Changes in Migraine Characteristics Over 30 Days of Ramadan Fasting

A Prospective Study

Amany H. Ragab MD; Nirmeen A. Kishk MD; Amr Hassan MD; Osama Yacoub MD; Lobna El Ghoneimy MD; Alaa Elmazny MD; Enji H. Elsawy MD; Doaa Mekkawy MD; Alshimaa S. Othman MD; Hoda Ibrahim Rizk MD; Mohammad Edrees Mohammad MD; Hatem S. Shehata MD; Nevin Shalaby MD; Rehab Magdy MD

Disclosures

Headache. 2021;61(10):1493-1498. 

In This Article

Abstract and Introduction

Abstract

Objective: To study Ramadan's effect on migraine from the start to the end of the month and the tolerability of patients with migraine to fasting.

Background: Fasting is a well-known trigger for migraine. Whether this effect on migraine is the same throughout the whole month, or whether it varies from the first to the last days of the month, has not been studied yet.

Methods: A prospective cohort observational study was carried out on persons with migraine who fasted from 24 April to 23 May during Ramadan 2020. Each patient was asked to fill out their headache diary starting from Shaaban (the month before Ramadan) to the end of Ramadan. The Ramadan diary was divided by 10 days each, by which the patient was asked to accurately describe their migraine attacks in terms of frequency, duration, and intensity by using the Visual Analog Scale. Migraine attacks during the first day of fasting were assessed separately.

Results: A total of 292 known persons with migraine from Egypt completed the study. Their median age was 33 years; 72/292 (24.7%) were male, and 220/292 (75.3%) were female. About 126/236 (53.4%) of the patients had migraine attacks on Ramadan's first day, most of them during fasting. The frequency of migraine attacks was significantly increased in Ramadan (median 4, interquartile range [IQR] 2–7) compared with Shaaban (median 3, IQR 1–6), p = 0.009. The number of attacks was significantly reduced in both the second (median 1, IQR 0–2.25) and the third 10 days of Ramadan (median 1, IQR 1–3) compared with the first 10 days (median 3, IQR 1–5) (p < 0.001 for each).

Conclusion: Ramadan's potential exacerbating effect on the frequency of migraine attacks should be discussed with patients with migraine. This effect appears to be limited to the first 10 days of Ramadan and then subsides with successive days of fasting.

Introduction

Fasting is a well-known worship ritual in several religions. The style of fasting differs between different religions. In Islam, intermittent fasting is obligatory for all healthy adults. Fasting is obligatory over 1 month yearly, called the Holy Ramadan, the ninth lunar month. Approximately fasting is around 14 h from dawn until sunset, with prohibition from food, drinks (including water, caffeine, and oral medications), sex, and smoking. Sick people and menstruating women are exempted from fasting. Additionally, pregnant and lactating women are not obligated to fast. Iftar is defined as breakfast at sunset.

There are around 1.8 billion Muslims in the world (24.1% of the world population), according to a study undertaken in 2015, making Islam the second largest religion in the world after Christianity.[1]

Migraine is the third most common disease globally with an estimated prevalence of 14.7% across the global population. Migraine is also considered the seventh most disabling disease.[2]

Fasting is a well-known triggering factor for migraine.[3–5] The studies of the effect of Islamic fasting on migraine are scarce.[5,6] Whether the effect on migraine is the same throughout the whole month, or whether it varies from the first to the last days of the month, is yet to be studied. In this study, the authors divided the month into thirds to describe Ramadan's effect on migraine characteristics at different periods of the month among Egyptian Muslims, with a particular focus on the first day of fasting.

We hypothesized that the fasting effect on migraine might differ throughout Ramadan, and the difficulty may be restricted to the beginning of the month.

Objective

To study Ramadan's effect on migraine from the start to the end of the month and the tolerability of patients with migraine to fasting. A second objective was to determine whether the effect of fasting on migraine will be the same throughout the month or whether it varies from the first to the last days of the month.

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