Migraines are headaches, typically on one side of the head, and often of a pulsating quality, lasting anywhere between 4-72 hours at a stretch. They usually come accompanied with symptoms such as nausea, vomiting, light, sound and touch sensitivity, and even a tingling sensation in other parts of the body. Particularly during Ramadan, migraine patients know how taxing this month can be, as fasting can initiate a number of triggers to induce attacks.

According to Dr Amir Ali, a retired Ear, Nose and Throat specialist, migraines are not regular headaches. They are caused by specific triggers to the brain, which may seem mild to most people, such as sunlight, or strong smells, but which feel like an outright assault to a patient during a migraine attack. The pain is moderate to severe in intensity. "Fasting is not directly associated with migraine as hunger is not a common trigger, but if fasting happens to include triggers that typically cause someone to experience migraine, like exhaustion, for instance, then an attack may be imminent," says Dr Ali.

Triggers are different for each individual. "I get migraine attacks from nasal blockages and sinusitis, nothing else," says Tawhidur Rashid, a long-suffering migraine patient. Some people may get migraines from the cold, while others get it from dust or sunlight.

A fasting person needs to wake up in the middle of the night to eat sehri. This disrupts sleep for the first few days and causes a general upheaval of daily routine. The sudden disruption in sleep pattern can trigger migraine in some patients. A person who is used to a certain level of caffeine through the day will experience strong withdrawals during fasting and this too may trigger attacks. Anyone who is used to drinking a lot of water through the day will feel a strong thirst, at least until they get habituated to fasting, and this can become a pain inducer too. This list of triggers is by no means exhaustive and migraine patients are encouraged to keep track of their triggers and avoid them as much as possible, while fasting.

Often, migraine patients claim that they can feel when a headache is forthcoming. They call it the migraine "aura." These sensory disturbances could be anything from seeing flashes of light, to blind spots or even a tingling in the limbs. "Removing oneself from the situation that may be triggering a migraine attack will help improve the situation," says Dr Amir Ali. Taking a nap, moving to a different spot if dust or environmental factors such as strong sunlight are the triggering agents, and generally taking it easy with exertion can all help the brain relax. "Pains, when unbearable, may cause the patient to vomit, which will invariably make them feel better, but this may not be the best outcome for someone who is fasting. Therefore, avoiding triggers is the only solution to evade or minimise the intensity of these attacks."

Ramadan is a revered month for Muslims and fasting is compulsory upon all those who can. Bangladesh goes through extreme heat waves, and an unexpected migraine attack, on top of the more predictable stressors of this month like hunger and thirst, can really bring one down. Changing one's lifestyle a few weeks ahead of Ramadan like altering the sleep routine, curbing caffeine intake, drinking more water in the later part of the day, including foods in your diet that keep you fuller for longer, like yoghurt, oats and whole wheat and avoiding crowds, dust and harsh sunlight can all help to relax common triggers. At the onset of a headache while fasting, it is advised to avoid physical exertion so as not to aggravate the pains further.