For those who have not experienced a migraine, perhaps it would seem just another headache. But for someone like me who has suffered through migraines that will last over a week even with medication, I can definitely tell you that it's much more. The ache is not confined to the head; it's the whole experience. Nausea, sensitivity to light, and throbs so bad it makes simple tasks unbearable. It also comes with an emotional burden—the loneliness and frustration are pretty unbearable. Through the years, realizing how hormones are also implicated in triggering and exacerbating my migraines has helped change the game in my dealing with these episodes.

What are Hormonal Migraines?

Hormonal migraines are caused by fluctuations in estrogen and progesterone, the two main female hormones. These hormones are essential for the reproductive system, regulating menstrual cycles and pregnancy. They also have an effect on brain chemicals, such as serotonin and dopamine, which affect mood and pain perception. When hormone levels fluctuate, such as during menstruation, pregnancy, or menopause, they can destabilize the pathways in the brain, causing migraines.

According to Dr. Shivananda Pai, Consultant Neurology, migraines are more than a neurological disorder. "Migraines represent a complex interplay of genetic, environmental, and hormonal factors. In women, hormonal fluctuations are a critical trigger that amplifies sensitivity to pain," he explains. Hormonal headaches are particularly challenging because they are influenced by multiple life stages, from puberty to post-menopause. Common causes include:

• Menstrual periods: Estrogen levels significantly drop just before menstruation often triggers a migraine.
• Pregnancy: Hormones can act to relieve symptoms or aggravate them during different times of pregnancy.
• Menopause: The hormonal fluctuation during menopause can intensify a migraine, while some women tend to find relief.
• Hormonal therapies: Birth control and HRT tend to level off hormone balances in some individuals but will exacerbate a migraine in others.

Complex Role of Hormones in Women’s Neurological Health

Estrogen and Neurological Health

Estrogen, often called the "hormone of femininity", does more than regulate reproductive functions. It is a powerful influencer of brain health. Estrogen modulates the activity of neurotransmitters like serotonin, which regulates mood and pain perception, and dopamine, associated with reward and pleasure.

During stages of hormonal stability, like in pregnancy's latter months, women may have fewer migraines because of the steady elevation of estrogen. However, a sudden downfall in estrogen destabilizes these chemicals in the brain, sending a heightened sensitivity for migraine triggers.

Menstrual Migraines

The most common form of hormonal migraines is menstrual migraines, which occur in response to the steep decline in estrogen levels just before menstruation. These are typically more intense and less responsive to standard treatment. The timing of these migraines provides clear evidence of the role hormones play in neurological health.

Pregnancy and Hormonal Shifts

Pregnancy is a rollercoaster of hormones. Although many women experience relief from migraines as a result of the constantly elevated levels of estrogen, some women, particularly in the first trimester, worsen. This individual variability is a characteristic of hormonal migraine triggers.

Hormonal Therapies and Management of Migraine

Hormonal treatments, such as oral contraceptives and HRT, have had mixed reviews regarding their use in managing migraine. Some women fare better with the stabilization the treatment provides, whereas others suffer worsening symptoms. This will depend on the nature and dose of the hormones used.

Post-Menopause: Migraine Remission or Continued Struggles?

For most women, menopause brings relief from their migraines. The decline in frequency and severity often accompanies stability in hormone levels. Even so, the susceptibility remains with some towards other forms of triggers including stress and sleep deprivation, not to forget diet-related factors and continues the saga of migraines well after the menopausal stages.

Effect on Neurological Health Due to Hormonal Changes

The relationship of hormones to neurological health goes beyond migraines. Hormonal changes have profound effects on a woman's brain in general.

Mood Disorders: Estrogen helps stabilize mood by regulating serotonin. Its decline at menopause increases the risk of mood swings and depression.

Neurodegenerative Diseases: Estrogen is neuroprotective, stimulating the growth and repair of brain cells. Its absence in post-menopausal women has been associated with an increased risk of Alzheimer's disease and cognitive decline.

Multiple Sclerosis (MS): Hormonal cycles may affect the course of MS, a disease that occurs more frequently in women than in men. Estrogen's anti-inflammatory effects provide transient protection during pregnancy, reducing relapse rates in women with MS.

"The intricate interplay between hormones and neurological health underscores the need for gender-specific treatment approaches," says Dr. Pai.

Managing Hormonal Migraines: Practical Strategies

While hormonal changes are inevitable, several strategies can help manage migraines effectively:

1. Tracking Your Cycle

Understanding your menstrual cycle can help identify patterns and predict when migraines might occur. This knowledge allows for preventive measures, such as scheduling medications or adjusting lifestyle habits.

2. Consulting Specialists

Working with a neurologist or gynecologist can help develop a personalized treatment plan. Options might include hormonal therapies, triptans, or preventive medications tailored to your specific needs.

3. Adopting a Healthy Lifestyle

A well-balanced diet, regular exercise, and stress management are all integral parts of managing migraines. For instance, magnesium-rich foods and hydration can help reduce the frequency and severity of attacks.

4. Exploring Preventive Therapies

For people with severe or frequent migraines, preventive medications, such as beta-blockers or CGRP inhibitors, may be prescribed. These medications stabilize brain activity and therefore reduce the chances of migraine during hormonal fluctuations.

5. Mind-Body Techniques

Techniques like yoga, meditation, and biofeedback can enhance wellness and reduce the debilitating effects of stress-one of the most common migraine triggers.

Research that was once in its embryonic stage continues to shed more light on the role of hormones in migraines and other neurological conditions. Further breakthroughs in genetic testing might enable doctors to predict, at least in a way, how an individual would react to hormonal therapies. The importance of gender-specific approaches is gradually being realized, which involves differentiating between the plight of women with migraines from others.

As Dr. Pai puts it, "Empowering women with knowledge about the hormonal underpinnings of migraines can lead to better, more personalized care. With the right strategies, migraines can be effectively managed, allowing women to lead fuller, healthier lives.

Migraines are not headaches; they are a complex neurological condition that deeply impacts the lives of millions of women. Understanding the role of hormones in triggering and exacerbating migraines is a vital step toward better management and relief.

Awareness, proactive care, and advances in medical research can help women regain their lives from the grip of hormonal migraines. Whether tracking cycles, adopting healthier habits, or seeking tailored medical care, every step taken toward understanding and managing migraines is a step toward empowerment.

Dr Shivananda Pai is a Consultant Neurology at KMC Hospital Dr B R Ambedkar Circle in Mangalore, India.

Brandes JL. The Influence of Estrogen on Migraine: A Systematic Review. JAMA. 2006;295(15):1824–1830. doi:10.1001/jama.295.15.1824

Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012 Apr;13(3):177-89. doi: 10.1007/s10194-012-0424-y. Epub 2012 Feb 26. PMID: 22367631; PMCID: PMC3311830.

Smoking has long been recognized as one of the most preventable causes of disease and early death worldwide. It plays a major role in heart attacks, strokes and several chronic illnesses. While public health messaging often focuses on how much a person smokes, new research suggests that when someone starts smoking may be just as important for long-term health.

A large nationwide study published in Scientific Reports analyzed health data from over nine million adults in South Korea. The findings were striking. People who began smoking before the age of 20 faced a significantly higher risk of stroke, heart attack and early death compared to those who started later, even if their total lifetime smoking exposure was similar.

Smoking Before 20: Why the age matters

Traditionally, doctors and researchers estimate smoking-related harm using pack-years, which combines the number of cigarettes smoked per day with the number of years a person has smoked. While this remains useful, the new study highlights an important gap. Two people with the same pack-years may not have the same health risks if one started smoking much earlier in life.

The researchers found that early starters had a much higher risk of stroke and heart attack than those who took up smoking after the age of 20. This suggests that the body may be especially vulnerable to tobacco damage during adolescence and early adulthood, making age of initiation an independent risk factor.

Smoking and stroke: what we already know

The link between smoking and stroke is well established. Long-term studies, including the famous Framingham Heart Study, have consistently shown that smokers are far more likely to experience a stroke than non-smokers. The risk increases with the number of cigarettes smoked and affects people across age groups.

Smoking damages blood vessels, speeds up plaque build-up in arteries, raises blood pressure and makes blood more likely to clot. All of these changes increase the chances of both ischaemic and haemorrhagic strokes. Younger adults who smoke are not protected simply because of their age, and in many cases, their relative risk is even higher.

Key findings from the Korean cohort

The study followed participants for nearly nine years using data from a mandatory national health screening programme. Researchers looked at stroke, heart attack, combined cardiovascular events and overall death rates.

Those who started smoking before 20 had about a 78 percent higher risk of stroke compared to non-smokers, especially when they also had high smoking exposure. Early starters also showed a much greater risk of heart attacks and combined cardiovascular events. Importantly, they had a higher risk of death from all causes, not just heart-related conditions. These patterns were consistent across men and women and across different metabolic health profiles.

Why early smoking causes greater harm

There are several reasons why smoking at a younger age may be more damaging. During adolescence, the heart, blood vessels and brain are still developing, which may make them more sensitive to toxins in tobacco smoke. Starting early is also linked to stronger nicotine dependence, making quitting harder and often leading to longer periods of smoking.

Early exposure may also trigger lasting inflammatory and metabolic changes in the body. These changes can increase stroke risk later in life, even when total cigarette exposure appears similar on paper.

What this means for public health

The findings send a clear message. Preventing smoking during adolescence could significantly reduce the future burden of stroke and heart disease. School-based education, strong warning messages and policies that limit youth access to tobacco remain critical.

Delaying smoking initiation, even by a few years, may have lifelong benefits. With cardiovascular diseases already among the leading causes of death globally, protecting young people from tobacco use is not just about avoiding addiction. It is about safeguarding their long-term health.

A simple tennis ball might be able to tell you whether you have dementia or not. While it sounds strange, experts explain that the strength of your hands is a major clue for how well your mind is aging.

In a recent video, Neurologist Dr. Baibing Chen explains that your grip strength is a "window" into your cognitive health. To squeeze your hand, your brain must coordinate nerves, muscles, and blood flow all at once. When this system weakens, it often suggests that the brain’s "resilience" or ability to bounce back is also lower.

While weak hands don't cause dementia, they can be an early warning sign. In some conditions, like vascular dementia, physical changes like slowing down or dropping things often happen before memory loss even begins.

How To Do The Tennis Ball Test At Home?

You don't need expensive equipment to check your strength. You can use a standard tennis ball or a stress ball to track your progress:

Get Ready: Sit up straight with your feet flat on the floor and your arm stretched out in front of you.

Squeeze: Grip the ball as hard as you possibly can.

Hold: Try to keep that strong squeeze for 15 to 30 seconds.

Repeat: Do this three times with each hand and note if you feel tired or if your strength fades quickly.

What the Numbers Mean

Researchers have found that people in the bottom 20% of grip strength have a much higher risk of developing memory problems.

For example, a massive study of nearly 200,000 adults showed that as grip strength drops, the risk of dementia goes up by about 12% to 20%.

Specifically, if a man’s grip strength is below 22 kg or a woman’s is below 14 kg, doctors consider that a "red flag" for future cognitive decline. These numbers are helpful because they show changes in the body years before memory loss actually starts.

What If You Fail The Tennis Ball Dementia Test?

It is very important to remember that a weak grip is not a guarantee of dementia. Many factors, such as arthritis, old injuries, or general lack of exercise, can cause your hands to feel weak.

The goal of this test is not to scare you, but to encourage you to be proactive. If you feel like your hands are getting "tired" faster during daily chores or you are dropping items more often, mention it to your doctor. They can help determine if it is just a muscle issue or something that needs more investigation.

How Is Dementia Diagnosed?

Dementia is one of the most common cognitive conditions in the world. According to the World Health Organization, there were 57 million people living with dementia in 2021, many of whom never had any treatment for it.

Early detection of dementia is an important part of the treatment. While it may not completely cure the disease, it can slow down the progress to help people retain as much of their abilities as possible.

Finding out if someone has Alzheimer’s is not as simple as taking one single test. Doctors act like detectives, gathering many different clues to figure out what is happening in the brain. To make an accurate diagnosis, healthcare providers use a combination of different tools and tests:

Brain Scans

Doctors may use imaging tests like MRI, CT, or PET scans to look at the physical structure of the brain and check for any unusual changes.

Cognitive Tests

There may be cognitive tests that check your recall skills. These are mental puzzles or questions that check your memory, problem-solving skills, and how well you can perform daily tasks.

Lab Work

This can also include blood tests or checking "spinal fluid" to look for specific markers that show up in people with certain types of dementia.

Physical Exams

A neurologist may also check your balance, your senses, and your reflexes to see how well your nerves are working.

Claire Danes recently revealed that she was shocked to learn that she was pregnant with her third child at 44. In an interview with Amy Poehler in an episode of Good Hang with Amy Poehler, the Beast In Me actress revealed that she burst into tears at her OB/GYN’s office, explaining that she didn’t know it was possible to be pregnant after 40.

Danes shared that she initially felt a strange sense of embarrassment about the pregnancy. Because she and her husband, Hugh Dancy, weren’t planning for a third, Danes felt like she had stepped outside of normal "parameters."

The debate surrounding pregnancies after 40 has always persisted. Many people like Claire believe that it is impossible to get pregnant after your biological clock runs out. However, in reality, things do not work like that. Dr Rohan Palshetkar, Consultant IVF specialist, at Bloom IVF explains a few factors one should know about.

Can You Get Pregnant After 40?

Yes, Dr Rohan explains that it is completely possible and safe with the current technological advancements. “Earlier we did have fetal medicine specialists, high resolution ultrasounds, better monitoring techniques and safter IVF options”

Screening tests are much more detailed, IVF options are more robust and egg freezing is also an empowering tool for women who wish to have pregnancies later in life, Dr Rohan explained.

However, he also pointed out that post 35 risks of having diabetes and hypertension increases, so consistent monitoring helps a lot.

What Are Some Risks Of Pregnancies After 40?

The chance of having a high-risk pregnancy increases for women above 40, according to the American College of Obstetricians & Gynecologists (ACOG). They explain that since women are born with all the eggs they will ever have, those eggs age right along with the body. As time goes on, the number of eggs decreases, and their quality can change.

While many women have healthy pregnancies in their 40s, here are some specific risks you should know about.

Chromosome Issues

Older eggs are more likely to have certain genetic changes. This means there is a higher chance for the baby to be born with a health condition like Down syndrome instead.

Miscarriage or Stillbirth

Women in their forties face a much higher statistical chance of losing a pregnancy. It is very important to stay in close contact with your doctor to monitor your baby's health.

Low Birth Weight

There is a greater risk that the baby will be born weighing less than what is considered healthy. Small babies often need extra medical care and stay in the hospital longer.

Blood Clots

Being pregnant naturally increases your risk of developing dangerous blood clots. However, this specific medical danger becomes even more likely for mothers who are over the age of thirty-five or forty.

Gestational Diabetes

This is a specific type of high blood sugar that some women develop only while they are pregnant. It requires careful diet management or medication to keep you and baby safe.

Preeclampsia

This is a very serious condition involving high blood pressure that can happen during pregnancy. It can be dangerous for the mother and the baby if it is not treated quickly.

Labor Challenges

Delivery can be more difficult for older mothers, often leading to longer labor times. Because of these complications, doctors are much more likely to recommend a surgical C-section birth instead.

How Doctors Support Pregnancies After 40

Being "high-risk" doesn’t mean something will go wrong; it just means your medical team will watch you more closely. Modern medicine has great tools to keep you and your baby safe, such as,

• Prenatal Screening
• Extra Ultrasounds
• Frequent Check-ups