Abstract

Migraine is a common condition that is often triggered by fasting, especially among Muslims during Ramadan. During Ramadan, Muslims abstain from food and fluids from dawn to sunset, accompanied by changes in sleep patterns, hydration, and caffeine intake, which might influence migraine characteristics. Existing studies reported conflicting effects on attack frequency and severity, and no comprehensive study addressed the effect of Ramadan fasting on migraine attacks. A systematic review was conducted in accordance with PRISMA guidelines. Databases were searched for observational studies evaluating migraine outcomes during Ramadan compared with non-fasting periods. Meta-analysis was undertaken, and sensitivity analyses using a leave-one out approach were also performed to assess the stability of pooled estimates. Eight observational studies with 1,262 participants were included. Most studies found an increase in migraine frequency during Ramadan, particularly during the early period of fasting. However, significant heterogeneity (I² = 99%) with conflicting effect directions made it difficult to evaluate pooled quantitative values for frequency. Sensitivity analysis revealed significant instability in the pooled data. Dehydration, sleep disruption, and caffeine withdrawal were among the most commonly mentioned contributing causes. Several studies reported changes in migraine frequency during Ramadan fasting, with considerable variation in both direction and magnitude. Migraine severity, however, appeared largely unaffected by fasting. The substantial heterogeneity observed suggested that migraine responses to Ramadan fasting were highly individualized and likely influenced by modifiable lifestyle factors. These findings support the need for personalized counseling and preventive strategies for migraine patients who plan to fast during Ramadan.

Key words: Fasting, migraine, Ramadan, frequency, severity, systematic review, meta-analysis