An End to the Yom Kippur (and Ramadan) Headache
An End to the Yom Kippur (and Ramadan) Headache
Fasting is a known trigger for headache. People who fast to comply with religious edict have
 been shown to be prone to headache which becomes more likely to occur with increasing length
 of fasting, and in people prone to headache. This has been documented as 'Yom Kippur
 Headache' and 'First of Ramadan Headache.' We performed a study to test the hypothesis that
 Rofecoxib, a pain medicine and anti-inflammatory, with a prolonged duration of action would
 prevent or attenuate headache when taken just prior to the complete (no food or drink) 25
 hour fast of Yom Kippur.
Introduction: Religious fasting is associated with headache. This has been documented as 'Yom
 Kippur Headache' and ' First- of - Ramadan Headache.' The Cox2 inhibitor, rofecoxib, has been
 reported effective in preventing perimenstrual migraine and in preventing recurrence of
 migraine. Given its 17 hour half-life, we undertook this study to see whether 50mg rofecoxib
 taken just prior to the 25 hour Yom Kippur fast would be effective in preventing headache.

 Methods: We performed a double blind randomized prospective trial of rofecoxib 50mg vs
 placebo, taken just prior to the onset of fasting, Yom Kippur 2004. Healthy adults aged 18 -
 65 were enrolled from the community and from hospital staff. Subjects completed a demographic
 data form and questions regarding headache history and a post-fast survey on headache during
 the fast, headache intensity, general ease of fasting and side effects.

 Results: We sent out 170 forms of which 105 were completed and returned. Of those subjects
 receiving rofecoxib (n=53), ten or 18.9% vs 34 or 65.4 % of the placebo group (n=52) had
 headache at some point during the fast (p<.0001). Severity of headache in the treatment group
 was significantly less for the treatment group (3.45 vs 6.29 on a visual analog scale of 10
 (p = .009)). None of those receiving rofecoxib reported a 'more difficult than usual fast'
 whereas the distribution of difficult to easy fast among the placebo group was more even.

 Conclusion: Rofecoxib 50mg taken prior to a twenty five hour ritual fast prevents and
 attenuates fasting headache.
Inclusion Criteria:

 -  History of fasting headache

 -  Age 18-65

 -  Intention to fast on Yom Kippur

 -  History of Fasting on Yom Kippur

 Exclusion Criteria:

 -  Pregnant or Nursing Women

 -  Known allergy to NSAID type medication

 -  History of chronic illness including heart, kidney, liver or peptic ulcer disease,
 hypertension, diabetes, lung disease including asthma, or a history of
 gastrointestinal bleeding.