By Penny Stern, MD
NEW YORK, Sep 17 (Reuters Health) -- Skipping meals can trigger headaches in people prone to migraines. On Yom Kippur, observed next Sunday, Jews abstain from food and beverages for 25 hours, but fasting on this solemn day need not provoke painful headaches in susceptible people if they follow a few simple rules, according to Dr. Larry Newman, director of the Headache Institute at St. Luke's-Roosevelt Hospital in New York.
Newman discussed with Reuters Health the recommendations he makes to patients prior to their embarking on the Yom Kippur fast. "We tell them not to gorge themselves on a huge meal before the fast. Instead -- like carbohydrate-loading for runners -- eat a meal loaded with complex carbohydrates like pasta, which can keep your body fueled long enough to prevent a 'fasting headache'."
Maintaining a proper fluid balance is also essential. "Part of the fasting-headache mechanism may have something to do with dehydration," Newman explained. Therefore, he advises patients to "drink plenty of fluids, especially water (before the start of the fast) and to limit the consumption of alcohol."
Since "withdrawal from both nicotine and caffeine can trigger headaches in people with or without a headache history," Newman suggests "going easy on the caffeine -- in drinks or food -- and limiting the amount of nicotine, if you can" before the fast.
Taking a nonsteroidal anti-inflammatory drug (NSAID) before beginning to fast may also help prevent a headache from developing. Newman told Reuters Health that NSAIDs have worked well in certain headache situations. "For instance, in women with (headache related to the menstrual cycle) we dose them with a long-acting anti-inflammatory before the predicted onset of their headache and we can ward it off. That's the reason we tell our patients to try an anti-inflammatory before the fast." People interested in trying this option should, of course, discuss it with their physician.
Oversleeping is also a potential contributor to the problem. "What happens with migraine is that you (often) need more than one trigger," Newman commented. "Sometimes sleeping too much, together with other (factors) such as caffeine withdrawal, can trigger a headache."
At the conclusion of Yom Kippur, Newman recommends "eating lightly to break the fast. To sit down and have 25 pounds of lox and pickled herring and chopped liver and everything else -- well, you can eat (these foods, but do so) in moderation. Don't have 14 bagels with lox and cream cheese, have two," he said.
Just as fasting can provoke headache, "certain foods are known to be potent migraine triggers -- MSG-containing foods, nitrate-containing foods -- delicatessen meats and hotdogs, smoked meats and smoked fishes (such as) lox, aged cheeses -- have been shown to do it," Newman told Reuters Health. In fact, he pointed out, "many of the foods typically eaten to break the fast" are such triggers. "So not only can fasting trigger migraine, but people then break the fast with triggers such as chocolate," he added.
While anyone may develop a headache during a prolonged fast, "people with migraine should be more cognizant of (this possibility) because they're more easily thrown into a headache than people without (a history of) migraine," according to Newman. He cited research carried out in Israel several years ago which found that 40% of 400 study subjects developed headaches following fasting. Of that group, the people most likely to get the headaches were individuals with a history of migraine.
