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Published on: June 2, 2014
Changes in migraine characteristics over 30 days of Ramadan fasting: A prospective study
Amany H Ragab1, Nirmeen A Kishk1, Amr Hassan1
1Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
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.
Insights
Fasting during Ramadan can trigger migraine attacks, particularly in the first 10 days. However, migraine frequency decreases in later Ramadan days for individuals with migraine.
Area of Science:
- Neurology
- Public Health
- Religious Studies
Background:
- Fasting is a known migraine trigger.
- The impact of fasting duration on migraine throughout Ramadan has not been previously studied.
- Understanding Ramadan's effect on migraine is crucial for patient care.
Purpose of the Study:
- To investigate the effect of Ramadan fasting on migraine frequency and severity.
- To assess patient tolerability to fasting during Ramadan.
- To determine if migraine patterns change throughout the month of Ramadan.
Main Methods:
- A prospective cohort observational study was conducted.
- 292 individuals with migraine completed headache diaries during Ramadan 2020 and the preceding month.
- Migraine attacks were analyzed by frequency, duration, and intensity (Visual Analog Scale) in 10-day intervals.
Main Results:
- Migraine attacks increased on the first day of fasting (53.4% of patients).
- Overall migraine frequency was higher during Ramadan compared to the month before (p=0.009).
- Migraine attack frequency significantly decreased in the second and third 10-day periods of Ramadan compared to the first (p<0.001).
Conclusions:
- Ramadan fasting can exacerbate migraine frequency, especially in the initial days.
- The exacerbating effect of Ramadan fasting on migraine appears temporary, subsiding after the first 10 days.
- Healthcare providers should discuss the potential impact of Ramadan fasting on migraine with patients.
