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This study was designed to estimate the frequency and characteristics of headaches occurring on the first day of Ramadan (Moslems' fasting month) and to determine possible causes. One hundred fifty copies of a specially designed questionnaire were distributed on the second day of fasting to a random sample of hospital staff. Completed questionnaires were obtained from 116 subjects (77%). Headaches were reported by 37 (41%) of the 91 persons who had fasted as compared to 2 (8%) of those 25 who did not fast (P = .002). The headache was of tension type in 78% of the cases. Headache frequency increased with the duration of fasting and affected mainly those prone to have headaches, more particularly of the tension type and the most important exogenous-associated factor was caffeine withdrawal. Other factors such as lack of sleep, hypoglycemia, and dehydration may have been contributory in a small number of cases. A progressive reduction of caffeine consumption in the weeks preceding the month of Ramadan and a cup of strong coffee just before the start of the fast may prevent the occurrence of first-of-Ramadan headache.

A 24-year-old woman with previously known pseudotumor cerebri syndrome (PTCS) presented with severe pain in the neck and shoulders followed by the classical symptoms and signs of bilateral brachial neuritis. At the same time, there was a recurrence of the PTCS which had been in remission for more than one-and-a-half years. Despite treatment with high doses of methylprednisolone, intravenous immunoglobulins and repeated cerebrospinal fluid drainage, both brachial plexopathy and the PTCS continued to worsen. Both lumbosacral plexuses became involved and the visual acuity deteriorated to a level such that a lumboperitoneal shunt had to be inserted. The neurological condition started to improve progressively after 8 weeks. This case is, to our knowledge, the first where brachial plexopathy has been described in association with a PTCS. Although the pathogenesis of this association is not clear, there are enough data to suggest the existence of a continuum between extended brachial plexopathy and Guillain Barre syndrome, with which PTCS has been associated in some instances., (Copyright 1999 Lippincott Williams & Wilkins)