Total Alcohol Free Feverfew Extract
Also known as: Feverfew, Total Alcohol Free Feverfew Extract, Tanacetum parthenium
Overview
Feverfew (*Tanacetum parthenium*) is a traditional herbal remedy derived from the dried leaves of the plant, primarily recognized for its potential in migraine prevention. Total alcohol free feverfew extract refers to a preparation standardized to active compounds, notably parthenolide, but processed without alcohol solvents, which may reduce irritation or specific side effects associated with alcohol-based extracts. While its main application is migraine prophylaxis, it also exhibits some mild anti-inflammatory properties. Research on feverfew is moderately mature, encompassing multiple randomized controlled trials (RCTs) and systematic reviews, though the quality and consistency of evidence vary. Some reviews find insufficient or inconclusive evidence for efficacy, particularly for alcohol-based extracts, while certain dried leaf preparations have shown modest benefits.
Benefits
Feverfew is most extensively studied for its role in migraine prevention. Some randomized controlled trials (RCTs) and meta-analyses suggest a reduction in migraine frequency and severity, though effect sizes are generally small and not always statistically significant. A 2015 Cochrane systematic review indicated that feverfew monopreparations significantly improved global assessment scores of migraine severity compared to placebo (p < 0.0001), especially in patients with classical migraine, although results were inconsistent across individual studies. Conversely, a 2011 systematic review concluded insufficient evidence to confirm feverfew's superiority over placebo in reducing migraine frequency or severity, noting that trials using alcoholic or CO2 extracts showed no benefit, while some dried leaf extract studies reported favorable outcomes. A more recent 2023 meta-analysis of three RCTs (n=237) found a non-significant reduction in migraine frequency with feverfew (Cohen’s d = -0.19), suggesting limited standalone efficacy. Beyond migraine, feverfew may offer mild anti-inflammatory effects through prostaglandin inhibition, although it does not inhibit cyclooxygenase enzymes like NSAIDs.
How it works
Feverfew's therapeutic effects are primarily attributed to parthenolide and other sesquiterpene lactones present in the plant. These compounds are believed to exert their action by inhibiting prostaglandin synthesis, which plays a role in inflammatory processes and pain perception. Additionally, feverfew may reduce platelet aggregation and modulate serotonin (5-HT) receptors, both of which are implicated in the pathophysiology of migraines. Its mechanism of action is thought to be similar to that of some 5-HT antagonists used in migraine treatment. Alcohol-free extracts aim to preserve these active compounds while minimizing any potential side effects associated with alcohol solvents. The oral bioavailability of parthenolide can vary, and standardization to at least 0.2% parthenolide is often recommended for clinical efficacy.
Side effects
Feverfew is generally considered safe, with most side effects being mild. The most common adverse reactions, affecting more than 5% of users, include gastrointestinal discomfort, mouth ulceration, and mild allergic reactions. Less common side effects, occurring in less than 1% of users, can include 'post-feverfew syndrome,' characterized by nervousness, insomnia, and joint pain, particularly upon abrupt cessation after prolonged use. Feverfew also carries a potential risk of bleeding due to its inhibitory effects on platelet aggregation. Consequently, it can interact with anticoagulant medications such as warfarin, increasing the risk of bleeding; therefore, concurrent use is contraindicated. Individuals with allergies to plants in the Asteraceae family (e.g., chamomile, ragweed, marigolds) should avoid feverfew due to the potential for cross-reactivity. Alcohol-free extracts may potentially reduce irritation compared to preparations containing alcohol.
Dosage
Clinical trials investigating feverfew for migraine prevention have utilized a range of dosages, typically from 50 mg to 143 mg daily of various preparations. For optimal efficacy and consistency, standardization of the extract is crucial. Health Canada, for instance, recommends a daily dose of 125 mg of dried feverfew leaf extract standardized to contain 0.2% parthenolide for migraine prophylaxis. While specific optimal dosing for alcohol-free extracts is less extensively defined, it is generally expected to be similar to that of dried leaf extracts, emphasizing consistent parthenolide content. In most studies, treatment duration typically ranges from 8 to 24 weeks, as benefits may not become apparent immediately. It is important to adhere to standardized preparations to ensure consistent active compound delivery and efficacy.
FAQs
Is feverfew effective for migraine prevention?
Evidence is mixed; some patients may experience benefits, but overall effect sizes are small and not consistently statistically significant across all studies. Efficacy can vary depending on the extract type and standardization.
Is alcohol-free feverfew extract safer?
Alcohol-free extracts may reduce solvent-related side effects or irritation compared to alcohol-based preparations. However, specific efficacy data for alcohol-free extracts is limited, and general safety precautions still apply.
Can feverfew be used with blood thinners?
No, feverfew can inhibit platelet aggregation and increase the risk of bleeding. It should be avoided if you are taking anticoagulant medications like warfarin or other blood thinners.
How long does it take for feverfew to show effects?
Studies suggest that consistent use for at least 8 weeks may be necessary to observe potential benefits for migraine prevention. Effects are not typically immediate.
What are the main side effects of feverfew?
Common side effects include gastrointestinal discomfort, mouth ulcers, and mild allergic reactions. Rare but serious side effects include increased bleeding risk, especially with anticoagulants, and 'post-feverfew syndrome' upon abrupt cessation.
Research Sources
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7133498/ – This Cochrane systematic review (Wider et al., 2015) analyzed double-blind RCTs (n=343) and found that feverfew monopreparations significantly improved global assessment scores of migraine severity compared to placebo (p<0.0001), particularly in classical migraine patients. However, the review noted significant inconsistency across individual trial results, with some alcoholic extract studies showing no benefit, highlighting variability in efficacy and study quality.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3210009/ – This systematic review (Pareek et al., 2011) evaluated 5 RCTs with 343 patients and concluded that there was insufficient evidence to definitively confirm feverfew’s efficacy for migraine prevention. The review observed that higher-quality trials using alcoholic and CO2 extracts showed no benefit, while some lower-quality trials with dried leaf extracts reported positive outcomes. It emphasized the critical need for standardized parthenolide content in future research to ensure consistent results.
- https://naturalmedfacts.com/articles/the-effect-of-feverfew-on-migraine-a-meta-analysis-of-clinical-trials/ – A recent meta-analysis (2023) including 3 RCTs (n=237) that investigated feverfew's effect on migraine frequency found a non-significant small effect size (Cohen’s d = -0.19; p=0.26). This suggests that feverfew may not be effective as a standalone prophylactic for migraine, though it could potentially have adjunctive benefits. The authors highlighted the ongoing need for larger, more rigorously standardized trials to clarify its clinical role.
- https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/210330 – This double-blind RCT (Miller, 1998) involving 72 participants reported a 24% reduction in migraine attacks with feverfew compared to placebo (p<0.005). The study also noted that feverfew inhibits prostaglandin production and platelet aggregation but does not inhibit cyclooxygenase. It cautioned about potential interactions with NSAIDs and anticoagulants, recommending careful consideration for patients on such medications.