FEVERFEW

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FEVERFEW

• Tanacetum parthenium
• Martha Beekmann
• Miranda Hoehn

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Feverfew
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Feverfew

• Derived from Latin word febrifugia, meaning
  driver out of fevers
• Members of the Daisy family (Asteraceae)
• Common ornamental with white and yellow flowers

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Other common names

• Chrysanthemum parthenium, Martricaria parthenium,
  Pyrenthum parthenium
• Featherfew, flirtwort, vetter-voo, feather-fully,
  German mutterkraut, and Bachelors Button

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Historic Uses

• Treatment of fever, headache, and migraine
• For difficulties associated with labor and
  regulation of menstruation
• Relief of stomach aches, toothaches, and insect
  bites

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Historic Uses

• Dioscorides noted use for arthritis, phlegme,
  melancholy, and for St. Anthonys fire
• Nicholas Culpeper, an English herbalist, noted
  use for female ailments, teething infants, and to
  decrease inflammation and nerve pain

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Historic Uses

• Edenburgh Dispensatory in Scotland noted use of
  feverfew for treating hysteria and gas
• Macdonalds Encyclopedia of Medicinal Plants
  noted uses for the stomach, and as an
  antispasmodic, a tranquilizer, and an emmenagogic
• John Hill (The Family Herbal) noted use for
  the worst headache

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Current Uses

• Prophylaxis of migraine attacks
• Relief of inflammation and pain associated with
  rheumatoid arthritis
• Treatment of psoriasis
• Decrease blood pressure
• Aid in digestion

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Methods of use

• Historically leaves were chewed very effective
  because they are rich in active compounds
• Today, capsule form preferred because leaves are
  so bitter

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Action

• Inhibits proinflammatory signaling pathway
• -inhibits release of serotonin from
  platelets
• -inhibits platelet aggregation
• -inhibits prostaglandin synthesis
• -inhibits histamine release
• -prevents vasoconstriction

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Active compounds

• Series of Sesquiterpene lactones
• -Parthenolide
• Lipophilic flavonoids
• -6-hydroxykaempferol
• -quercetagetin
• Essential oil
• -chrysanthenyl acetate

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Active Compounds

• Found at high levels
• -Leaves, flowering tops, and seeds
• Found at low levels
• -Stalks and roots

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Parthenolide

• Antisecretory effects on platelets and leukocytes
• Inhibits tyrosine phosphorylation of MAPKs and
  inhibits production of pro-inflammatory cytokines
  and CAMs

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Chrysanthenyl acetate

• Inhibits prostaglandin synthetase
• Inhibits synthesis of thromboxanes and
  leukotrienes by inhibiting phospholipase
• Interferes with initial step of thromboxane
  synthesis (release of arachidonic acid substrate
  from platelet phospholipids)
• Does not block cyclooxygenase enzyme required for
  prostaglandin synthesis

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Feverfew vs. Parthenolide

• Both feverfew extract and parthenolide were more
  effective as inhibitors of secretion and
  aggregation of platelets than placebos
• Feverfew powder has been shown to be more potent
  than any of its extracts or parthenolide alone in
  its antiserotonergic activity

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Efficacy

• One study showed 24 decrease in the number of
  migraine attacks in patients using feverfew
• Another showed 72 less frequent and/or painful
  migraines for participants in which conventional
  treatments did not relieve symptoms

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Recognition of efficacy

• Canadas Health Protection Branch has allowed a
  British feverfew product to receive a Drug
  Identification Number so it can be claimed as a
  nonprescription drug that is effective for
  treatment of migraines

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Side Effects

• Only mild and transient adverse effects
• -Lip swelling, mouth ulcers
• -Indigestion, heartburn, nausea
• -Dermatitis, skin rash
• -Increased risk of bleeding during surgery

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Side Effects of Discontinuation

• Often discontinuation leads to recurrence of
  migraines
• -Multiple patients discontinued participation in
  one study when put on a placebo (after having
  used feverfew) so they could go back on the
  feverfew.
• Postfeverfew syndrome occurred in 164 of 270
  participants in one study.
• -Symptoms include severe aches, pains,
  stiffness of joints, anxiety, poor sleep.

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Continuing Study

• Use of feverfew in the treatment and prevention
  of migraines is being widely studied since most
  of the evidence that exists is supporting the
  therapeutic use especially for the prophylaxis of
  migraine headaches

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