HeadWise HeadWise: Volume 3, Issue 2 | Page 26

Seymour Diamond, MD Executive Chairman and Founder National Headache Foundation Director Emeritus and Founder Diamond Headache Clinic Chicago, Illinois Mary A. Franklin Director of Operations National Headache Foundation Chicago, Illinois A s the Jewish high holidays approach in September this year, one becomes aware that some religious and traditional practices may pose a problem for the headache patient, and in particular the migraine sufferer. Fasting is often reported by patients, and cited in medical textbooks, as a headache trigger. Throughout Judaism, there are two days of fasting. Most readers will recognize Yom kippur (the Day of Atonement), which is the most holy day in the Jewish calendar. The other day of fasting is Tish B’av, a holiday beginning on the night of July 15, which commemorates the many tragedies that have befallen the Hebrew people. In a 1995 study in Israel of hospital employees before and after a 25-hour fasting period for Yom kippur, it was found that subjects with a history of headache were more likely to experience a fasting-induced headache than those without a headache history. The headaches were described as mild to moderate, of a nonpulsating quality, and located bilaterally and frontally. The number of reported headache attacks was related to the duration of the fasting. The researchers noted that withdrawal from caffeine HEAD WISE | Volume 3, Issue 2 • 2013 and nicotine did not seem to influence the occurrence of the headaches. The International Classification of Headache Disorders, divides headache into two classes—primary and secondary. Primary headaches, which include migraine and tension-type headache, have no underlying cause or disorder for the headaches. Secondary headaches can be traced to a specific cause—brain tumor, aneurysm, exposure to a substance such as nitrites. The most frequent form of secondary headaches are due to a disorder of homeostasis—the internal system that regulates our bodily functions and maintains stability. Fasting headache would be an easily identifiable form of a disorder of homeostasis. A new headache is considered to be a headache due to a disorder of homeostasis if it occurs for the first time in close relation to the disorder, and if the headache resolves or improves once the disorder is improved. Fasting headache would definitely improve, and hopefully disappear, after its victim eats or drinks. 24