Primary headache disorders susceptibility is associated with fasting-related headache: evidence from a multinational study across 14 countries

By
M. Ceren Akgor
K. Saghır
A. İ. Can
F. G. Sahbaz
E. U. Özcelik
A. C. Atalar
N. Ergin
M. O. Orun
A. A. Madani
E. A. A. Ibrahim
M. Togha
S. Amirguliyev
Y. Alabwah
J. A. Hashel
I. M. Dardar
R. E. Sahli
S. B. Sassi
M. Nada
N. Shalaby
Y. Dehal
Y. Naji
M. Amine
K. Alfred
R. Karacı
E. Yanık
G. Gürsoy
H. T. Celik
S. Tasdelen
E. Ekizoğlu
E. K. Orhan
D. Agırcan
H. Genc
T. Gesoglu Demir
F. M. Domac
N. Köse
N. Tepe
S. Öztürk
E. K. Cengiz
K. Erdogan
İ. Yıldırım
B. R. Hasırcı Bayır
E. A. Demirel
R. Ghouri
B. Tasdelen
H. Bolay
A. Ozge
N. Kissani
June 25, 2026
0 min

Frontiers In Neurology

Objective:

To determine the prevalence, clinical characteristics, and predictors of headache during Ramadan fasting and to explore the contribution of pre-existing primary headache disorders and lifestyle-related factors to headache occurrence.

Approach:

Study Design: A multinational cross-sectional survey across 14 countries involving adults (18–65 years) observing Ramadan fasting, utilizing a 17-item questionnaire.
Data Collection: Participants completed a structured questionnaire assessing demographic characteristics, lifestyle factors, headache history, and fasting-related headache features.
Analysis Method: Classification and regression tree (CRT) modelling were used to identify predictors and characterize fasting-related headache.

Key Findings:

Headache attacks occurred mainly in the afternoon/pre-iftar period and improved after iftar in 54.6% of cases.
Pre-existing primary headache disorders, particularly migraine, were more strongly associated with headache occurrence than lifestyle variables.