Feverfew is commonly used to prevent migraines

Ask Oro IKcBsnttDn Ednadn MJD) Ask Dr. Keith Roach M.D

Feverfew is commonly used to prevent migraines

DEAR DR. ROACH: I read your recent column on cluster headaches and would like to add a comment. I am a 56-year-old woman and started getting these headaches around 20 years old. They became even worse as I went through my career, likely induced by stress. Usually these were helped with Relpax if caught early, or Fioricet, which made me feel lethargic the next day. I am still going full speed ahead in my career, but I've added an herbal supplement to my daily regimen.

I started taking feverfew and have not had a headache since September of 2012 (a bad one requiring a shot of Demerol).

I would love to see doctors offer these supplements as an option rather than drugs that are both expensive and addictive. I have had fantastic results and would encourage you to check out feverfew as a recommendation to those suffering from cluster or tension headaches. -S.L.

ANSWER: Feverfew is a commonly used herbal supplement, especially for prevention of migraine headache. Although feverfew appears to be safe, a review of five trials on feverfew found that three of the trials showed effectiveness, while two others showed that it was no better than placebo.

I couldn't find any good data supporting the use of feverfew to prevent cluster headache (a very distinct type of headache that is different from migraine) or for tension headaches. What concerns me about your previous treatment is that you apparently weren't tried on any preventive treatment at all, and you were treated with opiate drugs, which are seldom used in migraine, and have potential for habituation and dependence.

I think feverfew is worth trying for some people with chronic migraine, or those who are getting frequent or debilitating attacks. The B vitamin riboflavin (at a high dose, 400 mg per day) also has been found to be helpful for preventing attacks. However, cluster headaches are treated differently.

DEAR DR. ROACH: We hear so much about fiber being good for you, but I would like to know if it can be too much of a good thing, even if you build up to a high amount gradually? For some time, I had been having an upset stomach that encompassed my entire abdomen (upper and lower), along with a nauseated sensation. When I cut way back on my fiber intake, things began to improve. Now I am not experiencing any discomfort. Could this have been from overdoing it on the fiber? I know fiber affects your digestive tract, but can it also cause discomfort as high up as the esophagus? I would appreciate it if you could advise as to how much daily fiber an adult should consume. — Anon.

ANSWER: Too much of anything is bad, and it sounds like you did exceed your limit on fiber. The distention caused by the fiber certainly could explain the symptoms you experienced, and the fact that it is better now helps confirm it.

Distention — that is, enlargement of part of the GI tract beyond its normal limits — causes a poorly localized discomfort and nausea. The fact that it felt as high as the esophagus doesn't necessarily mean the esophagus was involved, as the ability of the body to localize this sensation is poor.

The guidelines say 25 grams a day or so of fiber for women and 35 or so for men — that's from food, not from supplements. Most people don't get as much as this, and some will tolerate much more. However, you have to listen to your body. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall. com.