Feverfew is used to treat headache, fever, menstrual abnormalities, and prevent migraines (Jellin et al. 2003). The name is derived from the Latin word febrifugia, which means "fever reducer (Kaye et al. 2000)." Although feverfew is commonly used for migraine headaches, the literature is inconclusive regarding its efficacy (Murphy et al. 1988, De Weerdt et al. 1996). In a study reviewing evidence from double-blind randomized controlled trials of the clinical efficacy of feverfew versus placebo for migraine prophylaxis, investigators found insufficient evidence to suggest a benefit of feverfew over placebo for the prevention of migraine (Pittler and Ernst 2004). As with most herbal compounds, analyses of feverfew-based products have yielded significant variations in the parthenolide contents, which are believed to be the active ingredients (Nelson et al. 2002).
Regarding the effects of the antiinflammatory lactone parthenolide, a German study indicated that parthenolide may support T-cell survival by down-regulating the CD95 system. The CD95 system is a critical component of the apoptotic or programmed cell death pathway of activated T-cells. Further, the authors reported that parthenolide may have therapeutic potential as an antiapoptotic substance blocking the activation-induced cell death of T cells (Li-Weber et al. 2002).
Feverfew also has demonstrated inhibition of serotonin release from aggregating platelets. This mechanism may be related to the inhibition of arachidonic acid release via a phosholi-pase pathway (Marles et al. 1992, Fozard 1985, Makheja and Bailey 1982). It has also been found that feverfew has decreased approximately 86-88% of prostaglandin production without exhibiting inhibition of the cyclooxygenase enzyme (Collier et al. 1980).
Adverse reactions to feverfew include aphthous ulcers, abdominal pain, nausea, and vomiting. A rebound headache may occur with abrupt cessation of this herbal (Jellin et al. 2003,
Kaye et al. 2000). Better tolerance to feverfew has been suggested when compared to conventional migraine medications because in studies feverfew use resulted in no alteration in heart rate, blood pressure, body weight, or blood chemistry like conventional migraine medications (Jellin et al. 2003). A condition known as "post-feverfew syndrome" can occur in long-term users which manifests as fatigue, anxiety, headaches, insomnia, arthralgias, and muscle and joint stiffness (Jellin et al. 2003, Kaye et al. 2000).
Feverfew may inhibit platelet action; therefore, it is reasonable to avoid the concomitant use of this herb in patients taking medications such as, heparin, warfarin, NSAIDs, aspirin, and vitamin E (Heptinstall et al. 1987, Makheja and Bailey 1981). Further, herbs like feverfew can interact with iron preparations, thereby reducing the bioavailability of that substance (Miller 1998).
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