Sublingual feverfew and ginger combination can abort a migraine

It's long been known that the herb feverfew (Tanacetum parthenium) can reduce the frequency and intensity of migraine attacks if taken ahead of time on a regular basis, but alternatives to triptan medications for acute application are in short supply. Therefore I'm glad to see a study just published in Headache: The Journal of Head and Face Pain offering evidence that the novel sublingual preparation of feverfew plus ginger LipiGesic M™ can rapidly abort or ameliorate a migraine headache. The authors state:

"Therapeutic needs of migraineurs vary considerably from patient to patient and even attack to attack. Some attacks require high-end therapy, while other attacks have treatment needs that are less immediate. While triptans are considered the “gold standard” of migraine therapy, they do have limitations and many patients are seeking other therapeutic alternatives. In 2005, an open-label study of feverfew/ginger suggested efficacy for attacks of migraine treated early during the mild headache phase of the attack."

Pursuant to this they designed the double-bind placebo-controlled study reported here that included 60 patients who self-treated 221 attacks of migraine with either the sublingual feverfew/ginger preparation or placebo. Additionally...

"All subjects met International Headache Society criteria for migraine with or without aura, experiencing 2-6 attacks of migraine per month within the previous 3 months. Subjects had <15 headache days per month and were not experiencing medication overuse headache. Inclusion required that subjects were able to identify a period of mild headache in at least 75% of attacks. Subjects were required to be able to distinguish migraine from non-migraine headache."

Subjects were randomized to receive either sublingual feverfew/ginger or a matching placebo, and told (but not required) to initiate treatment as soon as they recognized that a migraine was starting. What were the results?

"Sixty subjects treated 208 evaluable attacks of migraine over a 1-month period; 45 subjects treated 163 attacks with sublingual feverfew/ginger and 15 subjects treated 58 attacks with a sublingual placebo preparation...At 2 hours, 32% of subjects receiving active medication and 16% of subjects receiving placebo were pain-free. At 2 hours, 63% of subjects receiving feverfew/ginger found pain relief (pain-free or mild headache) vs 39% for placebo. Pain level differences on a 4-point pain scale for those receiving feverfew/ginger vs placebo were −0.24 vs −0.04 respectively. Feverfew/ginger was generally well tolerated with oral numbness and nausea being the most frequently occurring adverse event."

This is clearly palliative treatment rather than therapy designed to address the underlying causes of migraine (see forthcoming posts regarding the functional medicine approach to migraine). However, an effective palliative that is wholesome and free of serious side-effects as implied in the authors' conclusion is welcome news:

"Sublingual feverfew/ginger appears safe and effective as a first-line abortive treatment for a population of migraineurs who frequently experience mild headache prior to the onset of moderate to severe headache."