Is feverfew a pharmacologic agent?
See response from: W. Pryse-Phillips
In a 1998 CMAJ article1 [full text] William Pryse-Phillips and colleagues discuss alternative medical practices2 in the management of migraine. They suggest that "a trial of feverfew may be appropriate in prophylaxis (class B recommendation)." Feverfew, Tenacetum parthenium, contains parthenolide, a compound that acts as a serotonin antagonist3 and also inhibits serum proteases and leukotrienes.4 Thus, feverfew should be considered a pharmacologic rather than a nonpharmacologic agent.
There is wide variation in the quantities of active compound in individual plants, plant parts, and fresh and dried preparations. As is the case for other proprietary herbal medications, some commercial feverfew products have been found to contain little or no active phytocompounds. Therefore, only standardized extracts should be used.5
In the article by Pryse-Phillips and colleagues feverfew is recommended as an option for migraine prophylaxis, but there is no guideline with respect to the duration of the trial. Prolonged use may be a concern because, as the authors point out, "there are no studies documenting [feverfew's] long-term safety or efficacy." Because of its pharmacologic properties, feverfew should not be used in combination with other migraine medications or with aspirin.
H.C. George Wong, MD
Competing interests: None declared.