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.

A new review of studies has found that people living with type 2 diabetes have a significantly higher risk of developing Alzheimer's disease.

Researchers from Curtin University conducted a systematic review and meta-analysis of 40 studies. They estimated that if 1,000 people with type 2 diabetes were followed for a year, an average of 4.7 would develop Alzheimer's disease.

Published in Alzheimer's Research & Therapy, a separate analysis found that type 2 diabetes was associated with a 53% higher adjusted relative risk of Alzheimer's disease compared with people without the condition.

How Does Blood Sugar Affect Memory?

Ahead of World Diabetes Day, Dr Sudhir Kumar, neurologist at Apollo Hospitals, Hyderabad, in a post on X, explained that several overlapping mechanisms may link type 2 diabetes to Alzheimer's disease. These include:

• Brain insulin resistance: Brain cells become less responsive to insulin, potentially impairing their ability to use glucose for energy and clear amyloid and tau proteins.
• Vascular damage: High blood sugar can damage large and small blood vessels in the brain, increasing the risk of strokes and vascular dementia.
• Chronic inflammation: Peripheral inflammation and lipid abnormalities can weaken the blood-brain barrier and trigger neuroinflammation.

How Does Diabetes Increase The Risk Of Dementia?

According to Alzheimer's Society UK, diabetes is an established risk factor for dementia. The risk also increases with the duration and severity of diabetes. However, having diabetes does not mean a person will necessarily develop dementia.

With diabetes and Alzheimer's disease cases rising globally, understanding the link between the two conditions is becoming increasingly important.

Insulin helps regulate blood sugar by enabling the body's cells to use glucose for energy. In people with diabetes, the body either does not produce enough insulin or cannot use it effectively, causing blood sugar levels to rise.

Studies have linked type 2 diabetes to an increased risk of dementia. In people with type 1 diabetes, severe and repeated episodes of high or low blood sugar have also been associated with a higher risk.

Diabetes and Alzheimer's disease may share certain underlying mechanisms. In both conditions, brain cells can become less responsive to insulin, potentially affecting brain function and contributing to the accumulation of amyloid and tau proteins associated with Alzheimer's disease.

How Can People With Diabetes Protect Their Brain Health?

Dr Kumar recommended the following measures for people living with type 2 diabetes:

• Maintain blood sugar levels: Aim to keep glucose within your target range.
• Avoid extreme fluctuations: Prevent prolonged high blood sugar (HbA1c of 7% or higher) and severe, repeated episodes of low blood sugar (hypoglycemia).
• Manage other health conditions: Keep blood pressure and cholesterol under control.
• Prioritise a healthy lifestyle: Eat whole foods, including vegetables, fruits and whole grains, and engage in regular physical activity to improve insulin sensitivity.

"Early detection, consistent blood sugar management, and working closely with your healthcare team can help safeguard your cognitive future," he said.

Four-year-old Deborah started school this year full of excitement. But she is struggling to understand why she now has to attend classes on a screen. The nursery student misses the school bus, chatting with friends and running around the classroom. Despite the appeal of screens, she finds it difficult to sit still for online lessons.

Coughing badly, she asks what pollution is and pleads with her family to let her play in the park.

Deborah is not alone. Across Delhi-NCR, children are facing similar disruptions as schools shift classes online amid deteriorating air quality, keeping them indoors for longer.

Air pollution in India is no longer just a winter problem. Although levels peak during the colder months, poor air quality has increasingly become a year-round concern, with Delhi-NCR experiencing severe pollution episodes.

Beyond its well-documented respiratory and developmental effects, pollution and the disruption it brings to children's daily lives may also affect their emotional well-being. HealthandMe spoke to health experts, who warned that reduced outdoor play, disrupted social interactions and increased screen time could add to children's psychological stress.

How Air Pollution Can Affect Children's Mental Health

Air pollution should not be viewed as an isolated exposure when examining its impact on children's mental health, said Dr. Pradeep B.S., a Professor of Epidemiology and Deputy Medical Superintendent at the National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bengaluru.

"Air pollution is a macro-level effect. If we reduce it to individual-level effects, we are scientifically wrong," he told HealthandMe on the sidelines of the 11th Together Against Stigma (TAS) Conference, held in the national capital.

He said air pollution is associated with several broader changes, including increased traffic, population growth, climate disturbances and unpredictable weather patterns. Together, these can have a silent effect on people's psychological well-being, including that of children and adolescents.

The effects may not always be direct. Respiratory and gastrointestinal problems, for instance, can prevent children from going outdoors and participating in activities. Losing the opportunity to play can itself become a source of distress.

He also pointed to urbanisation and road expansion, which not only contribute to pollution but also reduce green spaces, playgrounds and community recreational areas. The combination can limit children's opportunities to play, interact and socialise.

Environmental Stress Can Also Affect Children's Emotional Well-Being

Dr. Pallab K. Maulik, the Director of Research at The George Institute for Global Health India said air pollution is one of the contributors to mental health concerns, with both Indian and international research examining the association.

He told HealthandMe that pollution and environmental disasters can create anxiety and stress among children, particularly those whose everyday lives are disrupted by these conditions.

Citing an example from one of his study sites, he recalled speaking to a child living in a slum area whose home gets flooded whenever municipal tankers wash the streets. The child has to spend two days drying her books after the water enters the house.

Dr Pallab also referred to children in the Sundarbans who regularly experience flooding and salinity-related problems.

He said some adolescents are now using platforms such as adolescent parliaments to bring their concerns to local administrators. While children are becoming more aware of environmental challenges, he said, much more needs to be done to understand how environmental changes affect their mental health.

Staying Indoors, Screen Addiction And Anxiety

Dr Syed Hubbe Ali - Health Specialist (RMNCHA) at UNICEF highlighted another possible consequence of pollution-related restrictions on outdoor activities: increased screen exposure among children and adolescents.

When children cannot go outside, they tend to spend more time indoors, often turning to mobile phones, social media and online content. This can create a cycle of screen dependence, he explained.

He described how the pursuit of dopamine, associated with the brain's reward system, can encourage children to keep scrolling through social media content.

The cycle can become more complicated when children begin posting content and seeking validation through likes and engagement.

"Once you start developing your roles, the next stage comes when you see how many likes I got. I got the likes, I don't get the likes. Then the anxiety, you know, it starts," Dr Ali told HealthandMe.

He explained that not receiving the expected engagement can cause distress and, in some cases, contribute to depressive feelings and risky behaviour.

Dr Ali also raised concerns about children spending more time on screens for online learning. Referring to an NCERT survey conducted after the COVID-19 pandemic among 3.7 lakh children, he said only 51% were able to understand online content.

He suggested that learning methods need to move beyond conventional online teaching and incorporate more games and interactive approaches to improve children's engagement.

Why Outdoor Play And Social Spaces Matter

Dr Pradeep emphasised that the impact of pollution cannot be separated from the wider changes taking place in children's surroundings.

Reduced access to green spaces and recreational areas can affect opportunities for physical activity, social interaction and play. When children are unable to participate in these activities, the effects can extend beyond physical health.

Dr Ali also highlighted the importance of outdoor activities and sunlight exposure in children's everyday lives. He said keeping children indoors for prolonged periods can increase their dependence on digital platforms as a source of entertainment and stimulation.

Gait, or an individual's walking pattern, is an important marker of overall health, reflecting neurological integrity, musculoskeletal function and cognitive status. Although walking may seem effortless, people often dismiss changes in their gait as signs of tiredness or ageing.

Losing balance while walking can sometimes be attributed to fatigue, dehydration or a momentary lapse in attention. However, recurrent or unexplained balance problems can also indicate an underlying neurological condition and should not be ignored, experts warned.

Dr Gaurav Batra, Principal Consultant, Neurosurgery, Yashoda Super Speciality, said individuals experiencing instability, changes in their walking pattern or more frequent tripping than usual should seek medical evaluation.

"Walking seems so natural that it is often taken for granted. However, it involves the brain, nerves, muscles, eyes and the balance system in the inner ear working in unison," he told HealthandMe.

"When there is a disorder in one of these systems, the way a person walks can be affected, which is exactly why the type of imbalance becomes an important consideration. One person may feel like they are being dragged in a particular direction," the expert added.

When Is Loss Of Balance A Neurological Warning Sign?

New, persistent or worsening balance problems warrant attention, Dr Batra said. Changes in walking patterns or deteriorating balance could sometimes indicate an underlying problem affecting the brain or spinal cord.

Certain conditions can cause pressure on the brain or spinal cord in the neck, resulting in subtle changes in walking patterns and the ability to maintain balance.

Dr Batra advised against dismissing increasingly abnormal changes in walking, particularly when they affect daily activities or occur alongside stiffness, tremors, weakness, numbness or difficulty with coordination.

Neurological Conditions That Can Affect Balance

Dr Atampreet Singh, Senior Director and Head, Institute of Neurosciences, ShardaCare - Healthcity, explained that disruptions in the systems responsible for maintaining balance can cause unsteadiness, difficulty walking in a straight line, frequent stumbling and an increased tendency to fall.

Recurrent balance problems may be associated with several neurological conditions, including:

• Parkinson's disease: Can affect movement and coordination, making walking and maintaining balance difficult.
• Cerebellar disorders: Can interfere with coordination and the ability to maintain a steady gait.
• Peripheral neuropathy: Damage to peripheral nerves can affect sensation and balance.
• Multiple sclerosis: Can disrupt communication between the brain and the rest of the body, affecting coordination and walking.

In older adults, recurrent or unexplained falls may sometimes be an early indication of an underlying neurological or sensory deficit, Dr Singh told HealthandMe.

Sudden Loss Of Balance Could Indicate A Stroke

A sudden loss of balance, particularly when accompanied by other neurological symptoms, can be a warning sign of stroke and requires immediate medical attention.

Dr Singh highlighted the following symptoms to watch for:

• Weakness or numbness on one side of the body
• Facial weakness
• Difficulty speaking
• Severe dizziness
• Visual disturbances
• A sudden, severe headache

Such symptoms require immediate medical assessment, the expert noted.

When Should You See A Doctor?

Seek medical attention if unsteadiness persists or worsens, particularly when accompanied by weakness or numbness in the arms or legs, frequent falls, severe headache, vomiting, changes in vision or speech, or loss of bladder or bowel control.

A doctor may conduct a neurological examination and recommend brain or spinal imaging, if necessary, to determine the cause.

The doctors noted that early diagnosis is important because some underlying conditions are treatable, and timely intervention may help prevent permanent neurological problems.

They advised patients to pay attention to when the imbalance began, whether it appeared suddenly or developed gradually, and whether it is accompanied by tremors, dizziness, numbness, weakness, speech changes or difficulty with coordination.