We've all experienced it, that sensation which feels like a Mack truck is driving through your head - pounding, seething pain, or just an irritating, annoying ache, that makes it difficult to get through the day, go to sleep or relate to fellow human beings. Headaches are like the common cold. They come and go as they please - no one can escape. An occasional headache is one thing, but if you are one of the estimated 50 million Americans who experience headaches on a regular basis, you are well aware that they can be more than an annoyance. They can be debilitating. Tension, migraine, and cluster headaches are the most common of the dozen major types of headaches from which people suffer. Headaches are further classified into about 60 sub-types.

Just as there is more than one type of headache, they can be triggered by a variety of factors. If you have headaches on a regular basis, you and your health care practitioner may be better able to pinpoint the cause, which may aid in their prevention and treatment. Factors that can contribute to triggering headaches include stress, sudden weather changes, changes in hormonal balance, menstruation. Additional factors that might trigger a headache could include missing a meal, bright sunlight, too little sleep (as well as too much sleep), food reactions, poor air circulation, and eyestrain. If you and your health care provider can identify the cause, you may be able to prevent headaches, or at least become aware of patterns in your life that may trigger them.

While headaches are often a result of the stress of modern life, they are certainly nothing new to the human experience. If you thumb through old herbals you will occasionally come upon suggested treatments for what we would now describe as a headache, often couched in the archaic language of the day. For example, let's take a look at the herb feverfew.

In 1655, John Goodyer produced the first English translation of the materia medica of Dioscorides (the first century Greek physician, who served as a medical doctor in the Roman army). Dioscorides' work served as the basis for the practice of western medicine well into the sixteenth century. In Goodyer's translation of Dioscorides he says that the feverfew is good for "melancholicall," which in modern terms is interpreted as good for headaches.

The famous Herball of apothecary John Gerard was first published in 1597. In 1633, after Gerard's death, Thomas Johnson produced a second edition of the book, which is the most widely quoted version of Gerard's Herball. Here we learn that, "Feverfew dried and made into pouder, and two drams of it taken with honie or sweet wine, purgeth by siege melancholy and flegme, whereforre it is very good for them that are giddie in the head, or which have the turning called Vertigo, this is a swimming and turning in the head. Also it is good for such as be melancholike, sad, pensive, and without speech." (Johnson, 1633, p. 653). Once again, this means that feverfew was used for headaches in modern terms.

The famous (or infamous) English herbalist, Nicholas Culpepper, whose seventeenth century "English Physician" is the most widely printed English-language herbal of all time, also observed use of feverfew for headache. My 1787 Dublin edition of Culpepper says, "It is very effectual for all pains in the head coming of a cold cause, the herb being bruised and applied to the crown of the head; as also for the Vertigo, that is a sunning or swimming of the head".

References to feverfew for headaches are more than a passing historical footnote. Feverfew has become a rising star in the treatment of headaches, particularly helping to prevent migraines. Few ailments result in as numerous trips to medical practitioners in search of relief as a migraine headache. As many as one in eight people suffer from migraines. Feverfew (Tanacetum parthenium) is now being promoted as a welcome relief for migraine suffers. Several articles published in the past decade in British medical journals catapulted feverfew into recognition as a potential treatment or prevention of symptoms associated with migraine headaches.

Feverfew, grown in herb gardens and as an ornamental flower, is a perennial member of the aster family native to the mountain scrub and rocky ground of the Balkan peninsula. Used for the treatment of headaches for over 2,000 years, the plant has been cultivated in other parts of Europe for centuries, and is now a common plant throughout Europe. Feverfew is also found in North and South America, where it was introduced by early European settlers, escaped from cultivation, and now grows wild along roadsides and fields from Quebec south to Maryland, west to Ohio and Missouri. In modern botanical work, feverfew is listed as Tanacetum parthenium. Older herbals and botany books refer to it as Chrysanthemum parthenium.

Despite its long history of use for headaches, it is since the early 1980s that interest in the plant has once-again resurfaced. For most of the last two centuries feverfew has been a relatively obscure medicinal plant, sometimes used by herbalists for fevers, of course, as well as to regulate the menses, or as an external application for pain relief.

In the early to mid-1980s a number of research groups in the United Kingdom became interested in the use of feverfew for migraines based on the fact that it seemed quite a few individual migraine sufferers were using feverfew with some success. Consequently, a 1985 study by Johnson and co-workers at the City of London Migraine Clinic, in collaboration with the Chelsea College of the University of London, took an unusual approach to researching feverfew in the treatment of migraines. Bypassing animal studies, the researchers sought volunteers who already used feverfew for self medication of migraines. Seventeen patients who had been self-treating with feverfew were involved in the double-blind study, which examined the effects of withdrawal of feverfew for users who though it to be beneficial. The nine patients who received a placebo reported an increase in the frequency and severity of migraines and associated symptoms, such as nausea and vomiting.

This was the first clinical study on the effectiveness of feverfew in migraine prevention. Back then, no specific chemical was known from feverfew for its anti-migraine effect. A later study was published in the 23 July 1988 issue of the British medical journal The Lancet . The study by J.J. Murphy, S. Heptinstall, and J.R.A. Mitchell of the Department of Medicine, University Hospital, Nottingham, England, was entitled: "Randomized Double-Blind Placebo-Controlled Trial of Feverfew in Migraine Prevention." Seventy-two volunteers took part in the study. Information on fifty-nine patients was available at the end of trial. The researchers observed significant reduction of mean number, severity, and vomiting associated with migraines in volunteers who received feverfew compared to the controls. These researchers confirmed a reasonable basis for feverfew to help reduce symptoms associated with the management of migraines. This study, the first of its kind, pointed to the need for more intensive research of feverfew, especially in standardization of quality in commercial preparations as they relate to clinical applications.

Abnormal platelet behavior has been implicated as a possible explanation for the development of migraines. Platelets release the hormone serotonin (also referred to as 5&emdash;HT) during a migraine attack. Serotonin constricts blood vessels among other actions. Red wines, for example have been shown to release serotonin from blood platelets, inducing headaches. Some types of red wine have been found to produce a significantly greater release of the compound. Recent research has shown that a flavonoid fraction subgroup in red wine may be responsible for the serotonin release and resulting headaches. The challenge now is to find the exact compound responsible and remove it from commercial red wines.

Serotonin antagonists have been suggested for use in a supportive role in migraine prevention. Feverfew has been shown to inhibit serotonin release from platelets. The effectiveness of various feverfew preparations in inhibiting the release of serotonin from human blood platelets has been found to correlate well with parthenolide content in freeze-dried or air-dried whole feverfew leaf. Parthenolide is thought to be the primary active component of feverfew. Canadian regulatory authorities have proposed that feverfew leaf should contain a minimum of 0.2 percent parthenolide as a minimum standard for reasonable certainty of claims in feverfew products. A number of products standardized to parthenolide content are now available from various herb manufacturers. Commercial growers have helped in availability of standardized products by growing feverfew that is naturally high in parthenolide. This is important, since some feverfew varieties contain no parthenolide.

Recently, additional studies have provided more information on the plant. Researchers in the United Kingdom have identified a new flavonol in the plant called tanetin, which they showed could contributed to anti-inflammatory action of feverfew. In the U.K., feverfew is also used by consumers for the treatment of arthritis because of perceived anti-inflammatory effects. This study, published in the January 1995 issue of Phytochemistry, provides evidence for the presence of a compound in the plant to which anti-inflammatory activity can be attributed.

More research is being conducted on this important herb. Much of the research is sparked by successful traditional uses of the plant. In the future, we will know even more about how the plant can best be used for health benefits. Consumers who use feverfew for helping with migraine should discuss this possibility with a health care practitioner, and look for standardized products with predictable results.

References

1. Gunther, R. T. The Greek Herbal of Dioscorides. New York: Hafner Publishing Company, 1934, reprinted 1968.
2. Johnson, T. The Herball or Generall Historie of Plantes. New York: Dover Publications, Inc., 1633, reprinted 1975.
3. Culpepper, N. The English Physician Enlarged. Dublin: H. Colbert, 1787.
4. Foster, S. Feverfew - Tanacetum parthenium. Botanical Series, No. 310, Austin, Texas: American Botanical Council, 1991.