Managing Migraine During Ramadan

0:00 [Music]
0:05 so much I’ll just get my screen up
0:08 here okay so hopefully everyone can see
0:10 that um so um yeah soah this is um I’m
0:17 really honored to be here and I I
0:19 definitely want to thank migrant Canada
0:22 um for for organizing this I um this was
0:26 not my idea migrant cada on their own
0:29 came up with idea and I really um you
0:32 know give kudos to them for this because
0:33 I think it is a very important topic
0:35 it’s one that I never actually thought
0:37 about as a topic to speak on um but when
0:39 they had approached me for this I
0:40 thought it was a fantastic idea and I I
0:43 really applaud them for um putting this
0:45 on um so just as a disclosure or
0:50 disclaimer um although I am a Muslim who
0:53 um observes Ramadan and a miger as well
0:56 as a headache specialist I am not a
0:59 scholar or on so um when it comes to
1:01 things like religious advice and issues
1:03 of jurist prudence or pick and things
1:05 like that um I wouldn’t be able to give
1:07 you a clean answer um the the things
1:11 that do relate to that um I subscribe to
1:14 the hesty so anyone who understands that
1:18 um that’s the kind of um kind of jurist
1:22 prudence that I follow so um there would
1:24 be nuances with different sects and
1:27 different um ways of practicing Islam so
1:29 so it’s important to keep that in mind
1:31 um and so always uh contact your local
1:34 um scholar or email um as well as your
1:37 local um Health Care Providers um so
1:41 what we’re going to do today so we’re
1:42 going to start off by talking a little
1:43 bit about Ramadan make sure we’re all on
1:46 the same page because I know we have
1:47 people of various backgrounds um the
1:49 connection of Ramadan and migraines and
1:51 some of the more interesting research
1:53 that’s come out um in this regard which
1:55 um I think is kind of as we expected but
1:58 really helps confirm
2:01 um what many of us Mariners feel during
2:03 Ramadan and I think the the bulk of the
2:06 talk will be talking about practical
2:08 tips so how you manage your
2:09 medications caffeine hydration diet
2:12 sleep um and then probably most
2:14 importantly what do you do when you get
2:16 a migraine while
2:18 fasting so I thought it was it would be
2:21 good to get an idea of um the group that
2:24 we’re dealing with today so we’ll start
2:25 with the poll question so the first
2:27 question is you know why are you
2:28 attending this webinar
2:31 um and the the answers could be um that
2:33 you are a healthcare provider and want
2:35 to be better informed for your patients
2:37 um that you are a person with migraine
2:39 who will be observing ramadon this
2:40 directly affects you uh and a family
2:43 member who uh you knows someone with
2:45 migraine or chronic migraine and you
2:47 know they’re going to be fasting or you
2:49 just want to learn
2:50 more
2:52 um and the second poll
2:57 question um you know what is your
2:59 current level of knowledge on fasting
3:01 and migraine so is it minimal To None a
3:03 little a fair amount or a good amount I
3:07 apologize if you hear noise in the
3:08 background young children
3:12 excited so I’ll give you guys a chance
3:14 to answer that um and once we have a
3:17 good enough result we’ll see we have
3:19 from
3:28 there
3:40 we’ve had 17 of our 20 participants
3:45 answer so I’m G to end the poll now Dr H
3:48 yeah that sounds
3:52 good okay good so really good spread
3:54 actually um so the most common is
3:56 someone who’s a person of my grand
3:57 observing in Ramadan but we’ve got spr
4:00 throughout all categories so that’s
4:02 fantastic so um also gives me an idea
4:04 that I need to make sure that I keep the
4:06 knowledge base
4:08 broad um and then your current uh
4:10 knowledge um most people having on the
4:13 lower end so I think this is very worth
4:15 while talk then okay perfect so moving
4:18 forward
4:20 um a little bit of a background about
4:22 Ramadan so um just to make sure we’re
4:24 all on the same page so Ramadan this
4:26 year expect it to start around March
4:29 99th now remember that um the Islamic
4:31 calendar is based off of the lunar
4:33 calendar um and so the months shift
4:36 every year and um every year Ramadan
4:38 moves back roughly 10 days and so this
4:41 year we’re expecting to start around
4:43 March 9th um this is of course hugely
4:46 important time for Muslims um it is one
4:48 of the five pillars of Islam um and so a
4:52 very very important um devotional
4:56 activity and so in most um sex strands
5:00 of Islam the the fast is from the
5:01 pre-dawn to Sunset or what we call fuder
5:04 till MB um people who are fasting um
5:09 abstain from all food and drink so
5:11 that’s nothing by mouth
5:13 whatsoever and if you look at the preda
5:15 to Sunset again depending on where you
5:17 live in Canada and and the day of the
5:19 month as that obviously will shift as
5:21 you get more and more closer to summer
5:23 hours get longer for sunlight um you’re
5:25 looking at typically somewhere between
5:27 5: to 7:00 am as the start of the fast
5:30 until about 7 to 900 P.M to the end and
5:32 again that very much depends on where
5:34 you are now if there are um some people
5:37 who will Fast till absolute Darkness or
5:39 Isha prayer and so that would be even
5:41 later um so you kind of have to keep
5:42 that in mind that we’re looking at a
5:43 minimum of really 12 hours um of fasting
5:46 during the daytime and so people who
5:48 fast will typically have two main meals
5:52 there’s the sahor or the pre-dawn um
5:55 pre-fast meal U and ifar which is the
5:58 breaking of the fast um which are occurs
6:00 at mreb time or
6:02 Sunset um overall Ramadan um is not just
6:06 about fasting it’s it’s a month to get
6:07 closer to God through fasting Community
6:10 acts of Charity good deeds and prayer
6:13 which includes the night prayer and the
6:14 night vigil um so this isn’t important
6:17 and the reason I bring this up is
6:18 because it is actually important to
6:19 understand what this entails for those
6:22 who participate in this because this
6:23 does affect some of the things that
6:24 we’re going to be talking about um and
6:26 so the during Ramadan and for those of
6:29 you who live close to a mosque or have a
6:30 mosque close to your house in not a
6:33 practicing Muslim you’ll notice that in
6:35 Ramadan in the late nights the mosque
6:37 are completely packed and that’s because
6:39 you’re after Isa prayer so that’s after
6:41 complete darkness so people break their
6:43 fast you know around 7:00 to 900 p.m.
6:45 there’s usually about an hour gap
6:47 between that and the the the last prayer
6:50 of the day which is the fifth prayer um
6:52 and after that there’s a voluntary
6:54 prayer that many people will participate
6:56 in communally um and that last anywhere
7:00 from one to two hours it can be a very
7:01 slow melodic kind of prayer and then
7:04 there’s another prayer that can occur um
7:07 prior to the pre-dawn meal so waking up
7:10 earlier even earlier than 5:00 a. maybe
7:12 even 400 am uh to pray um x amount and
7:16 that can be variable from just five
7:18 minutes up to an hour depending on the
7:20 person even longer um and so that can
7:22 affect sleep quite a bit and so this is
7:24 an important thing to understand and
7:26 you’ll have to manage for for yourself
7:28 or for your patients who are um going to
7:31 be participating in these types of
7:33 activities so fur the background um
7:37 because I’m going to be mentioning some
7:37 of these terms I just don’t want anyone
7:39 to get lost so in terms of the Islamic
7:41 calendar right now we are in the month
7:43 of shaan which is the month before
7:45 Ramadan and islamically speaking uh
7:48 Shaban is often talked about as a month
7:50 to prepare ourselves body mind and soul
7:53 for Ramadan ahead and this is really
7:56 really important for this talk in
7:58 particular so we always think about
8:00 Shaban as a month where people are a
8:02 little bit more relaxed because they
8:03 know ramadan’s coming they’re kind of
8:05 saving their energy but in reality what
8:07 we should be doing is preparing
8:08 ourselves and this holds extremely true
8:11 for those um who are migrains um so it’s
8:16 recommended um for people to have
8:18 voluntary fasts increasing their prayers
8:21 and recitation of Quran things like that
8:22 so that they’re getting ready for
8:24 Ramadan um and in the same kind of vein
8:27 from a spiritual perspective I think
8:28 physically it’s very important for
8:30 people with migraine to prepare
8:33 themselves for the coming month and so
8:34 this is a good time to have this talk
8:36 and to hopefully hopefully we can give
8:38 you some tips on how to manage
8:40 that now a little bit about migraine um
8:43 I’m not going to explain the the complex
8:45 diagram of the right but that’s a very
8:46 classic diagram people use to talk about
8:48 migraine the real key thing that I want
8:50 to focus on for people is the
8:51 hypothalamus which is this Center here
8:55 um there are many different structures
8:57 that are important in migraine but
8:58 hypothalamus is critical
9:00 and you know one of the most classic um
9:03 phrases that I’ve heard and I love which
9:05 I always repeat to anyone who knows me
9:08 um and this will come up a lot during
9:10 this talk and I think really explains
9:11 everything is you know that migraine
9:13 brains don’t like change I think this is
9:16 the most important way of looking at
9:18 things and so if you think about that
9:20 and you think about triggers for
9:21 migraine that it all relates to change
9:24 and hypothalamus is really important for
9:26 homeostasis so keeping things balanced
9:28 keep keeping things even
9:30 and so when there are sudden shifts and
9:31 changes this can trigger migraines and
9:34 those sudden shifts could be from
9:35 weather so barometric pressure so a lot
9:37 of patients will tell you that you know
9:39 they’re a human barometer they know when
9:40 storm is coming before the the weather
9:43 actually starts stress changes hormonal
9:46 changes particularly in women with our
9:48 with the um menstrual cycle caffeine
9:51 changes so we know that we used to think
9:53 of caffeine as kind of if you take too
9:55 much caffeine it can cause migraine but
9:56 that’s not actually what the evidence
9:58 suggests the evidence probably suggest
9:59 more that caffeine it’s all about
10:02 staying consistent so if you drink one
10:03 cup of coffee every single day it’s
10:05 probably not going to trigger a migraine
10:06 but if you drink one one day three the
10:08 next and then zero the next that’s
10:10 what’s GNA that fluctuation that change
10:13 is is what’s going to trigger a migraine
10:15 same thing with sleep um most Mig
10:17 graters myself included I know that if I
10:20 don’t sleep well um either sleep too
10:22 much or too little that can trigger a
10:24 migraine diet same thing um particularly
10:27 when it comes to things like glucose
10:29 level bottles um unprocessed Foods
10:31 unhealthy Foods all these kinds of
10:33 things just suddenly Splurge that can
10:35 trigger a migraine so there are many
10:36 many things that come into it but many
10:38 of these things that we just mentioned
10:40 um so particularly the last three
10:41 caffeine sleep and diet are all things
10:43 that dramatically change in Ramadan for
10:45 the person who is
10:47 fasting so without preparation Ramadan
10:50 would then result in a sudden and
10:51 dramatic change to your system and
10:54 obviously then cause migraine and so
10:57 what do we know about Ramadan migrain so
10:59 these are two studies that were done the
11:00 last few years um so one out of Kuwait
11:02 and one out of Egypt and I’ll just kind
11:04 of mention them briefly so the Kuwait
11:05 study just kind of showed not
11:07 surprisingly that people with migraines
11:09 have an increase in their heading so for
11:11 the cohort that they looked at the
11:13 average person had 6.9 migrain days
11:16 leading up to Ramadan on average um
11:19 during Ramadan the average was 10.4 so
11:21 it increased by about three and a half
11:23 days per
11:24 month I think the more important study
11:26 was this one in Egypt and this actually
11:28 won the American headaches Society paper
11:29 of the year or of last year um and so um
11:34 they show in their cohort it just
11:35 increased from three to four which again
11:36 shows an increase there obviously were
11:38 people who had a little bit less migrain
11:39 compared to the qua group but the most
11:42 important thing were the next two points
11:43 which is they and they looked at it on a
11:45 temporal basis so every single day of
11:46 the month and when people got their
11:48 migraines and what they found was by far
11:50 most of the migraine attacks occurred
11:52 within the first 10 days of Ramadan and
11:55 then things settled and 53% of people
11:59 had migraine on day one and I think most
12:01 of us who fast and have migraines know
12:04 that day one is often the hardest day we
12:06 often are you know struggling to get to
12:08 the break F breaking of our fast as the
12:11 migraine starts to kick in and so this
12:13 just again emphasized that same point
12:15 that I was mentioning earlier is that
12:18 most people don’t plan ahead and what
12:19 we’re seeing are sudden changes to your
12:21 medications to caffeine hydration to
12:24 diet and to sleep and so it makes total
12:27 sense that it takes roughly 10 days for
12:29 your body to adapt to this change and
12:32 that’s why most people have migraines in
12:34 the first 10 days and so the the obvious
12:37 conclusion then is if we prepare
12:39 ourselves before Ramadan hopefully then
12:42 you won’t have this gigantic surge in
12:45 migraines and I’ve been doing this for
12:46 the last couple years actually and I
12:48 have noticed that if I’ve made sudden
12:49 changes or subtle changes throughout the
12:51 month of Shaban I definitely have found
12:54 that my migraines in the beginning of
12:55 rant are significantly less I typically
12:57 get about one um when I first start
13:00 fasting the first few days but that’s
13:01 about
13:02 it so here’s some practical tips so um
13:07 so this is an important question for
13:08 those who are on a preventative
13:10 medication so this is just for daily
13:13 medications um it’s important to know
13:15 that oral medications cannot be taken
13:17 while fasting so anything oral whether
13:19 that’s medication or not um cannot be
13:22 taken um without con breaking the fast
13:25 it’s important to discuss this with your
13:27 physician and look at ways of manag
13:29 managing this and getting around this so
13:31 for example if you’re on a once a day
13:33 medication which many of our prevented
13:34 medications are your options are
13:36 basically to take it at your pre-dawn
13:38 meal or in the evening obviously
13:40 preferable to take medications like
13:42 amitryptiline which can be sedating in
13:44 the evening times um but you may want
13:46 other medications that you know perhaps
13:49 don’t have those side effects to be
13:50 taken in the morning again you can work
13:53 with your doctor on what would be the
13:54 best for you for twice a day medications
13:57 that come simple obviously you take one
13:59 at the pre-dawn meal and one at AAR um
14:01 three times a day can be tricky
14:03 especially with these longer hours and
14:06 as we go further on in Ramadan you know
14:08 it stretches longer and longer so three
14:10 times a day is probably not going to be
14:12 doable um but do understand that if you
14:14 talk to your doctor there are some
14:15 medications like for example if you’re
14:17 on gavip pentin or diox or acetazolamide
14:20 that can be changed to twice a day
14:21 dosing um but that’ll need to be done
14:23 again with the help of your doctor um
14:25 and to make sure it’s dosed correctly so
14:27 there are alternatives and options for
14:29 you um so hopefully just by the fact of
14:32 you’re taking medications on a regular
14:34 basis shouldn’t be a reason to
14:36 necessarily stop you from
14:38 fting what about things like injectables
14:41 so less frequently taken treatment so
14:42 this can include things like botox
14:44 injections Vier cgrp monoclonal
14:47 antibodies nerve blocks and things like
14:49 that but anything that isn’t injectable
14:52 whether that’s subcutaneous
14:53 intramuscular or even
14:55 intravenous um are mostly considered to
14:58 not break the fast um and again this is
15:01 I’m speaking from the perspective of the
15:03 Hani fi so again if you are of a
15:06 different F or a different sect of Islam
15:07 please speak to your scholar about that
15:08 to clarify but generally speaking um
15:11 based on my understanding and this F
15:13 that that is acceptable and would not
15:14 break your F uh the exception to this
15:17 would be SPG blocks so if there’s anyone
15:19 who are getting phenoline gangon blocks
15:22 because of the um fluid then you know
15:24 when you’re squirting it into your nose
15:26 essentially it will go down and you will
15:28 swallow it um and so again that because
15:31 it’s essentially body mouth at the end
15:32 of the day and going down your throat um
15:35 that would constitute breaking the fast
15:36 so that would not be something that you
15:38 could do but if your nerve block or your
15:40 Botox appointment or whatever dra a mon
15:43 antibody Falls within Ramadan there’s no
15:45 issue if you getting those treatments
15:47 done as you normally
15:50 would um what about as needed
15:52 medications so we’re talking about
15:54 abortives now so um you know medications
15:56 used to stop migraines when they come so
15:59 obviously any oral and just as I
16:01 mentioned earlier even intranasal sprays
16:04 would constitute breaking your fast so
16:06 that’s non-steroidals gants tryp Dan
16:09 whether they’re oral or intranasal it
16:11 would be cons constituting breaking your
16:13 fast however as I mentioned earlier
16:16 injections would not break fast so if
16:18 you did if you were prescribed for
16:19 example a subcutaneous Summa tripan or
16:22 korac uh that would be considered um
16:25 acceptable and would not break your fast
16:27 and then there’s lots of other options
16:29 outside of medications right so things
16:30 like cop topical creams oils um and the
16:33 consensus for again for the FI that I’m
16:36 coming from which is the H fic that
16:37 would not break your
16:39 fast so and I will talk again more
16:42 detail about what to do when you get a
16:44 headache but this is just kind of
16:45 General kind of ideas of the treatments
16:48 and medications that you might be
16:50 on so what about caffeine so this is
16:52 something that I’ve been experimenting
16:53 with myself quite a while now um and so
16:56 I feel like I have at least the personal
16:57 experience for this there’s no real um
16:59 literature to back this up but this is
17:01 my own personal experience putting it
17:02 out there um so it makes sense that this
17:05 would this is a in my opinion probably
17:07 one of the most common causes of the
17:08 headache in day one or
17:10 two um as we all know sudden changes
17:13 will trigger headaches and so what I
17:14 recommend is trying a slow wean during
17:17 the month of Shaban so I’ve already
17:18 started my wean personally I typically
17:20 drink one to two cups of coffee per day
17:23 and so this would be like a sample
17:25 schedule okay so for someone who drinks
17:27 one to two cups of coffee um so that’s
17:29 like me um this is how I would recommend
17:32 doing it so in if you had four weeks we
17:33 don’t have four weeks now we’re closer
17:35 to two to three weeks but if you had the
17:37 four weeks I would start with one cup
17:39 per day for a full week so you’re not I
17:41 was saying no to any evening tea coffee
17:43 things like that um maybe the occasional
17:46 spurge but try not to then week two you
17:50 can alternate with you know one cup per
17:51 day and one half calf so you can either
17:54 if you’re grinding it yourself you can
17:55 mix the calf with calf um if you use an
17:59 espresso machine they have half calf
18:01 pods same thing with curig so try to do
18:05 more half calf um and then gradually do
18:09 only half calf and then gradually mixing
18:11 in decaf because remember decaf also
18:13 contains caffeine although much lower
18:15 levels it still has Sun caffeine and so
18:18 it’ll still get you through a little bit
18:19 just to kind of again slowly wean you
18:20 off until the point where you’re only on
18:22 decaf and then you could either have one
18:24 or two days before Ramadan where you’re
18:25 having none um or even if you stopped
18:27 with just decaf you should be okay now I
18:30 know that’s not possible for everyone um
18:33 so if it’s not possible try to reduce
18:35 gradually as I mentioned earlier in that
18:36 kind of similar fashion um and then you
18:39 can always have a small amount of
18:40 caffeine um at sahor or and or ifar
18:44 whatever works better for you um
18:46 especially in the first few days as
18:47 you’re kind of continuing to wean off of
18:49 it um but the key thing again is making
18:51 sure it’s a consistent keeping it
18:53 consistent and if you are going to
18:54 change it as we’re going to do in
18:55 ramadon naturally try to do that
18:57 gradually and not set that’s the key um
19:00 the other thing I always tell people
19:01 because people often forget this is that
19:04 you know green tea has a very high
19:06 caffeine level so if you’re thinking
19:07 that I drink green tea every day so I’m
19:09 fine I don’t need to worry about that
19:10 withdrawal green tea does have actually
19:12 very high caffeine in fact it has higher
19:14 caffeine than some coffees and so uh you
19:16 need to be careful with
19:18 that um so hydration so this is really
19:21 important um you know uh it’s very
19:25 common and many people will tell you
19:26 particularly when when it was a few
19:27 years ago when Ramadan was in the summer
19:30 um dehydration was one of the bigger
19:32 kind of difficult parts of Ramadan um
19:35 it’s very very important that you drink
19:37 lots of fluids um your pre-dawn meal
19:39 your AAR um and particularly when you’re
19:42 up at night prayer so if you’re in Taj
19:44 or prayers Ure you’re drinking lots of
19:47 water throughout that um and if if you
19:50 can’t drink water you don’t like water
19:52 electroly drinks would be fine as well
19:54 definitely avoid juices and sugary
19:56 drinks I know people from the Indian sub
19:58 continent I love Rua but it’s a really
20:00 good idea to avoid that as much as
20:03 possible because that is going to cause
20:05 significant fluctuations in your glucose
20:07 levels um which you know the spikes and
20:10 drops of that will will trigger
20:12 migraines um so really really important
20:14 to try to make sure you’re maintaining
20:16 that um you know if you’re having dates
20:18 to break your fast that’s totally fine
20:21 but if you’re having dates with sugary
20:23 drinks with all the other sugars that’s
20:25 when you start running into
20:27 problems and you know coming to diet so
20:29 obviously I know that culturally
20:31 speaking you know across all the
20:33 cultures around the world we celebrate
20:35 Ramadan you know food is a big part of
20:38 Ramadan you know the AAR Feast um meet
20:41 coming together as a community potl you
20:43 know is a big part of Ramadan and so I
20:46 don’t want to you know be kind of you
20:48 know the Debbie Downer here and make
20:49 people not eat nice foods but you know
20:52 at the same time it’s important to make
20:53 sure that we’re smart about this and
20:55 that we’re not going to you know suffer
20:57 from that so really try to avoid foods
21:00 high in processed sugars refined carbs
21:03 or fried foods um you’re always good
21:06 sticking with things that are local
21:07 organic natural um and really the key
21:10 thing I think particularly for sahur so
21:12 the breakfast meal but you know anytime
21:16 um thear as well you know you want to
21:18 try to stick with things that are more
21:19 slow relase energy food so not like that
21:21 refined high sugar content but more
21:24 things like proteins things like lentils
21:26 nuts beans if you’re gonna have rice and
21:29 bread have brown rice have whole wheat
21:31 bread um I personally love overnight
21:33 oats as a fantastic sahour so I usually
21:36 have overnight oats with some CH SE just
21:38 like in that picture with some fruit um
21:40 typically berries and it’s a phenomenal
21:43 um soor and often I personally don’t
21:46 feel very hungry I drink that with lots
21:47 of water I have that with lots of water
21:49 and I I don’t usually feel much of the
21:50 fast so that slow release energy foods
21:52 will help you get through the fast but
21:54 I’ll also ensure that your blood sugar
21:55 levels and things are reasonably stable
21:57 throughout the day not triggering
22:00 migraines what about sleep so as I
22:02 mentioned um there are there are
22:05 significant changes um in sleep schedule
22:07 and again this is variable depending on
22:09 each individual person and how they are
22:12 um how they’re practicing during the
22:14 month of Ramadan so you know there are
22:16 some people who throughout the entire
22:18 month will be waking up early for the
22:19 Haj prayers will be going to TWI at the
22:22 mosque every night um and others will do
22:25 it sporadically as they’re able
22:26 depending on their work and other things
22:28 so
22:29 um you know it’s important to keep this
22:32 in mind and you know think about how you
22:35 need to kind of gradually again change
22:37 this for
22:38 Ramadan um Maps uh are something that
22:42 people like to do in Ramadan it’s again
22:43 as I mentioned for those who of us who
22:45 are lucky enough because for example if
22:46 you’ve got kids or you’re working it’s
22:48 not always possible um but sometimes
22:50 particularly if you’re going to be up
22:52 late and you’re going to be um up early
22:55 um a nap is not necessarily a bad idea
22:56 the key thing with naps though try to
22:59 keep them short ideally like a catnap so
23:02 you know somewhere in the 30 minute
23:04 range um is ideal to try to just give
23:06 you that boost of energy um and you know
23:09 particularly if you’re having issues
23:11 with migraine which we’ll talk about in
23:13 a sec so some some suggestions um you
23:17 can start doing some night visuals early
23:18 so if you’re planning on doing it
23:19 throughout the entire month you know I’d
23:21 recommend start doing some even during
23:24 Shaban so if you’re gonna be doing the
23:26 Haj prayers waking up early start doing
23:29 that you know and then maybe go back to
23:30 sleep after the pre-done prayer and so
23:33 that at least you’re getting somewhat
23:34 used to waking up at that time and your
23:36 circadian rhythm which is that normal
23:37 Rhythm that you have in your body or
23:39 daytime and night time will start to
23:41 slowly adapt to that um another trick
23:44 that some people mentioned if you are
23:45 already waking up early and you know
23:46 right now uh fudger prayer which is the
23:48 morning prayer is relatively late so
23:51 it’s a time that you would normally wake
23:52 up at not a bad idea to start waking up
23:54 maybe a little bit earlier and earlier
23:55 and earlier so that you’re getting
23:57 closer to the time that you would have
23:58 your pre-done meal um so that again
24:01 it’ll be a gradual change um to to
24:06 Ramadan what about exercise so this is
24:09 another thing that’s really important so
24:10 for those of you particularly those of
24:11 you who are very active um don’t neglect
24:14 exercise because again if you are very
24:16 active and then you suddenly stop um the
24:19 changes that that can have to your body
24:20 again could trigger um migraines so um I
24:24 recommend continuing it I personally
24:26 love to exercise right before th time um
24:30 or some people like to do it in the
24:31 morning again before sahor so I would
24:34 strongly recommend any kind of physical
24:36 exertion before a meal as opposed to
24:40 after a meal so if you for example did
24:42 sahour you TR and you started your fast
24:45 and then exercised you know you’re
24:48 putting yourself in a precarious
24:49 position because if you’re getting
24:50 dehydrated if you’re getting you know
24:52 your muscles and everything are sore
24:53 tired you need a little bit of protein
24:55 you won’t be able to do that so it’s
24:57 very important to do the before an
24:59 opportunity to eat um and so I
25:01 personally like doing it before ifar but
25:03 whatever works for you um maintain it
25:05 but again at this time I would say
25:07 overall keep it relatively light you not
25:09 overdo it you probably don’t want to be
25:11 getting into too much anerobic activity
25:13 keeping it simple a little bit more the
25:16 kind of low aerobic type activity would
25:18 be ideal um but if you want to obviously
25:20 keep up some if you are someone who
25:22 lifts weights and um wants to maintain
25:25 that a little bit of that just to
25:27 maintain things as opposed to gaming uh
25:29 would be unnecessarily a bad
25:32 idea all right so the last bit of this
25:34 talk um before we get into Q&A I want to
25:37 make sure we have lots of time for Q&A
25:38 which it looks like we will um you know
25:41 what do you do when you get a migraine
25:43 while
25:44 fasting so I’m GNA borrow this from uh
25:47 Christina Le um the ktic society and so
25:51 you know for those of you who are not
25:52 familiar with this this is a really
25:54 fantastic um you know idea for patient
25:58 to take home and very easy to understand
26:00 so if you’re not familiar with this I
26:02 think it’s a great idea for you to have
26:03 for your migraines in general um and
26:06 this is in relation to you know acute
26:07 therapy so when you get your headache
26:09 stopping the migraine and so we kind of
26:12 break it down to three traffic lights so
26:13 green yellow red green means I can go
26:17 meaning you can keep doing your normal
26:18 activities you’re otherwise fine and in
26:21 these scenarios you want to use kind of
26:22 simpler options uh treat early and kind
26:26 of leave it at that if you’re a yellow
26:28 like that means you’re kind of having to
26:29 slow down um you’re not able to do your
26:32 fully normal function but you can do
26:34 some things this is a good option to to
26:36 reach for your your main treatment
26:38 option so that’s whether you’re that’s
26:39 your trip Dan that’s your gepants
26:41 whatever it may be and then the red is
26:44 like you have to stop or you wake up
26:47 with a migraine um and if that’s the
26:49 case that means you’re at a very severe
26:51 migraine make sure you hit it hard
26:52 combination therapies is the best way to
26:54 do it um but again you want to make sure
26:57 particular for those who have chronic
26:58 migraine but you’re not overdoing it
27:00 with medication overuse so this is kind
27:02 of the background that’s that’s I think
27:03 a fantastic option for anyone who’s not
27:05 familiar with this I’m happy to kind of
27:08 uh promote it here again but I thought I
27:10 would use this in a in a Ramadan way so
27:12 kind of the Ramadan addition to the the
27:15 Tropic light um CHS guidelines and so
27:19 think of green as you know again the
27:21 same thing I can go I can keep going but
27:24 I my green starting to build at that
27:26 point I would use all the conservative
27:27 measures you have that would not break
27:29 your fast and we’ll talk about all those
27:32 things if it’s I need to slow down I
27:36 think the big question then you have to
27:37 ask yourself is how long is left and can
27:39 I make it if you’re early on in the fast
27:42 and you’re really having to slow down
27:44 you know that might be a suggestion that
27:45 you might need to break your fast um
27:48 however if you’re right towards the end
27:50 and you’re just starting to slow down
27:51 and you only have like a couple hours
27:52 left it might be reasonable to try the
27:54 conservative measures and see what you
27:55 can do and try to get through it um so
27:58 that’s that’s kind of that in between
28:00 and then if you really are in the red
28:02 stage and S fee and or you woken up with
28:05 the migraine after you know you’re early
28:07 in the morning you have the whole day to
28:08 go um I think it’s probably a good idea
28:11 to break the fast at that stage with
28:13 your typical um oral abortive options or
28:17 subcutaneous or whatever you have um and
28:19 remember that if you’re breaking your
28:21 fast for a medical reason and this
28:22 definitely would constitute a medical
28:24 reason it can be made up at a later time
28:26 so um as a one to one so there’s no um
28:30 you know you’re not supposed to fast
28:32 technically if you’re sick so if you are
28:34 unwell it’s it’s a good idea to break it
28:36 take your medication um and it can be
28:38 made up at a later
28:40 time so um what about What treatments
28:43 can you do without breaking effect so as
28:45 I alluded to earlier um if you if you
28:48 are prescribed injectable options like
28:49 sum tripon korac those are things you
28:52 can use now obviously um not the vast
28:55 majority of Migra I should say um
28:57 probably don’t have these options and
28:59 that’s for a good thing because these
29:01 are really reserved for people who are
29:02 more severe or more chronic um migraines
29:04 or more refractory migraines so not
29:06 responding to typical
29:08 treatments but there are tons of other
29:10 things that people do right so there’s
29:11 you know a lot of people know about ice
29:13 or heat and kind of putting it over the
29:14 neck back to the head that’s totally
29:15 reasonable consider trying die um for
29:18 those of you not familiar I’m sure some
29:20 people have heard of this peppermint oil
29:21 is a is a great option um if there’s
29:24 anyone out there who has responded to
29:25 nerve blocks in the past peppermint oil
29:28 essentially do a similar thing just not
29:30 to a as a bit of a degree as a nerve
29:32 block and I always just take what I
29:34 recommended you take it if it’s a
29:35 one-sided headache focus on the one side
29:38 if it’s bilateral both sides do both
29:40 sides and essentially just follow the
29:41 hairline all the way around and that way
29:44 the peppermint oil will essentially
29:45 Target all the nerves um that you’re
29:47 hoping to Target from from a headache be
29:49 careful I always say be careful with
29:51 getting it too L down on your forehead
29:53 it gets to your eyebrow and into your
29:55 eyee it can really start to burn so just
29:57 be careful with that there are a lot of
29:59 other topical preparations that you can
30:01 use um I have my own concoction that
30:03 I’ve kind of borrowed from our
30:04 colleagues in Calgary um which is a
30:07 combination of Gab pentin Dak and
30:09 cyclobenzaprine it’s cream you have to
30:11 get it made um kind of specially
30:13 formulary but um the pharmacist can get
30:16 that for you um and whatever your doctor
30:18 uses um it’s worth a try particularly if
30:20 the neck is a big part of your migraines
30:22 so if you’re getting a lot of tightness
30:23 in your shoulders and your neck that’s
30:24 part of your headaches you can try that
30:26 that might help help settle things down
30:28 for your headache um for those of you
30:30 who use nerve stimulators obviously that
30:32 can be used so the seph device which you
30:34 can buy pretty much anywhere us at
30:36 Costco but unfortunately they don’t sell
30:37 it there anymore but I think you can
30:38 still get it from Amazon and that’s a
30:40 super orbital nerve um stimulator so
30:42 just over the forehead and then there’s
30:44 also the gamma core which is for the
30:45 bagal nerve stimulator so those are both
30:47 things you could consider trying um if
30:49 you’re already using them totally use
30:51 them during this time and then don’t
30:53 forget that one of the most powerful
30:55 abortives you have is sleep so if you’re
30:58 able to if you have the option um taking
31:00 a nap um is definitely something you can
31:03 do um and obviously um can help get you
31:06 through the
31:08 migraine now um obviously then if you
31:11 need to break the fast you need to break
31:13 the fast and that’s important thing to
31:14 think about um and you know um you know
31:18 in our religion God is forgiving and if
31:20 you truly are having a bad headache uh
31:23 you know it’s very much within the realm
31:25 of acceptability to break your fast in
31:27 that scenario
31:29 um and then you know there’s there’s the
31:31 more complicated scenarios right so
31:32 people what about people who have like
31:34 chronic daily headache or chronic
31:36 migraine or other forms of chronic
31:38 headache or chronic pain um and I think
31:41 these are individual discussions that
31:43 need to be had and these are you know
31:45 really needs to be decided on an
31:46 individual basis and no one scenario is
31:49 the same so this is something you really
31:51 need to talk to your physician and
31:52 you’re locally know about um and you
31:55 really need to start questioning whether
31:56 fasting is a good idea or not for you
31:59 this year um and I know that’s hard and
32:02 I know there’s lots of people who
32:03 struggle with this um you know because
32:05 they they have that yearning they want
32:07 to fast they want to be devotional in
32:10 that way um and you know um many of the
32:14 scholars I’ve spoken to talk about how
32:15 just that yearning alone proves that you
32:18 know you’ll get the benefits from this
32:20 Ramadan so don’t um you know despair in
32:24 terms of you know God’s forgiveness and
32:26 have that discussion because you know
32:28 there are many scenarios where it’s
32:30 totally reasonable not to fast that
32:32 Ramadan and if it is a scenario where
32:34 you think for example that you just
32:36 haven’t gotten the right treatment up to
32:37 this point and there are other things
32:38 being tried uh perhaps with the headache
32:41 specialist you know that the fast can be
32:43 made up at a later time when your
32:45 headaches are under better control so
32:47 let’s say theoretically you’re working
32:48 through something like botox injections
32:50 you just started and you’re not sure if
32:52 it’s going to work or not but you’re
32:53 only on the first cycle you need to give
32:54 it three full Cycles before you really
32:56 know how it’s going to work but your
32:57 headaches right now or daily they’re
32:59 severe totally reasonable to say you
33:01 know I can’t fast this year but I’m
33:02 going to try to hopefully make it up in
33:04 at another time if if it doesn’t get
33:07 that way then there’s always the last
33:08 option which you know for those and
33:10 there are many people who are like this
33:11 if you’re unlikely to ever have good
33:14 control and I would talk about that with
33:15 your headache specialist um there is
33:17 always the fidia which is kind of that
33:19 compensatory charity um for those who
33:22 have chronic illnesses and are not um or
33:24 deemed kind of medically unable to fast
33:27 because that is definitely one of the
33:28 exemptions for fasting so if you do have
33:31 chronic migraines or chronic headaches
33:33 that have not responded to many many
33:35 different therapies um it’s very
33:37 reasonable to consider the fidia and and
33:39 again talk to your mom talk to your
33:41 heing specialist um and try to come to a
33:43 good conclusion that is best for