Feverfew for Migraine Prophylaxis

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S'more info about feverfew and migraines ..

 

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Chris (list mom)

 

http://www.alittleolfactory.com

 

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http://www.jr2.ox.ac.uk/bandolier/booth/alternat/AT006.html

 

 

Feverfew for Migraine Prophylaxis

 

 

Clinical bottom line: Overall, these studies suggest that feverfew may

be beneficial for the prevention of migraine attacks. However, the

effectiveness has not been established beyond reasonable doubt. More

data is needed to determine which dose and formulation should be

prescribed, and how effective it is. Future trials should measure

clinically relevant outcomes in accordance with International Headache

Society (IHS) criteria.

 

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Feverfew (Tanacetum parthenemium L) is a popular herbal remedy

recommended for the prevention of migraine. The pharmacological

properties of feverfew have been extensively investigated but remain

unclear.

 

 

Systematic review

 

 

Vogler BK, Pittler MH and Ernst E. Feverfew as a preventive treatment

for migraine: a systematic review. Cephalalgia. 1998; 18:704-708

 

 

Date review completed: April 1998

 

 

Number of trials included: 5

 

 

Number of patients: 196

 

 

Control group: placebo

 

 

Main outcomes: headache severity and frequency, nausea and vomiting,

photophobia

 

 

Inclusion criteria were randomised, double-blind, placebo-controlled

trials of feverfew mono-preparations taken for migraine prophylaxis. No

restriction to language of publication.

 

 

Reviewers conducted extensive searches of all main databases and

reference lists of retrieved reports, and contacted manufacturers of

feverfew preparations. Trials were scored for methodological quality

using the Oxford scale (Jadad et al., 1996). Reviewers provided a

descriptive summary of included trials, as pooling of data for

meta-analysis was not possible.

 

 

 

Findings

 

 

Five trials were found, one in abstract form that measured serotonin

uptake and platelet activity and is not discussed further here. Four

randomised, double-blind, placebo-controlled trials were found reporting

on clinical outcomes. All trials scored at least three of five points on

the quality scale. Trials varied with respect to dosing schedules and

formulations of feverfew, and outcome measures. Only one trial used IHS

criteria for migraine definition, diagnostic criteria were unclear in

two of the other trials. Three trials were of crossover and one of

parallel design. Reviewers did not state if there were any carry-over

effects in the crossover studies. One trial had less than ten patients

per treatment group. Overall three trials reported results in favour of

feverfew over placebo and one found no difference.

 

 

One trial randomised 17 patients to 100 mg feverfew daily (capsules

containing freeze-dried leaves) or placebo for 24 weeks. All patients

had taken raw feverfew leaves every day for three to four years. There

was a significant increase in attack frequency in the placebo group

(p<0.02), attack frequency remained constant in the feverfew group. Five

of eight patients in the feverfew group reported good to excellent

effectiveness based on a global assessment of treatment, compared with

one of nine in placebo group. There are too few patients to draw

meaningful conclusions from these results.

 

 

One trial randomised 72 patients to either one capsule dried feverfew

leaves daily (dose not stated) or placebo for eight months (crossing

over to other treatment after four months). A significant reduction in

headache frequency (p<0.005) was reported by the feverfew group compared

with placebo. Global assessment of treatment showed feverfew

significantly better than placebo (p<0.0001).

 

 

One trial randomised 50 patients with IHS definition of migraine to 143

mg feverfew daily (capsule containing an alcoholic extract of feverfew)

or placebo for four months (cross over at two months). There was no

significant difference in headache frequency or number of workdays lost

between the groups.

 

 

One trial randomised 57 patients with medical diagnosis of migraine to

100 mg feverfew daily or placebo for two months (cross over after one

month). All patients had received 100 mg feverfew daily for two month

run-in period. There was a significant difference in all outcomes

including migraine severity between feverfew and placebo (p<0.01).

 

 

Adverse effects were reported as being mild and reversible. In total

three patients withdrew on feverfew and five on placebo.

 

 

 

Further reading

 

 

Pittler MH, Vogler BK and Ernst E. Feverfew for preventing migraine.

Cochrane review 2000

 

 

 

Related topics

 

 

* Identifier AT006 - 5346 FEVERFEW FOR MIGRAINE PROPHYLAXIS:

Feb-2000