The context in which kava is used, together with its underlying psychopharmacological mechanisms, were investigated. A systematic search was conducted using the computerised databases Medline, OVID and PsychLIT for all articles containing any of the following words: kava, kavain, kawa and Piper methysticum. All articles from this collection containing data that, in the opinion of the authors, could inform the neurological and cognitive sequelae of kava use were included. The use of kava occurs among indigenous populations in the South Pacific and in northern Australia; it is also used throughout the Western world as a herbal medicine. Animal studies show that kava lactones alter neuronal excitation through direct interactions with voltage-dependent ion channels, giving rise to kava’s muscle relaxant, anaesthetic, anxiolytic and anticonvulsive properties. Several isolated cases of psychotic and severe dystonic reactions following kava use suggest that kava also has psychoactive properties, yet there is no conclusive evidence that kava interferes with normal cognitive processes. The authors concluded that kava is effective in the treatment of tension and anxiety. There may be risk factors for severe motor and psychiatric responses to kava use, although these are not well understood.