Fasting Headache


Headache is a common disorder in the general population. Fasting headache is coded to Group 10 of the second edition of the International Classification of Headache Disorders (“Headache attributed to disorder of homeostasis”). A study conducted in Denmark’s general population found a lifetime prevalence rate of 4.1% for fasting headache. Fasting headache is usually diffuse or located in the frontal region, and the pain is nonpulsating and of mild or moderate intensity. In most cases, the headache occurs after at least 16 h of fasting and resolves within 72 h after resumption of food intake. The likelihood of developing fasting headache increases directly with the duration of the fast. Headache sufferers have a higher risk of developing headache during fasting than people who do not usually suffer from headache. Hypoglycemia and caffeine withdrawal have been especially implicated as causative factors, but much remains to be understood about this topic.

This is a preview of subscription content, access via your institution.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.

    Jensen R, Stovner LJ: Epidemiology and comorbidity of headache. Lancet Neurol 2008, 7:354–361.

    Article  PubMed  Google Scholar 

  2. 2.

    Lipton RB, Scher AI, Kolodner K, et al.: Migraine in the United States: epidemiology and patterns of health care use. Neurology 2002, 58:885–894.

    CAS  PubMed  Google Scholar 

  3. 3.

    Henry P, Auray JP, Gaudin AF, et al.: Prevalence and clinical characteristics of migraine in France. Neurology 2002, 59:232–237.

    CAS  PubMed  Google Scholar 

  4. 4.

    Brandes JL: The migraine cycle: patient burden of migraine during and between migraine attacks. Headache 2008, 48:430–441.

    Article  PubMed  Google Scholar 

  5. 5.

    Hu XH, Markson LE, Lipton RB, et al.: Burden of migraine in the United States: disability and economic costs. Arch Intern Med 1999, 159:813–818.

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004, 24(Suppl 1):9–160.

    Google Scholar 

  7. 7.

    Rasmussen BK, Olesen J: Symptomatic and nonsymptomatic headaches in a general population. Neurology 1992, 42:1225–1231.

    CAS  PubMed  Google Scholar 

  8. 8.

    Rasmussen BK, Jensen R, Schroll M, Olesen J: Epidemiology of headache in a general population: a prevalence study. J Clin Epidemiol 1991, 44:1147–1157.

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia 1988, 8(Suppl 7):1–96.

    Google Scholar 

  10. 10.

    Mosek A, Korczyn AD: Yom Kippur headache. Neurology 1995, 45:1953–1955.

    CAS  PubMed  Google Scholar 

  11. 11.

    Mosek A, Korczyn AD: Fasting headache, weight loss, and dehydration. Headache 1999, 39:225–227.

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Awada A, al Jumah M: The first-of-Ramadan headache. Headache 1999, 39:490–493.

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Dalton K: Food intake prior to a migraine attack: study of 2313 spontaneous attack. Headache 1975, 15:188–193

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Mitsikostas DD, Thomas A, Gatzonis S, et al.: An epidemiological study of headache among the Monks of Athos (Greece). Headache 1994, 34:539–541.

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Shah PA, Nafee A: Clinical profile of headache and cranial neuralgias. J Assoc Physicians India 1999, 47:1072–1075.

    CAS  PubMed  Google Scholar 

  16. 16.

    Topacoglu H, Karcioglu O, Yuruktumen A, et al.: Impact of Ramadan on demographics and frequencies of disease-related visits in the emergency department. Int J Clin Pract 2005, 59:900–905.

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Martin VT, Behbehani MM: Toward a rational understanding of migraine trigger factors. Med Clin North Am 2001, 85:911–941.

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Critchley M: Migraine. Lancet 1933, 1:123–126.

    Article  Google Scholar 

  19. 19.

    Gray PA, Burtness HL: Hypoglycemic Headache. Endocrinology 1935, 19:549–560.

    Article  Google Scholar 

  20. 20.

    Blau JN, Cumings JN: Method of precipitating and preventing some migraine attacks. Br Med J 1966, 2:1242–1243.

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Blau JN, Pyke DA: Effect of diabetes in migraine. Lancet 1970, 2:241–243.

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Blau JN: Adult migraine: the patient observed. In Migraine: Clinical, Therapeutic, Conceptual and Research Aspects. Edited by Blau JN. London: Chapman and Hall; 1987:3–30.

    Google Scholar 

  23. 23.

    Pearce J: Insulin induced hypoglycemia in migraine. J Neurol Neurosurg Psychiatry 1971, 34:154–156.

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Jacome DE: Hypoglycemia rebound migraine. Headache 2001, 41:895–898.

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Vukmir RB, Paris PM, Yealy DM: Glucagon: prehospital therapy for hypoglycemia. Ann Emerg Med 1991, 20:375–379.

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    •• Olesen J, Burstein R, Aschina M, Tfelt-Hansen P: Origin of pain in migraine: evidence for peripheral sensitisation. Lancet Neurol 2009, 8:679–690. The authors propose a very interesting model of pathophysiology of pain in migraine; this theory may be used to speculate about the origin of pain in patients affected by fasting headache.

    Article  PubMed  Google Scholar 

  27. 27.

    Service FJ: Hypoglycemic disorders. In Cecil’s Textbook of Medicine, edn. 18. Edited by Wyngaarden JB, Smith LH, Bennet JC. Philadelphia: WB Saunders; 1992:1310–1317.

    Google Scholar 

  28. 28.

    Malouf R, Brust JC: Hypoglycemia: causes, neurological manifestations, and outcome. Ann Neurol 1985, 17:421–430.

    Article  CAS  PubMed  Google Scholar 

  29. 29.

    Dexter JD, Roberts J, Byer JA: The five hour tolerance test and effect of low sucrose diet in migraine. Headache 1978, 18:91–94.

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Shapiro RE: Caffeine and headaches. Neurol Sci 2007, 28(Suppl 2):S179–S183.

    Article  PubMed  Google Scholar 

  31. 31.

    Dreisbach RH, Pfeiffer C: Caffeine-withdrawal headache. J Lab Clin Med 1943, 28:1212–1219.

    CAS  Google Scholar 

  32. 32.

    Silverman K, Evans SM, Strain EC, Griffiths RR: Withdrawal syndrome after the double blind cessation of caffeine consumption. N Engl J Med 1992, 327:1109–1114.

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Juliano LM, Griffiths RR: A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology (Berl) 2004, 176:1–29.

    Article  CAS  Google Scholar 

  34. 34.

    Evans SM, Griffiths RR: Caffeine withdrawal: a parametric analysis of caffeine dosing condition. J Pharmacol Exp Ther 1999, 289:285–294.

    CAS  PubMed  Google Scholar 

  35. 35.

    Smith R: Caffeine withdrawal headache. J Clin Pharm Ther 1987, 12:53–57.

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Couturier EG, Hering R, Steiner TJ: Weekend attacks in migraine patients: caused by caffeine withdrawal? Cephalalgia 1992, 12:99–100.

    Article  CAS  PubMed  Google Scholar 

  37. 37.

    Nikolajsen L, Larsen KM, Kierkegaard O: Effect of previous frequency of headache, duration of fasting and caffeine abstinence on perioperative headache. Br J Anaesth 1994, 72:295–297.

    Article  CAS  PubMed  Google Scholar 

  38. 38.

    Weber JG, Ereth MH, Danielson DR: Perioperative ingestion of caffeine and postoperative headache. Mayo Clin Proc 1993, 68:842–845.

    CAS  PubMed  Google Scholar 

  39. 39.

    Shorofsky MA, Lamm RN: Caffeine withdrawal headache and fasting. N Y State J Med 1977, 77:217–218.

    CAS  PubMed  Google Scholar 

  40. 40.

    Silberstein SD, Goadsby PJ, Lipton RB: Management of migraine: an algorithmic approach. Neurology 2000, 55(9 Suppl 2):S46–S52.

    CAS  PubMed  Google Scholar 

  41. 41.

    Drescher MJ, Elstein Y: Prophylactic COX 2 inhibitor: an end to the Yom Kippur headache. Headache 2006, 46:1487–1491.

    Article  PubMed  Google Scholar 

  42. 42.

    •• Drescher MJ, Alpert EA, Zalut T, et al.: Prophylactic etoricoxib is effective in preventing Yom Kippur headache: a placebo-controlled double-blind and randomized trial of prophylaxis for ritual fasting headache. Headache 2009 Dec 21 (Epub ahead of print). This interesting paper focuses on therapy of fasting headache.

  43. 43.

    Pringsheim T, Davenport WJ, Dodick D: Acute treatment and prevention of menstrually related migraine headache: evidence-based review. Neurology 2008, 70:1555–1563.

    Article  CAS  PubMed  Google Scholar 

  44. 44.

    Silberstein SD: Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000, 55:754–762. (Published erratum appears in Neurology 2000, 56:142.)

    CAS  PubMed  Google Scholar 

Download references


Dr. Gian Camillo Manzoni: a consultant for Boehringer-Ingelheim, Angelini, and Allergan; received research support from Merck, Sharp, and Dohme. No other potential conflicts of interest relevant to this article were reported.

Author information



Corresponding author

Correspondence to Paola Torelli.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Torelli, P., Manzoni, G.C. Fasting Headache. Curr Pain Headache Rep 14, 284–291 (2010).

Download citation


  • Secondary headache
  • Fasting
  • Homeostasis disorders
  • Hypoglycemia
  • Caffeine withdrawal