Beduin doctor: Migraines common during Ramadan fast

Jewish researchers suggest medication.

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)
An estimated 90 million of the world’s 1.57 billion Muslims are likely to suffer from migraine headaches during the dawn-to-dusk fasts during the month of Ramadan – which begins on Wednesday, at the height of summer heat. But Jewish researchers in the US and Israel have suggested how to help prevent the problem.
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.
The phenomenon of migraine headaches among Jews fasting on Yom Kippur is known, but it is 25 hours at a time and only one day a year. The Ramadan fasts begin at dawn, end at dusk and continues for a month.
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.
Meanwhile, Dr. Michael J. Drescher of Hartford Hospital in Connecticut and colleagues at Sheba and Shaare Zedek Medical Centers in Israel recently suggested that otherwise-healthy Muslims suffering from migraine attacks during the Ramadan fast ask their doctors for a prescription for etoricoxib (commercial name Arcoxia) to prevent the headaches that come with fasting.
Writing in the journal Headache, they 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 would be suitable for preventing or alleviating the headaches associated with short fasts.
The team suggested that Muslims who suffer from migraines during Ramadan ask their doctors for the drug, which caused no serious side effects in the test group.
“It seems unlikely that shortterm or single-dose use of etoricoxib in the context of preventing fasting headache would pose” a risk to the cardiovascular system, they concluded.