Many people who fast over Ramadan suffer mild or moderate headaches as a result of factors such as hypoglycemia, caffeine withdrawal, change in sleep patterns and the stress of fasting itself.
The fasting month of Ramadan is an annual religious practice of Muslims prior to the "Hari Raya Puasa" celebration. During the one-month period, Muslims fast from sunrise to sunset (participants abstain from eating, drinking and smoking for 29 to 30 days).
In a prospective study carried out over four months at the University of Malaya (two months before the month of Ramadan and one month after) 83 subjects were given headache diaries and at the end of each month the severity of headache was quantified using the Chronic Pain Grade. They found that the pain intensity increased in 48% of the subjects. They concluded that fasting over Ramadan was a significant precipitating factor for headache.
Headache onset often occurs in the afternoon or evening just before the fast is broken. Headache frequency typically increases over the duration of fasting. Those prone to headaches at other times of the year are most likely to get headaches, but some patients that experience headaches during this time have no history of headaches or migraines.
The good news, says Dr Elliot Shevel, chairman of the South African Headache Society, is that you can manage these headaches without breaking your fast.
How to eliminate headaches from your fasting regimen during Ramadan
Dr Shevel highlights caffeine withdrawal as the most common cause of headache while fasting. Patients can often prevent headaches by reducing caffeine consumption in the weeks leading up to Ramadan month, while a cup of strong coffee just before the start of the fast for the day may prevent caffeine withdrawal headache.
Hypoglycaemia (low blood sugar) can also trigger headaches in many people. 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. Eating a meal with low sugar content before the fast may prevent the onset of a headache during the day.
The Health24 Glycemic Index tool categorises carbohydrate-containing foods according to the rate at which they increase our blood-glucose levels.
Dehydration is another common trigger, adequate intake of fluid before the onset of the fast can often prevent headaches. The human brain is more than 75% water, and it is very sensitive to the amount of water available to it. When the brain detects that the water supply is too low, it begins to produce histamines. This is essentially a process 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 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," says Dr Shevel.
"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."
When to call your doctor
If your headaches persist after Ramadan or are severe in nature, patients are advised to seek help from a medical professional. Dr Shevel explains that headaches can be most successfully treated using a multidisciplinary approach, since no one medical specialisation covers all the psychological and physical dimensions of severe headaches. – Health24
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