg/day containing 2.19 μmol parthenolide) or switch to placebo for 6 months, then crossed over.
Findings: Patients switched to placebo experienced a significant increase in migraine frequency, severity, duration, and associated nausea and vomiting compared to those who continued feverfew. Mean number of migraines increased significantly in the placebo group. The study demonstrated both the prophylactic efficacy of feverfew and a 'post-feverfew syndrome' — abrupt discontinuation led to rebound increases in migraine frequency, joint stiffness, and nervousness.
Limitations: Crossover design rather than parallel groups. Participants were self-selected feverfew users (selection bias toward responders). Single freeze-dried leaf preparation. Relatively small sample by modern standards.
[4]
Migraine prophylaxis — first open trial at City of London Migraine Clinic
Open-label study at the City of London Migraine Clinic investigating the migraine-preventive effects of eating fresh feverfew leaves in patients who reported self-medicating with the herb.
Findings: A high proportion of migraine sufferers who had been self-treating with fresh feverfew leaves reported significant reduction in migraine frequency and severity. Some reported complete cessation of migraines after years of regular feverfew use. This study was the catalyst for subsequent controlled trials and brought feverfew to mainstream scientific attention.
Limitations: Open-label, no placebo control. Self-selected participants. Variable doses (patients were chewing their own home-grown leaves). Observational and susceptible to placebo effect. But the magnitude of benefit reported in some cases was striking and prompted the subsequent controlled research.
[5]
Migraine prophylaxis — CO2 extract (MIG-99) RCT
Multicenter, randomized, double-blind, placebo-controlled, dose-finding trial of a CO2-extracted feverfew preparation (MIG-99) standardized to parthenolide content, in 147 migraine patients over 12 weeks.
Findings: The high-dose group (6.25 mg MIG-99, three times daily) showed a significant reduction in migraine frequency compared to placebo (1.9 vs. 1.3 attacks reduction, P = 0.046). The effect was more pronounced in a per-protocol analysis. Lower doses showed trends but did not reach statistical significance, suggesting a dose-response relationship.
Limitations: Moderate sample size (n=147). The magnitude of effect was modest. The extract used (CO2 supercritical) differs significantly from traditional preparations (whole leaf, tincture) in its phytochemical profile — CO2 extraction may concentrate parthenolide but lose water-soluble constituents. Industry-funded.
[6]
Cochrane systematic review of feverfew for migraine
Cochrane systematic review of randomized, double-blind, placebo-controlled clinical trials of oral feverfew preparations for prevention of migraine headaches.
Findings: The review identified 5 eligible trials with a total of 343 patients. Results were mixed but suggestive of efficacy. The authors concluded that evidence suggests feverfew is effective for prevention of migraine, but cautioned that trial results were mixed, likely due to differences in feverfew preparations (parthenolide content, processing), study methodology, and patient populations. The review called for larger, well-designed trials using standardized preparations.
Limitations: Only 5 trials met inclusion criteria. Significant heterogeneity in preparations used across studies. Small sample sizes in most trials. Some positive trials used preparations no longer available. The inconsistent results across trials are best explained by variability in actual parthenolide content of the products tested.
[7]
Parthenolide and NF-κB signaling — mechanistic studies
Series of mechanistic studies elucidating parthenolide's inhibition of the NF-κB transcription factor pathway, a master regulator of inflammatory gene expression.
Findings: Parthenolide directly inhibits IκB kinase β (IKKβ) by alkylating cysteine-179 in the activation loop, preventing phosphorylation and degradation of IκBα and thus blocking NF-κB nuclear translocation. This results in suppression of NF-κB-dependent gene expression including pro-inflammatory cytokines (TNF-α, IL-1β, IL-6), COX-2, iNOS, and adhesion molecules. The NF-κB inhibitory activity is considered central to both the anti-inflammatory and potential anticancer properties of feverfew.
Limitations: Primarily in vitro and cell culture studies. In vivo confirmation of the NF-κB pathway as the primary mediator of feverfew's clinical effects in migraine is incomplete. Parthenolide bioavailability and pharmacokinetics in humans need further characterization.
Antiplatelet activity and serotonin release inhibition
In vitro and ex vivo studies examining feverfew's effects on platelet aggregation and serotonin release, key mechanisms in migraine pathophysiology.
Findings: Feverfew extracts and purified parthenolide inhibit platelet aggregation induced by ADP, collagen, arachidonic acid, and thrombin. Importantly, feverfew inhibits serotonin (5-HT) release from platelets — this is considered directly relevant to migraine, where excessive platelet serotonin release triggers the initial vasoconstrictive phase followed by rebound vasodilation and pain. The mechanism involves inhibition of platelet phospholipase A2 and suppression of thromboxane A2 synthesis.
Limitations: In vitro and ex vivo data. Clinical relevance of the antiplatelet mechanism to migraine prevention is strongly supported by theoretical considerations but direct in vivo confirmation through platelet function studies in migraine patients taking feverfew is limited.
[12]
Feverfew combined with ginger for migraine — RCT
Double-blind, randomized, placebo-controlled trial evaluating a sublingual combination of feverfew (parthenolide) and ginger for acute treatment of migraine headache in the mild phase.
Findings: Sublingual administration of a feverfew-ginger combination at the onset of mild headache phase of migraine resulted in significantly greater pain relief at 2 hours compared to placebo. A higher proportion of subjects were pain-free or had only mild headache at 2 hours in the treatment group.
Limitations: Combination product — cannot attribute effects to feverfew alone vs. ginger alone. Sublingual route differs from typical oral administration. Acute treatment rather than prophylaxis (the primary evidence base for feverfew). Relatively small sample. The sublingual formulation may have different pharmacokinetics than oral preparations.
[9]
Parthenolide anticancer research
Preclinical studies examining parthenolide's anticancer properties, particularly in leukemia and other hematological malignancies.
Findings: Parthenolide selectively induces apoptosis in cancer cells (particularly leukemia stem cells) while sparing normal hematopoietic cells. Mechanisms include NF-κB inhibition, reactive oxygen species generation, inhibition of HDAC1, and activation of p53. Parthenolide also targets cancer stem cells in acute myelogenous leukemia (AML) models — a property not shared by many conventional chemotherapy agents. Dimethylaminoparthenolide (DMAPT), a water-soluble parthenolide analog, has been developed for improved bioavailability and has entered early clinical investigation.
Limitations: Entirely preclinical. Parthenolide's poor oral bioavailability and aqueous solubility limit direct clinical translation. The anticancer research uses purified parthenolide or analogs at concentrations unlikely achievable through whole-plant feverfew consumption. This is pharmaceutical parthenolide research, not herbal medicine evidence.
[11]
Product quality and parthenolide content variability
Analytical studies evaluating the parthenolide content of commercial feverfew products and the impact of processing on sesquiterpene lactone levels.
Findings: Studies consistently reveal enormous variability in parthenolide content among commercial feverfew products — many contain little to no detectable parthenolide despite label claims. Air-drying can reduce parthenolide content by 50–90% compared to freeze-drying. Some products tested contained no detectable parthenolide. This variability is considered the primary reason for inconsistent results across clinical trials and is a critical issue for clinical practice — product selection and quality verification are essential.
Limitations: Analytical studies rather than clinical trials. Product formulations change over time. Results highlight the importance of third-party testing and pharmacopeial compliance rather than providing efficacy data per se.
[13]
Preparations & Dosage
Capsule / Powder
Strength: Freeze-dried leaf powder, standardized to ≥0.2% parthenolide
Freeze-dried feverfew leaf encapsulated. This is the preferred form for migraine prophylaxis based on clinical evidence. Ensure the product is standardized to contain a minimum of 0.2% parthenolide (pharmacopeial standard). Freeze-dried leaf preserves parthenolide content far better than conventionally air-dried material.
50–150 mg freeze-dried leaf daily (standardized to ≥0.2% parthenolide) providing approximately 250–500 μg parthenolide per day. The Murphy et al. (1988) trial used 82 mg/day of freeze-dried leaf. Most guidelines recommend 50–125 mg/day.
Once or twice daily with food. Consistent daily use is essential for migraine prophylaxis.
Minimum 4–12 weeks trial for migraine prophylaxis assessment. If effective, may be continued long-term. Taper gradually when discontinuing to avoid post-feverfew syndrome (rebound headaches, joint stiffness).
Not established. Not recommended for children under 2 years. For older children, use only under qualified practitioner guidance at reduced doses.
Freeze-dried leaf capsules are the best-studied preparation form. CRITICAL: product quality varies enormously. Select products verified by independent testing (e.g., ConsumerLab, USP verification) or from manufacturers with documented parthenolide content and freeze-drying process. Air-dried leaf capsules may have little therapeutic value due to parthenolide degradation. The traditional method of chewing fresh leaves is effective but causes mouth ulceration in 10–18% of users.
Tincture
Strength: 1:2 fresh herb in 45% ethanol; or 1:5 dried herb in 45% ethanol
Prepare from fresh flowering aerial parts. Macerate fresh herb in 45–60% ethanol at 1:2 ratio. Alternatively, dried herb at 1:5 in 45% ethanol. Macerate 2–4 weeks, press and filter.
1–2 mL, 2–3 times daily.
2–3 times daily.
Minimum 4–8 weeks for migraine prophylaxis. Long-term use acceptable.
Not established for children under 12.
Fresh-plant tincture is preferred to dried, as fresh preparation better preserves the volatile sesquiterpene lactones. Some practitioners prefer the fresh tincture for migraine prophylaxis as an alternative to capsules. The ethanol solvent extracts parthenolide effectively. Tincture allows flexible dosing and easy formulation with synergistic herbs (e.g., butterbur, white willow, ginkgo).
Infusion (Tea)
Strength: 1–2 g dried herb per 200 mL water
Pour 200 mL of boiling water over 1–2 g of dried feverfew herb (leaf and flower). Cover and steep for 10–15 minutes. Strain. The tea is notably bitter.
One cup 2–3 times daily.
2–3 times daily.
Ongoing for prophylactic use.
Not commonly used in children.
Infusion is a traditional preparation form but may be less effective for migraine prophylaxis than freeze-dried capsules or tincture, as hot water extraction may not fully dissolve the lipophilic sesquiterpene lactones. The bitter taste limits compliance for some patients. The infusion is more appropriate for traditional uses (fever, digestive complaints) where the broader phytochemical matrix may be relevant. Honey may be added to improve palatability.
[10]
Standardized Extract
Strength: Variable by manufacturer. Standardized to parthenolide content.
Commercially prepared CO2 or ethanol extract standardized to parthenolide content. MIG-99 (used in the Pfaffenrath trial) is a supercritical CO2 extract. Follow manufacturer's specific dosing based on the concentration of the particular extract.
Per manufacturer guidelines based on parthenolide content. Target: 250–500 μg parthenolide daily from the extract. MIG-99 trial dose: 6.25 mg three times daily.
1–3 times daily depending on extract concentration.
Minimum 8–12 weeks for migraine prophylaxis assessment.
Not established.
Standardized extracts offer more consistent parthenolide delivery than crude herb preparations. However, concentrated extracts may lack the full phytochemical matrix (flavonoids, volatile oils) that may contribute to whole-plant efficacy. The MIG-99 CO2 extract used in the Pfaffenrath trial is a specific pharmaceutical preparation not widely available as a consumer supplement.
[6]
Safety & Interactions
Class 2b
Not to be used during lactation (AHPA Botanical Safety Handbook)
Contraindications
Feverfew has traditional emmenagogue activity and may stimulate uterine contractions. The Botanical Safety Handbook classifies it as Class 2b (not to be used during pregnancy). Parthenolide has demonstrated effects on smooth muscle contraction. The risk of miscarriage or premature labor, while not documented in clinical reports, is a reasonable theoretical concern based on the pharmacological profile and traditional caution.
Cross-reactivity with other Asteraceae plants (chamomile, ragweed, chrysanthemum, echinacea, etc.) is possible. The sesquiterpene lactones (particularly the alpha-methylene-gamma-butyrolactone moiety of parthenolide) are the primary allergens. Patients with known Asteraceae allergy should avoid feverfew.
No safety data in very young children. The Botanical Safety Handbook and most authorities advise against use in children under 2 years.
Drug Interactions
| Drug / Class | Severity | Mechanism |
|---|---|---|
| Warfarin (Coumadin) (Anticoagulants (vitamin K antagonists)) | moderate | Feverfew inhibits platelet aggregation and thromboxane A2 synthesis. Combined with warfarin's inhibition of vitamin K-dependent clotting factors, there is an increased risk of bleeding. |
| Aspirin, clopidogrel (Plavix), ticagrelor (Brilinta), prasugrel (Effient) (Antiplatelet agents) | moderate | Additive inhibition of platelet aggregation through complementary mechanisms — feverfew inhibits platelet serotonin release and thromboxane synthesis; aspirin irreversibly inhibits COX-1; clopidogrel blocks ADP receptors. |
| Heparin, enoxaparin (Lovenox), and other injectable anticoagulants (Anticoagulants (heparins)) | moderate | Additive anticoagulant and antiplatelet effects increasing bleeding risk. |
| NSAIDs (ibuprofen, naproxen, diclofenac) (Nonsteroidal anti-inflammatory drugs) | minor | Overlapping prostaglandin synthesis inhibition. Theoretical additive antiplatelet effect and GI mucosal irritation. |
Pregnancy & Lactation
Pregnancy
possibly unsafe
Lactation
insufficient data
PREGNANCY: Contraindicated. Feverfew has traditional emmenagogue activity and the Botanical Safety Handbook classifies it as Class 2b (not for use during pregnancy). Parthenolide affects smooth muscle contraction and prostaglandin synthesis — mechanisms that could theoretically promote uterine activity. No clinical reports of feverfew-induced miscarriage exist, but the precautionary principle applies strongly. LACTATION: Insufficient data. No human lactation studies. The bitter and pungent sesquiterpene lactones could theoretically pass into breast milk and affect infant palatability or cause GI upset. Avoid during lactation unless benefit clearly outweighs risk.
Adverse Effects
References
Monograph Sources
- [1] Gardner Z, McGuffin M (eds.). American Herbal Products Association's Botanical Safety Handbook, Second Edition: Tanacetum parthenium. CRC Press, Boca Raton (2013)
- [2] European Medicines Agency (EMA), Committee on Herbal Medicinal Products (HMPC). Community Herbal Monograph on Tanacetum parthenium (L.) Schultz Bip., herba. European Medicines Agency, London (2010)
- [3] ESCOP (European Scientific Cooperative on Phytotherapy). ESCOP Monographs: Tanaceti parthenii herba (Feverfew). ESCOP / Thieme, Stuttgart (2003)
Clinical Studies
- [4] Murphy JJ, Heptinstall S, Mitchell JR. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet (1988) ; 2 : 189-192 . PMID: 2899663
- [5] Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J (Clin Res Ed) (1985) ; 291 : 569-573 . PMID: 3929876
- [6] Pfaffenrath V, Diener HC, Fischer M, Friede M, Henneicke-von Zepelin HH. The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis — a double-blind, multicentre, randomized placebo-controlled dose-response study. Cephalalgia (2002) ; 22 : 523-532 . PMID: 12230594
- [7] Pittler MH, Ernst E. Feverfew for preventing migraine. Cochrane Database Syst Rev (2004) ; 1 : CD002286 . PMID: 14973986
- [8] Diener HC, Pfaffenrath V, Schnitker J, Friede M, Henneicke-von Zepelin HH. Efficacy and safety of 6.25 mg t.i.d. feverfew CO2-extract (MIG-99) in migraine prevention — a randomized, double-blind, multicentre, placebo-controlled study. Cephalalgia (2005) ; 25 : 1031-1041 . PMID: 16232154
- [9] Cady RK, Goldstein J, Nett R, Mitchell R, Beach ME, Browning R. A double-blind placebo-controlled pilot study of sublingual feverfew and ginger (LipiGesic M) in the treatment of migraine. Headache (2011) ; 51 : 1078-1086 . PMID: 21631494
Traditional Texts
- [10] Hoffmann D. Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press, Rochester, VT (2003) : 552-554
- [11] Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine, Second Edition. Churchill Livingstone/Elsevier, Edinburgh (2013) : 481-494
Pharmacopeias & Reviews
- [12] Heptinstall S, Awang DV, Dawson BA, Kindack D, Knight DW, May J. Parthenolide content and bioactivity of feverfew (Tanacetum parthenium (L.) Schultz-Bip.). Estimation of commercial and authenticated feverfew products. J Pharm Pharmacol (1992) ; 44 : 391-395 . PMID: 1359067
- [13] Ernst E, Pittler MH. The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review. Public Health Nutr (2000) ; 3 : 509-514 . PMID: 11135803
Last updated: 2026-03-23 | Status: published
Unlock the Full Materia Medica
This monograph is part of our complete evidence-based herbal reference. Enter your email to get free, unlimited access to all of our monographs.
No spam, ever. Unsubscribe anytime.
You're In!
You now have full access to all of our herbal monographs.