Prophylactic Etoricoxib Is Effective in Preventing Yom Kippur Headache: A Placebo-Controlled Double-Blind and Randomized Trial of Prophylaxis for Ritual Fasting Headache

Headache 21 Dec. 2009Research Submission
Michael J. Drescher, MD, FACEP; Evan A. Alpert, MD; Todd Zalut, MD, FACEP; Rafael Torgovicky, MD, MHA; Zev Wimpfheimer, MD, FACEP
From the Division of Emergency Medicine, Hartford Hospital/University of Connecticut, Hartford, CT, USA (M.J. Drescher); Department of Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel (E.A. Alpert); Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel (T. Zalut and Z. Wimpfheimer); Medical Department, MSD, Israel (R. Torgovicky).
Correspondence to M.J. Drescher, Division of Emergency Medicine, Hartford Hospital, 80 Seymour St., Hartford, CT 06102, USA. 

This research was supported by grant number ARX_ISP_IL0802 from MSD Israel.

Conflict of Interest: Dr. Torgovicky is an employee of MSD Israel. All other authors report no conflict of interest.
ABSTRACT
Background.—Religious fasting is associated with headache. This has been documented as "Yom Kippur Headache" and "First-of-Ramadan Headache." Rofecoxib (Vioxx®), a cyclooxygenase-2 (Cox-2) inhibitor with a 17-hour half-life, has been shown to be effective in preventing fasting headache when taken just prior to the 25-hour Yom Kippur fast. Unfortunately for fasters rofecoxib is no longer available. We hypothesized that etoricoxib, another Cox-2 inhibitor with a longer half-life, would also be effective in preventing fasting headache.

Methods.—We performed a double-blind randomized prospective trial of etoricoxib 120 mg vs placebo, taken just prior to the onset of fasting, Yom Kippur 2008. Healthy adults aged 18-65 years were enrolled from the community. Subjects completed a demographic data form and questions regarding headache history and a post-fast survey on headache during the fast. We compared incidence, time of onset and intensity of headache, general ease of fasting, and side effects in control and treatment groups.

Results.—We enrolled 211 patients and 195 completed the post-fast questionnaire (92%). Of those subjects receiving etoricoxib (n = 99), 36 or 36.4% vs 65 or 67.7% of the placebo group (n = 96) developed any headache during the fast (P < .0001). Median severity of headache in the treatment group was significantly lower for the treatment group (3.0 vs 5.0 on a visual analog scale of 10; P = .024). Also, participants in the treatment group reported an easier fast than the placebo group, as compared with previous fasting experience (4.0 vs 3.5 on a scale of 1-5; P < .0001).

Conclusion.—Etoricoxib 120 mg taken prior to a 25-hour ritual fast decreases incidence of and attenuates fasting headache. NCT number is NCTT00752921.