Fasting as a Trigger of Migraine: Epidemiology, Pathophysiological Mechanisms, and Clinical Approach - a Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.67.74126Keywords
migraine, fasting, migraine triggers, dietary triggers, headacheAbstract
Background. Migraine is a complex neurobiological disorder and one of the leading causes of disability worldwide, affecting approximately 14.1% of the global population. Among the numerous factors capable of precipitating migraine attacks, fasting occupies a particularly prominent position, yet the underlying mechanisms and clinical implications of this relationship remain incompletely understood.
Aim. To synthesize current evidence regarding fasting as a migraine trigger, with particular emphasis on its epidemiology, proposed pathophysiological mechanisms, and clinical approach.
Material and methods. A narrative literature review was conducted using PubMed and Google Scholar. Original articles, reviews, case series, and case reports were analyzed. The studies included both clinical human studies and experimental animal models.
Results. Fasting is reported as a migraine trigger by approximately 44% of patients, making it one of the most prevalent dietary precipitants. Multiple pathophysiological mechanisms have been proposed, including hypoglycemia-driven modulation of cortical spreading depression, astrocytic glycogen depletion, hypothalamic orexinergic and neuropeptide Y pathway dysregulation, and caffeine withdrawal. Clinical data further reveal persistent gaps between trigger recognition and behavioral modification among patients, while short-term preventive pharmacotherapy with rimegepant during predictable fasting periods has been examined in migraine populations.
Conclusions. Fasting represents a prevalent, modifiable, and mechanistically plausible migraine trigger acting through multiple converging pathways. Its systematic identification during clinical assessment, combined with individualized lifestyle and pharmacological strategies, may contribute to reducing attack burden in susceptible individuals. Further prospective research and randomized trials are needed to establish evidence-based recommendations.
References
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. https://doi.org/10.1177/0333102417738202
GBD 2023 Headache Collaborators. Global, regional, and national burden of headache disorders, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet Neurol. 2025 Dec;24(12):1005-1015. https://doi.org/10.1016/S1474-4422(25)00402-8
Mollaoğlu M. Trigger factors in migraine patients. J Health Psychol. 2013 Jul;18(7):984-94. https://doi.org/10.1177/1359105312446773
Peroutka SJ. What turns on a migraine? A systematic review of migraine precipitating factors. Curr Pain Headache Rep. 2014 Oct;18(10):454. https://doi.org/10.1007/s11916-014-0454-z
Hindiyeh NA, Zhang N, Farrar M, Banerjee P, Lombard L, Aurora SK. The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. Headache. 2020 Jul;60(7):1300-1316. https://doi.org/10.1111/head.13836
Awada A, Jumah MA. The first-of-Ramadan headache. Headache. 1999 Jul-Aug;39(7):490-3. https://doi.org/10.1046/j.1526-4610.1999.3907490.x
Abu-Salameh I, Plakht Y, Ifergane G. Migraine exacerbation during Ramadan fasting. J Headache Pain. 2010 Dec;11(6):513-7. https://doi.org/10.1007/s10194-010-0242-z
Goufa E, Chentouf A, Belabbas S, Boughrara W. Impact of fasting during Ramadan on migraine in the Algerian population. Neurologia (Engl Ed). 2025 Oct;40(8):762-767. https://doi.org/10.1016/j.nrl.2023.02.014
Mosek A, Korczyn AD. Yom Kippur headache. Neurology. 1995 Nov;45(11):1953-5. https://doi.org/10.1212/wnl.45.11.1953
Pearce J. Insulin induced hypoglycaemia in migraine. J Neurol Neurosurg Psychiatry. 1971 Apr;34(2):154-6. https://doi.org/10.1136/jnnp.34.2.154
Hoffmann U, Sukhotinsky I, Eikermann-Haerter K, Ayata C. Glucose modulation of spreading depression susceptibility. J Cereb Blood Flow Metab. 2013 Feb;33(2):191-5. https://doi.org/10.1038/jcbfm.2012.132
Martins-Oliveira M, Akerman S, Holland PR, Hoffmann JR, Tavares I, Goadsby PJ. Neuroendocrine signaling modulates specific neural networks relevant to migraine. Neurobiol Dis. 2017 May;101:16-26. https://doi.org/10.1016/j.nbd.2017.01.005
Brown AM, Ransom BR. Astrocyte glycogen and brain energy metabolism. Glia. 2007 Sep;55(12):1263-1271. https://doi.org/10.1002/glia.20557
Dalkara T, Kiliç K. How does fasting trigger migraine? A hypothesis. Curr Pain Headache Rep. 2013 Oct;17(10):368. https://doi.org/10.1007/s11916-013-0368-1
Kilic K, Karatas H, Dönmez-Demir B, Eren-Kocak E, Gursoy-Ozdemir Y, Can A, Petit JM, Magistretti PJ, Dalkara T. Inadequate brain glycogen or sleep increases spreading depression susceptibility. Ann Neurol. 2018 Jan;83(1):61-73. https://doi.org/10.1002/ana.25122
Salinas-Abarca AB, Gamal-Eltrabily M, Romero-Reyes M, Akerman S. The role and interaction of hypothalamic-related neurotransmitters in migraine. J Headache Pain. 2025 May 12;26(1):110. https://doi.org/10.1186/s10194-025-02044-w
Martins-Oliveira M, Tavares I, Goadsby PJ. Was it something I ate? Understanding the bidirectional interaction of migraine and appetite neural circuits. Brain Res. 2021 Nov 1;1770:147629. https://doi.org/10.1016/j.brainres.2021.147629
Alstadhaug KB, Ofte HK, Müller KI, Andreou AP. Sudden Caffeine Withdrawal Triggers Migraine-A Randomized Controlled Trial. Front Neurol. 2020 Sep 10;11:1002. https://doi.org/10.3389/fneur.2020.01002
Nowaczewska M, Wiciński M, Kaźmierczak W. The Ambiguous Role of Caffeine in Migraine Headache: From Trigger to Treatment. Nutrients. 2020 Jul 28;12(8):2259. https://doi.org/10.3390/nu12082259
Ghimire MR , Thapa M , Shrestha AM , Bhattrai S , Ghimire S , Sharma N , Soti B , Dutta A , Shrestha S , Pokhare M , Poudel R , Thapa LJ . Clinical Profile and Knowledge, Attitude and Practice of Patients Presenting with Headache. Kathmandu Univ Med J (KUMJ). 2023 Apr-Jun;21(82):190-196.
Agbetou M, Adoukonou T. Lifestyle Modifications for Migraine Management. Front Neurol. 2022 Mar 18;13:719467. https://doi.org/10.3389/fneur.2022.719467
Elmazny A, Yehia Ismaeel A, Hussein M, Khedr D, Elashiry A, Tarek MA, Dahshan A, Hassan A, Ashraf Ibrahim O, Wagdy M, Farrag MA, Abd El Baky DL, Magdy R. Assessment of eating behavior in patients with migraine: a case-control study. Nutr Neurosci. 2026 Apr;29(4):458-465. https://doi.org/10.1080/1028415X.2025.2572081
Alsaadi T, Suliman R, Yang J, Agarwal E, Fullerton T, Chou DE, Whalen E, El Jadam C, Al Qaisi I, Amin Y, Alkhateri A, Alsaffarini K, Abraham L, Zunaed Z, Ahmed HM, Fathy M, Hegab M, Vainstein N. A randomized open-label study to evaluate the effectiveness and safety of once-daily rimegepant 75 mg orally disintegrating tablet for the short-term preventive treatment of fasting-triggered headache in individuals with migraine. Cephalalgia. 2025 Jul;45(7):3331024251355947. https://doi.org/10.1177/03331024251355947
Antinew J, Fountaine RJ, Loprinzo V, Straghan E, Dubrovin S, DeBesi P, Vatakis N, Fullerton T. A phase 4, 24-week, open-label study to evaluate the safety and tolerability of once-daily dosing of 75 mg rimegepant for episodic migraine prevention. J Headache Pain. 2025 Dec 9;27(1):17. https://doi.org/10.1186/s10194-025-02225-7
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Michał Tokarczyk, Andrzej Samujlik, Kinga Karczewska, Małgorzata Kurowska, Małgorzata Anna Ziółek, Jagoda Kuniewicz, Julia Maria Kuczkowska, Maria Karolina Skorupa, Milena Wątek, Tomasz Piszczek
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 38
Number of citations: 0
