Headaches from ritual fasting: a medication that decreases their incidence or attenuates them.

Background: There are religious "prohibitions against taking anything by mouth, there's little these observers can do until the fast ends -- nightly for Muslims, and after 25 hours for Jews."

Dr. Michael Drescher (Hartford Hospital, CT and Israeli researchers evaluated 120 mg dose of etoricoxib (Arcoxia), taken prior to 25-hour ritual fast.*  This drug is a COX-2 selective inhibitor, a cousin of rofecoxib (Vioxx), which Merck had pulled from the U.S. market in September 2004 because "it was linked to increased risks of heart attacks and other serious complications." [This was a double blinded, placebo-controlled study, without cross-over.]

With an extraordinary survey response rate, there were 195 healthy non-elderly study participants observed right after a fasting holiday, "36% who took etoricoxib developed headaches, compared to about 68% who took placebo."  Also, those who took etoricoxib had "less severe headaches, and they had an easier time fasting." 

Comment: "Because of the 25-hour fast, Dr. Drescher's team knew they needed a headache drug that wouldn't wear off quickly. Yom Kippur headache* usually kicks in at about 15 or 16 hours. That led Dr. Drescher and a colleague to rofecoxib, which has a half-life of 17 hours."  However, before they did the study, the researchers asked "'every credible rabbinical source' they could find whether taking a drug to prevent headaches would be in the spirit of the fast. (Their study cites the Biblical book of Leviticus, for example.)"  It was, "to coin a phrase, kosher. 'Rabbis told us it's not a matter of suffering,' Dr. Drescher said. 'It's about divorcing yourself from the day to day.'"

See Medscape's republishing of Reuter Health Information's "Could Vioxx Cousin Prevent Religious Fast Headache?" by I. Oransky, MD

Original Article: Drescher MJ, Alpert EA, Zalut T, Torgovicky R, Wimpfheimer Z. "Prophylactic Etoricoxib Is Effective in Preventing Yom Kippur Headache: A Placebo-Controlled Double-Blind and Randomized Trial of Prophylaxis for Ritual Fasting Headache." Headache: The Journal of Head and Face Pain 2009.

See also: Sahai-Srivastava S, Ko DY "Pathophysiology and Treatment of Migraine and Related Headache."  Updated: Dec 10, 2009