Beduin doctor: Migraines common during Ramadan fast

Healthy Muslims who get migraines during Ramadan invited to participate in Jerusalem clinical trial.

By JUDY SIEGEL-ITZKOVICH
Arab pharmacy 311 (photo credit: Marc Israel Sellem/The Jerusalem Post)
Arab pharmacy 311
(photo credit: Marc Israel Sellem/The Jerusalem Post)
Doctors at Jerusalem's Shaare Zedek Medical Center have invited healthy Muslims aged 18 to 65 who suffer from migraine headaches during the month-long dawn-to-dusk fast of Ramadan to participate in a clinical trial for prevention of the pain.
An estimated 90 million of the world’s 1.57 billion Muslims are likely to suffer from migraine headaches during Ramadan – which begins on Wednesday, at the height of summer heat. After Jewish researchers in Israel and the US and found that the COX-2 inhibitor etoricoxib (commercial name Arcoxia) reduces the rate of migraines during the 25-hour Jewish fast of Yom Kippur, a Shaare Zedek team headed by Dr. Michael J. Drescher and Dr. Zev Wimpfheimer are testing Muslims who want to volunteer for the clinical trial.
Writing in the journal Headache, Drescher and colleagues noted that they had previously recommended a different Cox-2 inhibitor, Vioxx, but it was taken off the market because it caused a higher risk of cardiovascular complications in some people taking it for 18 months or longer. Thus they studied a “cousin” of Vioxx that is regarded as safer and is still prescribed.
Before Yom Kippur, they enrolled 211 Jewish patients, some of whom received the drug, with the rest getting a placebo. They found that those who received etoricoxib had a much easier fast compared to previous fasts. As the drug has a half-life of 22 hours and the team suggested it could be suitable for preventing or alleviating the headaches associated with short fasts.
The clinical trial for Muslims is double-blinded, with neither the doctors nor the participants knowing who is taking the etoricoxib half of the month and a harmless placebo the rest of the month. Anyone who wants to participate in the free trial should call (052) 337-4676 or go into the Web site www.ramadanheadache.com.
“It seems unlikely that short term (or single-dose) use of etoricoxib in the context of preventing fasting headache would pose” a risk to the cardiovascular system, Drescher said.
Meanwhile, Dr. Ibrahim Abu-Salameh, Israel’s only Beduin neurologist – who works at Soroka University Medical Center in Beersheba – headed a team that found migraine attacks are three times more common during the Muslim fast than in the rest of the year.
Working with colleagues Dr. Igal Plecht and Dr. Gal Ifergan of the Beersheba hospital, Abu-Salameh studied 32 Beduin who suffered from migraine attacks during the Ramadan fast last year and compared the statistics to an ordinary month without the fast as a control.
Migraines were much more common in women than men; three-quarters of the women complained of migraine while fasting, compared to a much lower figure among the men. The Soroka study was published recently in the Journal of Headache and Pain.
Because the Muslim calendar is a lunar one (with no leap years, as in the Jewish calendar), the month of Ramadan moves gradually backward through the seasons. When it occurs in the summer, the fasts are longer, due to the many hours of sunlight, and harder because of the hot weather.
Abu-Salameh said that he has gotten migraine headaches during Ramadan, and has treated Beduin who came to his clinic complaining about severe headaches. He noted that the medical literature has almost ignored the phenomenon until now.