Many Muslims look forward to the month of Ramadan. However, many also experience ‘fasting headaches’ during this time. Learn more about its symptoms, causes and how you can beat it this Ramadan.

by Ain Nadzirah

Ramadan fasting requires a Muslim to abstain from the consumption of all food and liquids including gum chewing, as well as smoking, from dawn to sunset. This religious ritual is practised yearly in the 9th month of the Islamic calendar, also known as the holy month of Ramadan. Yet, Muslims struggle with the same side effect over and over again every time the month of fasting arrives—which is the fasting headaches.

Fasting Headache Symptoms

The symptoms of a fasting headache are quite similar to tension headaches—which is the most occurring type of headache that causes tightness or pressure around the head. However, a study reported the following key symptoms: 

• Bilateral: pain on both sides of your head
• Frontal: located at the frontest part of your head
• Often occurs in the afternoon or in the evening before iftar (breaking fast), but can also start mildly in the morning
• Pain ranges from mildly severe to moderately severe
• Usually last for 1 to 2 hours 

The severity of symptoms may slightly vary from one person to another. Some might experience a pulsating sensation—pain that beats rapidly like a pulse—but that might not be the case for others.

In Malaysia for example, almost all Muslims typically experience First-of-Ramadan headaches, which are intense especially during the first few days of Ramadan. The good news is that these headaches gradually subside, as the body and mind begin to adapt to the change of lifestyle during the fasting month.   

Fasting Headache Causes

Suffering from headaches while fasting easily invites distress that may leave a negative impact on your daily functioning, such as poor concentration and inability to complete tasks. Therefore, finding out the causes or possible contributing factors can be helpful before making active changes to your Ramadan habits.

• Change in sleeping pattern

Ramadan necessitates Muslims to wake up early for a pre-dawn meal, known as Sahur, to ensure their body is equipped with enough nutrients and energy throughout the fasting day. This change in their sleeping hours can affect the quality of sleep due to their usual nighttime being disturbed. 

On normal days, getting a full 8 hours of sleep is already a difficult goal to achieve especially during working days when we often manage to secure only a maximum of 6 hours or even less. Now comparing that with the need to rise much earlier than usual during Ramadan days, one is inevitably expected to suffer sleep deprivation. 

The holy month also serves as a time for improving spirituality and relationship with God, hence Muslims would occasionally wake up one-third of the night to perform additional prayers.   

The reduced amount of sleep can be the cause of dizziness and feeling lethargic, thus serving as a formula for a headache.  

• Dehydration

A human adult is made up of 60% water, which shows the importance of maintaining bodily fluids. In order for our body to function at its best, water plays a crucial role in carrying oxygen and nutrients mainly through our blood. At the same time, our body is also losing water whenever we sweat or urinate. 

Being dehydrated means losing more fluids than what you consume, resulting in a lack of water content in the body. When this happens, your brain will respond by shrinking itself from your skull, giving rise to headache pain.  

Decreased amount of fluid intake during Ramadan is very common, as no drinking is allowed during the day. To those who live in a hot climate like Malaysia, the possibility of getting a headache due to lack of hydration is much higher. Sadly, Muslims fail to compensate for the fluid loss at night by not drinking enough water or taking in water-rich foods like fruits. In most cases, they drink too much water out of extreme thirst only to end up urinating more frequently—creating a counterproductive effect of dehydration again the next day.

• Low blood sugar (Hypoglycemia) 

It is actually normal to have our blood sugar level going through rising and falling on an average day, depending on various circumstances. The sign of warning is when the level drops lower than the healthy scale of 70 mg/dL, indicating a condition called hypoglycemia or extremely low blood sugar. 

Hypoglycemia is primarily concerned with diabetic patients whose sugar intake tends to be extra sensitive. Some of the symptoms include headaches, feeling shaky and weak, as well as nausea. 

However, healthy individuals can also experience low blood sugar a few hours after breaking the fast (or Iftar), if they take on simple carbohydrates such as refined grains and high-sugar food. Unlike complex carbs which take time to break down, these unhealthy carbs are instantly used up by your body for energy—causing a spike in your sugar level and also a fast drop afterwards. Such a rapid process may trigger a headache. 

• Caffeine and smoking withdrawal

Withdrawal refers to our body’s reaction when we suddenly reduce or cut down certain addictive substances such as caffeine and nicotine found in cigarettes.

For some of us who rely on several cups of coffee or tea during the day to enhance alertness, limiting the amount of drinking when fasting can induce withdrawal symptoms for example moodiness, lack of mental clarity, anxiety, and headaches. The same applies to the habit of smoking. 

• Lack of nutrition 

The only time we have the opportunity to boost our nutrient intake during Ramadan is during the pre-dawn meal (Sahur), breaking fast (Iftar), and the nighttime in between. Unfortunately, most of us tend to do the following:

• Skipping Sahur in favour of extra sleeping time
• Cravings for fried or sugary foods from the Ramadan bazaar during Iftar 
• Not consuming enough liquids and water-rich foods at night

As a result, we miss the chance to restore the vitamins and minerals necessary for our body to perform well during the day. Such poor eating habits lead to other consequences mentioned previously—dehydration, hypoglycemia, and lethargy—which eventually cause headaches. 

• Longer hours of fasting

While the common hours of Ramadan fasting around the world usually extend from 11 to 16 hours, some countries experience longer daylight and shorter night time during the summer season. This is a normal occurrence in the northern part of the globe—regions such as Scandinavian countries, Russia, and Canada—whereby they are situated closer to the Sun at a certain time of the year (summer), as the Earth orbits around the hot star.  

In 2018, Muslims in Iceland endured the longest duration of Ramadan for 22 hours of fasting due to the late sunsets. 

As summer entails hot weather and longer hours, the northern population especially those who work outdoors are more vulnerable to frequent headaches with possible pain that lasts for more than 2 hours. The longer you function without food or drink, the more energy is being depleted within your body which then leads to other health issues like fatigue, lightheadedness, and headache.   

Nonetheless, Islam recognizes the harmful risks to our health. That is why leniency is applied in regards to fasting for prolonged hours; either to follow the dawn and sunset time of Makkah or the times of the closest city that runs on a shorter daytime.

• Existing headaches

Research suggests that those who commonly have existing migraines tend to suffer from fasting headaches during Ramadan more frequently and with much more severe pain, as compared to other months. 

Fasting Headache Remedies

Consumable remedies serve as fast–action treatments to relieve ailments, which is unfortunately bad news during Ramadan as eating and drinking are not allowed until sunset. Regardless, here are some alternatives that can be useful to ease your fasting headaches:

• Aromatherapy

Essential oils such as lavender and peppermint are known for their therapeutic abilities to induce calmness and soothe nausea or headaches. The fragrance has a positive effect on the limbic system of our brain—the part that is responsible for regulating our emotions and mood. The most common way of inhaling them is by putting a few drops of essential oil in a diffuser to release scented vapours around the room.  

Note that there are specific rulings for the usage of essential oils when fasting in Ramadan. You can either apply them directly on the temples of your head (given that your skin is not sensitive to essential oils) or diffuse them into the air to breathe in the scented vapour. Inhaling the scents directly from the oils, however, is prohibited.

• Head massages

According to the American Massage Therapy Association, head massages are effective in reducing pressure or tension around the head, as well as the severity and duration of pain. The relaxation benefit from massaging your head, if done properly, can improve blood circulation, thus alleviating headache pain. 

• Apply cold compress

Cold compresses, like ice packs and cold wet towels, on your head or neck help to numb the headache pain by temporarily restricting blood flow to the pain nerves. In other words, the signal to sense pain is disturbed or numbed. Instead of feeling pain, your brain shifts to focus on the cold sensation. 

Keep in mind to place a cloth between the cold compress and your skin. Letting ice be in contact with your skin directly will cause injury to your skin and underlying tissues. 

• Have a rest

One of the perks of fasting during Ramadan is having extra time for rest during lunch break. When your head feels heavy and lightheaded, having your eyes closed and laying down somewhere quiet or dark can work wonders. This is especially a great way for migraine sufferers as their pain tends to be sensitive to light and sound. 

Taking a 20-minute nap may also grant you a slight relief for your headache, but avoid waking up in a sudden motion as that can trigger a headrush which may worsen the pain. 

• Breaking fast

As fasting in Ramadan is a religious obligation for Muslims, breaking fast is allowed ONLY if all available remedies have been attempted and proven ineffective. In order to avoid risking their health, exceptions are applied for the following groups:

• Young children
• Senior citizens or elderly
• Pregnant mothers
• Those who are unwell or have serious medical conditions
• Travellers

These individuals are not obligated to achieve full-day fasting, hence they are highly encouraged to break their fast if necessary. 

Fasting Headache Prevention

The best effort to reduce the possibility of getting a fasting headache is by trying to practise the following steps of prevention:

1. Eat moderately during Iftar. Overeating can cause your organs to work harder than usual to break down more calories and such pressure can cause dizziness or possibly a headache. It is recommended to break your fast with dates before any meals due to its light amount of sugar as an appetiser for Iftar. 
   
   
2. Do not skip your Sahur. The pre-dawn meal is the most essential source of energy to sustain your well-being throughout the fasting day. Prioritise eating carbohydrates and protein for energy, fibre to prolong fullness, as well as water-rich fruits and vegetables to keep you hydrated. Cut down on snacks, oily foods and those high in sugar or sodium. A quick tip : delaying Sahur to 30 or 40 minutes before dawn helps to curb early hunger. 
   
   
3. Drink enough plain water by adhering to the 2-4-2 method; 2 glasses during Iftar, 4 glasses between post-Iftar until bedtime, and another 2 glasses during Sahur. Skip fruit-flavoured drinks, carbonated, and caffeinated drinks—all of which makes you even thirstier.  
   
   
4. Maintain a consistent sleeping pattern by going to bed and waking up to fixed times for every Sahur. Avoid any distractions, especially screen time, before hitting the sack to enhance the quality of your sleep. Do not forget to spend a small portion during the day for napping and resting.
     
5. To overcome withdrawals, do early preparation by gradually reducing the amount of caffeine and smoking prior to Ramadan. For caffeine drinkers, you can still have a cup of your caffeinated drink during Sahur—just do not forget to rinse your mouth with plain water afterwards. 
   
   
6. For patients with migraines, chronic diseases, and other medical conditions, it is recommended to consult with a doctor on what risks they can expect during Ramadan. Seek advice on the time adjustments for medications when fasting and have discussions on ways to reduce the severity of headache symptoms. 
   
   

Getting Help During Ramadan

Ramadan is a month packed with preparations; be it spiritually, physically, or even in our daily tasks. As much time is spent performing worship acts and charity to strengthen faith, there are also family obligations to keep up with—including our ageing seniors.  

Here at Homage, we take caregiver burnout very seriously and always believe that  you do not have to do everything on your own (although that should be applauded!). If you have to be apart from your elderly during this Ramadan, consider our respite care and home care services to assist you with their needs while you are away. 

On that note, we wish you an advance ‘Selamat Hari Raya’ and may you have another blessed Ramadan this year with your loved ones!