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Avoiding the Ramadan Headache

by Dujanah Descartes

Ramadan is here and for many of us who fast, this month means days and nights filled with peaceful worship and meaningful contemplation; however, for some of us, it means disturbing headaches.

Some of us suffer mild or moderate headaches resulting from low blood sugar, dehydration, caffeine withdrawal, changes in sleep patterns and even the stress of fasting itself.

Malaysia’s University of Malaya carried out a four-month study, two months before Ramadan and one month after, in which eighty-three subjects recorded their headache frequency and severity in headache diaries. The study found those prone to headaches at other times of the year are most likely to get headaches during Ramadan, with, the frequency of headaches increasing during the month of fasting, but some patients who experience headaches during this time have no other history of headaches or migraines. According to the study, these headaches most often occur in the afternoon or evening just before iftar.

Despite the bad news, the good news is that people can manage these headaches without missing any fasts. Dr Elliot Shevel, chairman of the South African Headache Society, outlines several steps for avoiding Ramadan headaches. Caffeine withdrawal is the most common cause of headache while fasting; therefore he recommends reducing caffeine consumption in the weeks leading up to Ramadan. However, if you are reading this during Ramadan and it’s too late to give up your double latte or diet Coke, the physician recommends a cup of strong coffee at suhoor, just before the start of the fast, saying this may prevent a caffeine withdrawal headache.

Because low blood sugar can also trigger headaches, Dr. Shevel suggests a low sugar suhoor meal. “If a meal with high sugar content is taken before the day’s fast begins, it can cause a rapid rise in blood sugar levels followed by a fast drop that may trigger a headache,” he said.

Dehydration is another common trigger for headaches, so adequate fluid intake at suhoor is essential -- particularly this year, with Ramadan falling in a hot summer month.

Because the human brain is more than 75% water, it is sensitive to the amount of water available to it. When the brain detects the water supply as too low, it begins to produce histamines. They are essentially a source of water rationing and conservation, in order to safeguard the brain in case the water shortage continues for a long period of time. The histamines directly cause pain and fatigue; in other words, a banging headache and the low energy that usually accompanies it.

“Headache sufferers should also, as far as possible, try to avoid exposure to other triggers such as fluid retention, stress, fatigue and lack of sleep during Ramadan, when there is a greater tendency to experience headache,” said Dr Shevel. (People should) “rest and sleep often to help prevent being subjected to headaches, and the pain often melts away when the fast is broken for the day.

”Some people also get relief with over-the-counter headache medicines from a pharmacy; however, headaches that don’t go away or are particularly severe should be reported to your health care provider. Dr Shevel concludes that headaches can be most successfully treated using a multidisciplinary approach, as no one medical specialization covers all the psychological and physical dimensions of severe headaches.

With care and preparation, careful fasters can often avoid headache during Ramadan and focus on the blessings and light of this sacred month.

For more information, please contact Kayleen Naidoo, Research Assistant to Dr. E. Shevel at The Migraine Research Institute and The Headache Clinic kayleen@headclin.com.