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.

Four-year-old Sienna Dunion had initially flu-like symptoms, however her condition rapidly worsened, leading to a coma. What seemed like a simple flu was actually Acute Necrotising Encephalitis (ANE), a rare and severe brain disorder. After undergoing multiple surgeries and having removed 60% of her intestines, she is now struggling to walk and talk like from before.

How Did It Begin?

The first indication, which was very easy to miss was when she asked to return home five minutes after heading out to play with her scooter, reports The Independent. She had always been happy and exciting, so for her to return home so soon was not normal. She had also complained about feeling "cold and chilly" to her older sister, however, all of such symptoms were just seen as a common cold or flu signs.

As a result, her parents, Gary and Angelina Dunion, decided to keep her off school on Monday 17 November. Her temperature raised, no one was really concerned. All of these were cold and flu symptoms. She was still playing with her Barbies.

But it was on a Wednesday morning when she became unresponsive and had to make an emergency trip to A&E in Kettering. This is when she was induced into coma and diagnosed with the rare brain disease ANE.

Three weeks later, her family is facing the challenges to cope with the new changes which may take away how her daughter was before. Now, she requires years of intense rehabilitation to learn how to walk and talk again.

What is Acute Necrotising Encephalitis (ANE)?

Acute necrotizing encephalopathy (ANE) is a rare and serious brain condition that can cause sudden and rapid neurological decline after a viral infection, most often the flu or COVID-19. Because only a small number of cases have been reported worldwide, there is no standard treatment, making diagnosis and management especially difficult.

Sienna's father told The Independent, "For us, it’s really important that people can understand this has happened to a really healthy four-year-old girl who had no underlying issues. It has completely changed our lives overnight. What started as a flu has turned into a complicated brain disease and the last three weeks have just been horrendous.”

A Rare Diagnosis, But Urgent Care

Sienna had been feeling unwell on Monday and Tuesday, but it was on November 19 that her condition suddenly worsened. Her mother, Mrs Dunion, became alarmed when she tried to wake her and realised Sienna was unresponsive.

At A&E, doctors initially believed she was dehydrated after she tested positive for influenza. However, a CT scan showed unusual findings, including white lesions, while other test results remained unclear.

By 11 pm, doctors decided Sienna needed to be moved to the intensive care unit at Nottingham’s Queen’s Medical Centre. An MRI scan later confirmed a diagnosis of acute necrotising encephalopathy (ANE), a rare condition linked to viral infections.

Because of how uncommon the disease is, doctors designed a personalised treatment plan for her. This included plasma exchange, a procedure her family described as effectively washing her brain.

On Saturday, November 22, an ultrasound revealed a large build-up of fluid in her stomach. Sienna had to undergo emergency surgery, during which 60 per cent of her intestines were removed. Her father called it the hardest night of his life.

She later needed two more surgeries after air was found in her abdomen. Sienna now has a stoma bag and will live with short bowel syndrome for the rest of her life.

“The one thing doctors have been clear about is that she will not be the same when she fully wakes up,” Mr Dunion said. “She will need extensive rehabilitation.”

Although Sienna is awake, her father explained that she does not understand what is happening around her. She is weak, struggles to track with her eyes, and cannot eat on her own. The family is now fundraising to support her rehabilitation, including physiotherapy, speech and language therapy, feeding support, and changes needed at home.

A family struggling to cope

The couple also have a seven-year-old daughter, who is very close to Sienna. “They are best friends,” Mr Dunion said. “She keeps asking, ‘Where is Sienna? When can we be a family again?’”

He added that it is impossible to explain the seriousness of the situation to her. “I can’t tell her that she won’t be able to talk to her sister for a long time.”

“She was the most caring, easygoing four-year-old I’ve ever known,” her father said. “Even when she had a fever, she would check our temperature to make sure we were okay.”

He described her as a social child who loved being around other kids and had an infectious belly laugh. “We just don’t know if we’ll hear that laugh again,” he said.

The last thing anyone hopes to unwrap this Christmas is a heavy dose of flu. Yet as hospital admissions linked to the virus climb to levels not seen since 2010, this winter’s flu surge has pushed the NHS into what officials are calling a “worst-case scenario.”

Infections have jumped by over 50 per cent in just one week, and health leaders say there is still no clear peak. On average, 2,660 people a day were occupying hospital beds with flu last week, the highest figure ever recorded for this point in the season. Data from the UK Health Security Agency show the highest infection rates among children aged five to 14, followed closely by young people between 15 and 24. A number of schools have temporarily closed to curb outbreaks, while NHS leaders have advised people to consider wearing masks at work or on public transport, echoing guidance seen during the Covid years.

What Is Super Flu?

The strain driving the current spike has picked up the nickname “super flu” because it is believed to be a mutated form of influenza A (H3N2), known as “subclade K.”

Influenza H3N2 does not circulate as often as some other flu strains. Dr Simon Clarke, associate professor of cellular microbiology at the University of Reading, explains that the letters “H” and “N” refer to two proteins found on the virus surface, haemagglutinin and neuraminidase. “The numbers simply tell us which versions of those proteins are present,” says Dr Clarke. “It’s a way of grouping strains. This year, H3N2 happens to be the one in the lead.”

“H3 subtypes are relatively uncommon,” he adds. “That means fewer people have built up immunity. There is also evidence they spread more easily and mutate faster, which makes them harder for vaccines to keep up with.

“What we are seeing now is the outcome of that: cases rising sharply earlier than usual, with numbers likely to climb further as winter goes on.”

How Does Super Flu Differ From The Usual Variety?

Broadly speaking, flu falls into three main groups, A, B and C, according to Professor Ed Hutchinson from the Glasgow Centre for Virus Research. “Types A and B are the ones that make people seriously ill each winter. Influenza C circulates too, but it rarely causes severe disease. They are related, but not closely enough that immunity to one protects against the others,” he explains.

The concern is not that the virus has suddenly become far more deadly. Many people will catch it and recover without major problems. “The issue is scale,” Hutchinson says, as reported by The Telegraph. “When a virus spreads widely, even a small proportion of severe cases quickly adds up. That is what puts pressure on individuals and on the NHS.”

Last week, around 1,700 flu patients were in hospital, a 63 per cent increase on the previous week and more than 50 per cent higher than the same period last year. This rise is partly linked to a particularly aggressive subtype of the circulating H3N2 virus. “This strain is appearing earlier and spreading faster than we would expect, and immunity levels in the population are lower than usual for this stage of the season,” says Dr Aslam.

Is The Flu Shot Effective Against Super Flu?

Recent figures suggest the flu vaccine cuts the risk of hospital admission by roughly 30 to 40 per cent in older adults. That protection rate is lower than for some other vaccines, but it is in line with flu vaccine performance in past years. For that reason, advice has not changed. Vaccination remains the single most effective step people can take to protect themselves and to ease pressure on the NHS.

Why Does The Vaccine Have Different Effectiveness In Different Age Groups?

This season’s vaccines are still doing a solid job of preventing severe illness. Vaccinated children are about 70 to 75 per cent less likely to need a hospital visit or admission for flu. Among adults, the reduction is closer to 30 to 40 per cent.

One reason for this gap is the type of vaccine used. Children receive a nasal spray, while adults are given an injection. Research shows the nasal spray works particularly well in children but is less effective in adults, which is why different recommendations exist. So the comparison reflects not just age, but also different vaccines.

Another factor is prior immunity. Adults have encountered many flu viruses over their lifetime, so the added benefit of each new vaccine dose may be smaller than it is for a child. Even so, that extra protection still matters and can make a real difference.

A medical expert has revealed that you might be able to tell which winter illness you’re dealing with just by the type of cough you have. According to Dr. Rupa Parmar, a GP and medical director at Midland Health, coughing can present differently depending on whether you have a cold, flu, or COVID-19. During the winter months, certain infections become more common. Viruses spread more easily in cold weather, and spending more time indoors with others makes transmission more likely.

Still, it can be tricky to identify exactly what’s wrong because symptoms often overlap. Dr. Parmar advises: “There are some key differences between a cold, Covid, and flu that make it easier to tell them apart. But if you’re unsure, always check with your doctor. It’s better to be safe when it comes to your health.”

Cold and Flu

Dr. Parmar explained: “A cold usually causes a mild cough, while a flu cough is typically dry.” According to the NHS, cold symptoms develop gradually over two to three days. In contrast, flu symptoms “come on very quickly,” with a dry cough being a key sign.

Covid

Covid can also cause a dry cough, but it is usually persistent. Dr. Parmar said: “Covid tends to trigger a dry, continuous cough. Many people cough for over an hour at a time or have three or more coughing episodes in a single day.”

The NHS defines this as: “A new, continuous cough—meaning you’re coughing a lot for more than an hour or have three or more coughing episodes within 24 hours.”

What Is ‘Super Flu’?

NHS officials are warning that the UK may be facing an unusually severe flu season. Cases have started a month earlier than usual, driven by a stronger strain of the influenza A(H3N2) virus, sometimes being called “super flu.” Despite its intensity, vaccines remain effective against this strain, offering protection to those who get immunized.

Other Key Covid Symptoms

Other signs of Covid to watch for include:

• High temperature—you may feel hot, cold, shivery, or notice heat on your chest or back (you don’t always need a thermometer)
• Loss or change of smell or taste
• Shortness of breath
• Feeling very tired or drained
• Body aches
• Headache
• Sore throat
• Stuffy or runny nose
• Loss of apetite
• Diarrhea
• Nausea or vomiting

The NHS warns: “Covid symptoms can resemble those of other illnesses like colds or flu. Most people recover within a few weeks, but some may take longer. If you have a cough, pharmacists can offer guidance on treatment.”

If You Have Covid

The NHS advises staying at home and avoiding contact with others if you or your child:

• Have a high temperature
• Do not feel well enough to attend work, school, childcare, or daily activities
• You can resume normal activities once you feel better or no longer have a high temperature.