Impact of Ramadan Fasting on Migraine Headache

Abstract Background: Fasting is known as a migraine trigger for migraine. Muslims fast one month every luminal year. We aimed to study the impact of The Holy month of Ramadan on episodic migraine.Methods: This retrospective study included patients diagnosed as migraine according to The International Classification of Headache Disorders, 3rd edition (ICDH-3). Both genders, aged between 18 and 65 years were included. The impact of fasting and changing habits during the month of Ramadan was studied. Frequency, severity of migraine attacks and number of analgesic days during Ramadan were compared to those during Shaban, the Immediate previous month to Ramadan. Number of breaking fasting due to migraine was reported.Results: This study identified 293 with migraine with mean age and mean disease duration 37.09 ±9.36, 12.34±9.27 years respectively. Most of them were females(89.1%). During Ramadan month, the patient had significant increase in migraine days 10.42±7.98 compared with 6.90±6.55 migraine days during the previous month (p < 0.001). Also, days of analgesic use (11.32±10.46 versus 6.11±6.69;P<0,001) and migraine severity (7.46±2.39 versus 6.84±2.25; P<0,001) were significantly increased during Ramadan compared to Shaban. Most of the patients completed fasting the whole month of Ramadan. A minority (1.7) could not tolerate fasting whole Ramadan due intolerable migraine headache and 36.5% broke their fasting for some days during Ramadan. Some patients changed previous prophylactic therapy before fasting to reduce the impact of fasting on migraine headache. Most of our cohort (82.3%) continue on the same management plan for migraine during Ramadan. Majority of cohort (75.4%) reported that migraine interfered with their daily activities due to fasting during Ramadan. Conclusion: Ramadan fasting has negative impact on the majority of migraine patients. Physicians should educate migraine patients who to manage their headache and habits before starting fasting.