“for those adhering to religious rituals, a new set of problems arise. Rules vary throughout Judaism. For the migraine sufferer, the ultra-Orthodox may be less stringent on Tish B’av but not on Yom Kippur.”
Hypoglycemia (low blood sugar levels) has been linked to fasting headaches, especially migraine attacks associated with fasting. As early as 1933, the great British neurologist, MacDonald Critchley indicated that migraine attacks associated with fasting and strenuous exercise, might be relieved by food intake. It has been recommended that to avoid fasting headaches and those migraine attacks associated with fasting, the patient should maintain a regular meal schedule, even when dieting for weight loss. Missing or skipping a meal should be avoided in order to maintain your homeostasis. But for those adhering to religious rituals, a new set of problems arise. Rules vary throughout Judaism. For the migraine sufferer, the ultra-Orthodox may be less stringent on Tish B’av but not on Yom Kippur. Eating even a little bit of food on Yom Kippur is a Torah prohibition, and that rule applies even to a person who is ill. In cases in which migraine could precurse a life-threatening event (chashash sakanat nefashot), such as a stroke, eating minimal amounts would be permitted. But of course, they would need to have a previous history of such events related to fasting. Guidelines have been established and were printed on www.israelnationalnews.com last year: • The individual has been diagnosed with migraine that can be caused by fasting • The migraine appears after an aura, and the aura lasts for over one hour • No migraine medications (such as suppositories or sprays) can prevent the onset of the migraine These religious dilemmas are not limited to Judaism. Christians, and particularly Catholics, may face the issue during the Lenten season. Catholic adults, from 18 to 59,
are expected to refrain from eating between meals during the 40 days before Easter, and all those from age 14 until death, are to abstain from eating meats and meat products on Ash Wednesday and every Friday during Lent. Rules may be bent for medical reasons, and dispensations can be granted. For Muslims, the fasting headaches are called “Firstof-Ramadan” (FAR) headaches which are triggered as a result of the ritualistic fasting. Those with previous histories of headache, either migraine or tension-type, are more likely to develop a fasting headache. Hypoglycemia did not seem to be a factor for this religious group, as most Muslims seemed to eat a meal before dawn and then a second meal after dusk. However, caffeine withdrawal from coffee and tea, and dehydration may play a factor in the FAR headaches. Consumption of a caffeinated beverage or water seemed to relieve the headache symptoms. For the migraine sufferer who is observing Ramadan, use of an abortive agent prior to fasting, may be effective at thwarting the “fasting migraine attack.” HW
Further reading
1. 2. Mosek A, Korczyn AD. Yom Kippur Headache. Neurology 1995; 45:1953-1955. Torelli P, Evangelista A, Bini A, et al. Fasting headache: A review of the literature and new hypotheses. Headache 2009; 49:744-752. 3. Melamed E. Yom Kippur Q&A: Revealing G-d’s kingdom in Israel. www.israelnationalnews.com; accessed 9/24/12.
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