JBBS  Vol.3 No.4 , August 2013
Effect of Fasting during Ramadan on Migraine Sufferers
Abstract: Background: Fasting during Ramadan in Muslim communities is distinct from regular voluntary or experimental fasting. Its consequent caffeine withdrawal, stress and low blood glucose level (hypoglycemia) may trigger headache in patients with migraine. Objectives: The main aim of this study was to evaluate the effect of the Ramadan fasting on the frequency of migraine attacks among observant Muslim migraine sufferers. Material and Methods: This research study was based on fasting Muslims; both genders were aged between 18 and 65 years. Fifty migraineurs were selected, participated and gave consent at Internal Medicine and Neurology Clinics in Riyadh National Hospital, KSA. Those patients were recruited over three consecutive months of Ragab, Shaban and Ramadan during the period of 2010 and 2013. The effect of fasting and special eating pattern during the month of Ramadan compared with the preceding two months (Ragab and Shaban) was studied. The primary parameters used for comparisons were migraine attack count, duration of migraine attacks in days, attack duration and severity of the attacks. Results: Only forty three migraine sufferers completed the current study to the end, 4 patients of them were males (9.3%) and 39 were females (90.7%). They were aged between 18 and 44 years (Mean ± SD, 30.9 ± 6.9 years). Most of the fasting migraineurs during Ramadan were caffeine drinkers (n = 36, 83.7%), cigarette smokers (n = 2, 4.6%), overweight or obese (with BMI > 25) n = 27, 62.8%), under stress (n = 29, 67.4%) and with low to moderate physical activities (No exercise) (n = 31, 72%). The worst time for the fasting individuals was afternoon between 2:00 PM to 4:30 PM because majority of them had headache during these hours. This study showed a significant reduction in migraine attack count, number of headache days, number of attacks with acute medication and total medication intake among migraineurs during the month of Ramadan compared with the two pre-Ramadan months. However, attack severity and attack duration did not change significantly between all three months. Conclusion: In conclusion, the present study did not find any negative effects of fasting during Ramadan on the migraine sufferers.
Cite this paper: W. Gabr, E. Barakat and M. Shams, "Effect of Fasting during Ramadan on Migraine Sufferers," Journal of Behavioral and Brain Science, Vol. 3 No. 4, 2013, pp. 373-378. doi: 10.4236/jbbs.2013.34037.

[1]   “The International Classification of Headache Disorders: 2nd Edition,” Cephalalgia, Vol. 24, Suppl. 1, 2004, pp. 91-60.

[2]   C. Waeber and M. A. Moskowitz, “Therapeutic Implications of Central and Peripheral Neurologic Mechanisms in Migraine,” Neurology, Vol. 61, No. 8, 2003, pp. S9-S20. doi:10.1212/WNL.61.8_suppl_4.S9

[3]   P. J. Goadsby, R. B. Lipton and M. D. Ferrari, “Migraine—Current Understanding and Treatment,” New England Journal of Medicine, Vol. 346, 2002, pp. 257-270. doi:10.1056/NEJMra010917

[4]   R. B. Lipton, W. F. Stewart, S. Diamond, M. L. Diamond and M. Reed, “Prevalence and Burden of Migraine in the United States: Data from the American Migraine Study II,” Headache, Vol. 41, No. 7, 2001, pp. 646-657. doi:10.1046/j.1526-4610.2001.041007646.x

[5]   N. Schmitz, F. Admiraal-Behloul, E. B. Arkink, et al., “Attack Frequency and Disease Duration as Indicators for Brain Damage in Migraine,” Headache, Vol. 48, No. 7, 2008, pp. 1044-1055. doi:10.1111/j.1526-4610.2008.01133.x

[6]   T. J. Steiner, K. Paemeleire, R. Jensen, et al., “European Principles of Management of Common Headache Disorders in Primary Care,” Journal of Headache and Pain, Vol. 8, Suppl. 1, 2007, pp. S3-S47.

[7]   M. C. Kruit, L. J. Launer, J. Overbosch, M. A. van Buchem and M. D. Ferrari, “Iron Accumulation in Deep Brain Nuclei in Migraine: A Population-Based Magnetic Resonance Imaging Study,” Cephalalgia, Vol. 29, No. 3, 2009, pp. 351-359. doi:10.1111/j.1468-2982.2008.01723.x

[8]   E. Hazard, J. Munakata, M. E. Bigal, M. F. Rupnow and R. B. Lipton, “The Burden of Migraine in the United States: Current and Emerging Perspectives on Disease Management and Economic Analysis,” Value Health, Vol. 12, No. 1, 2009, pp. 55-64. doi:10.1111/j.1524-4733.2008.00404.x

[9]   J. Olesen, M. G. Bousser, H. C. Diener, et al., “New Appendix Criteria Open for a Broader Concept of Chronic Migraine,” Cephalalgia, Vol. 26, No. 6, 2006, pp. 742-746. doi:10.1111/j.1468-2982.2006.01172.x

[10]   A. I. Scher, L. A. Midgette and R. B. Lipton, “Risk Factors for Headache Chronification,” Headache, Vol. 48, No. 1, 2008, pp. 16-25. doi:10.1111/j.1526-4610.2007.00970.x

[11]   A. H. Sakr, “Fasting in Islam,” Journal of the American Dietetic Association, Vol. 67, 1975, pp. 17-21.

[12]   J. N. Blau, “Migraine Triggers: Practice and Theory,” Pathologie Biologie (Paris), Vol. 40, 1992, pp. 367-372.

[13]   J. M. Hockaday, D. H. Williamson and C. W. Whitty, “Blood-Group Levels and Fatty-Acid Metabolism in Migraine Related to Fasting,” Lancet, Vol. 297, No. 7710, 1971, pp. 1153-1156. doi:10.1016/S0140-6736(71)91662-X

[14]   J. W. Lance and M. Anthony, “Some Clinical Aspects of Migraine. A Prospective Survey of 500 Patients,” Archives of Neurology, Vol. 15, No. 4, 1966, pp. 356-361. doi:10.1001/archneur.1966.00470160022003

[15]   M. Aslam and A. Assad, “Drug Regimens and Fasting during Ramadan: A Survey in Kuwait,” Public Health, Vol. 100, No. 1, 1986, pp. 49-53. doi:10.1016/S0033-3506(86)80086-5

[16]   Headache Classification Committee of the International Headache Society, “Classification and Diagnostic Criteria for Headache Disorders, Cranial Neuralgias and Facial Pain,” Cephalalgia, Vol. 8, Suppl. 7, 1988, pp. 1-96.

[17]   T. W. Victor, X. Hu, J. C. Campbell, D. C. Buse and R. B. Lipton, “Migraine Prevalence by Age and Sex in the United States: A Life-Span Study,” Cephalalgia, Vol. 30, No. 9, 2010, pp. 1065-1072. doi:10.1177/0333102409355601

[18]   W. F. Stewart, M. S. Linet, D. D. Celentano, N. M. Van and D. Ziegler, “Age-and Sex-Specific Incidence Rates of Migraine with and without Visual Aura,” American Journal of Epidemiology, Vol. 134, 1991, pp. 1111-1120.

[19]   M. Aguggia, G. D’Andrea and G. Bussone, “Neurophysiology and Neuromodulators,” Neurological Sciences, Vol. 28, Suppl. 2, 2007, pp. S97-S100. doi:10.1007/s10072-007-0759-3

[20]   J. N. Blau, “Migraine Triggers: Practice and Theory,” Pathologie Biologie (Paris), Vol. 40, 1992, pp. 367-372.

[21]   E. L. Spierings, A. H. Ranke and P. C. Honkoop, “Precipitating and Aggravating Factors of Migraine versus Tension-Type Headache,” Headache, Vol. 41, No. 6, 2001, pp. 554-558. doi:10.1046/j.1526-4610.2001.041006554.x

[22]   F. C. Rose, “Trigger Factors and Natural History of Migraine,” Functional Neurology, Vol. 1, 1986, pp. 379-384.

[23]   V. Van den Bergh, W. K. Amery and J. Waelkens, “Trigger Factors in Migraine: A Study Conducted by the Belgian Migraine Society,” Headache, Vol. 27, No. 4, 1987, pp. 191-196.

[24]   L. Kelman, “The Triggers or Precipitants of the Acute Migraine Attack,” Cephalalgia, Vol. 27, No. 4, 2007, pp. 394-402. doi:10.1111/j.1468-2982.2007.01303.x

[25]   C. Finocchi and G. Sivori, “Food as Trigger and Aggravating Factor of Migraine,” Neurological Sciences, Vol. 33, 2012, Suppl. 1, pp. S77-S80.

[26]   P. T. Fukui, T. R. Goncalves, C. G. Strabelli, et al., “Trigger Factors in Migraine Patients,” Arquivos de Neuro-Psiquiatria, Vol. 66, No. 3a, 2008, pp. 494-499. doi:10.1590/S0004-282X2008000400011

[27]   N. Karli, M. Zarifoglu, N. Calisir and S. Akgoz, “Comparison of Pre-Headache Phases and Trigger Factors of Migraine and Episodic Tension-Type Headache: Do They Share Similar Clinical Pathophysiology?” Cephalalgia, Vol. 25, No. 6, 2005, pp. 444-451. doi:10.1111/j.1468-2982.2005.00880.x

[28]   A. Bener, A. Azhar and M. Bessisso, “Do Fasting and Eating Habits in Ramadan Affect Migraine, Headache and Sleep Disorders,” Journal of Nutrition & Food Sciences, Vol. 37, p. 7.

[29]   A. Chakravarty, A. Mukherjee and D. Roy, “Trigger Factors in Childhood Migraine: A Clinic-Based Study from Eastern India,” Journal of Headache and Pain, Vol. 10, No. 5, 2009, pp. 375-380. doi:10.1007/s10194-009-0147-x

[30]   A. Milde-Busch, A. Blaschek, I. Borggrafe, F. Heinen, A. Straube and R. von Kries, “Associations of Diet and Lifestyle with Headache in High-School Students: Results from a Cross-Sectional Study,” Headache, Vol. 50, No. 7, 2010, pp. 1104-1114.

[31]   R. F. Camboim, K. Castro, V. R. de Oliveira, P. A. da Silveira, M. L. Fagundes Chaves and I. D. Schweigert Perry, “Perceived Migraine Triggers: Do Dietary Factors Play a Role?” Nutrición Hospitalaria, Vol. 27, No. 2, 2012, pp. 483-489.