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.

Urgent action is required to strengthen diagnostics and vaccines to address gaps in dengue treatment, public health experts said.

The experts, including scientists and policymakers, were speaking at a day-long dialogue hosted in New Delhi by the Drugs for Neglected Diseases initiative (DNDi) in collaboration with the Translational Health Science and Technology Institute (THSTI), the Ministry of Health and Family Welfare, and the WHO South-East Asia Region.

The convening assumes significance ahead of the monsoon season, which historically sees a rise in Aedes aegypti mosquito populations and dengue transmission across health systems in South and South-East Asia.

"The WHO South-East Asia Region alone accounts for more than half of the global dengue burden, with 1.3 billion people living at risk across 10 endemic countries," said Dr Catharina Boehme, Officer in charge, World Health Organization, South-East Asia Regional Office.

Dr. Boehme called the rising burden of dengue both an economic crisis and a social crisis. She noted that beyond health system costs, dengue often leads to "lost productivity, lost wages, lost futures".

"To change this trajectory, we must close the gap on diagnostics, on vaccines, on therapeutics, and on health system resilience," Dr. Boehme said.

Also read: New dengue vaccine over 80% effective, prevents severe disease for up to 5 years

India Advancing in Dengue Fight, Gaps Remain

India reported over 2.89 lakh dengue cases in 2023, though experts believe the actual burden could be significantly higher due to underreporting and surveillance gaps.

Taruna Madan Gupta, Scientist G and Head, Development Research Division, ICMR, called dengue an "unequivocally a national health priority for India."

Gupta noted that "India is advancing on multiple fronts—from strengthening public health systems to enabling public-private partnerships, including Phase III trials of an indigenous tetravalent dengue vaccine with over 10,000 participants, and regulatory progress on global vaccines".

However, the expert flagged a critical gap, which is "the absence of an effective therapeutic" for the mosquito-borne disease.

The experts noted that even though there are improvements in surveillance and scientific understanding, patients still lack access to specific treatment options.

“Addressing this gap requires sustained commitment from governments, funders, and partners," said Dr Sanjay Sarin, Continental Lead Asia and Director South Asia, DNDi.

What Is Dengue?

Dengue fever is a viral disease transmitted by Aedes mosquitoes, which are most active during the daytime. Dengue fever typically has minor or no symptoms, but it can occasionally result in severe sickness, hospitalization, and even death.

Common Symptoms include:

• Sudden onset of high-grade fever.
• Intense headache
• Severe muscle, joint, or bone pain.
• Skin Rash that often appears 2–5 days after the fever starts
• Nausea and Vomiting
• Fatigue

It estimates that:

• About 390 million dengue infections occur annually worldwide
• Nearly 100 million people develop symptoms each year

These vaccines are designed to protect against all four serotypes of the virus, with a focus on reducing severe disease and hospitalizations.

In today’s fast-paced, wellness-driven world, looking fit does not always translate to being reproductively healthy. Currently, even fit and active individuals are facing fertility challenges due to hidden hormonal and metabolic imbalances. Hence, it is necessary to focus on reproductive health. Dr. Meenu Handa, Director of Fertility & Head Academic of Reproductive Medicine, Motherhood Hospitals, Gurgaon, decoded the link and listed some of the common fertility issues that most people overlook.

Now, a large number of people are opting for various activities such as yoga, Zumba, Pilates, the gym, and kickboxing to stay fit. Those who are health-conscious are also maintaining an optimum weight with a proper diet. These habits, in turn, can help to ensure good fertility. Shockingly, many people who are perfectly fit and fine on the outside may also struggle with fertility problems. Yes, that is right! This is also a common occurrence nowadays. Couples are panicking as they seem to adhere to a well-balanced lifestyle but still fail to conceive. So, this can be referred to as “invisible fertility issues," where underlying hormonal or metabolic imbalances silently affect reproductive health.

Decoding invisible fertility issues

Dr Handa said that many men and women who exercise regularly may suffer from issues such as hormone imbalance, fluctuating insulin levels, poor thyroid function, and compromised reproductive organ health. Conditions like polycystic ovary syndrome (PCOS), thyroid disorders, insulin resistance, and even chronic stress can exist without obvious physical signs and can take a toll on fertility. The expert also shared some of the common hidden infertility issues.

Even couples who are physically fit today often deal with high mental stress due to demanding jobs and poor work-life balance. This ongoing stress can quietly disturb hormonal balance in the body. Increased cortisol levels may affect ovulation in women and sperm production in men and, over time, can impact egg and sperm quality—making natural conception more difficult. That is why managing stress is just as important as staying physically fit when planning a pregnancy.

Women may have issues like poor ovulation, compromised egg quality, or hormonal imbalance, even if their menses tend to be regular. In some cases, even subtle symptoms like fatigue, acne, hair fall, or mood swings may be overlooked but can signal deeper hormonal concerns. Men can struggle with low sperm count, which can affect their fertility. Even insufficient sleep, excessive exercise, or extreme dieting can increase the chances of hormonal imbalance and fertility issues. It is necessary to consult an expert and seek timely help. Pollution and lifestyle stress also contribute to the trend.

Couples should not just plan a pregnancy because they are fit and exercise daily. Pregnancy should not rely only on outward fitness as a sign of reproductive health. Regular health check-ups, including hormone tests and fertility assessments, can help identify hidden issues early.

Follow these tips

1. Couples should eat a well-balanced diet, exercise daily, stay stress-free by practicing yoga and meditation, and get enough rest.
2. It is also imperative to maintain blood pressure and blood sugar levels within the recommended range, include healthy fats and proteins in the diet, avoid overtraining, and manage stress through relaxation techniques like yoga or meditation, which can support hormonal balance.
3. If a couple is unable to conceive even after 6–12 months of trying (depending on age), a detailed fertility evaluation is recommended.
4. Seeking timely medical advice is equally important if conception is delayed.
5. Couples who find it challenging to conceive may be advised to use ARTs, such as in vitro fertilisation (IVF).

So, awareness, balanced lifestyle choices, and timely medical support can make a huge difference in improving fertility outcomes.

A heatwave is getting worse with each passing day, and with it come dehydration, stomach flu, and sometimes even mood swings. But little do people realise that the risks associated with a heatwave could be much worse - it turns out that exposure to extreme heat could also give you a stroke. Dr Deep Das, Consultant - Neurology, CK Birla Hospitals, CMRI, in an interview with Health and Me, decoded the link between heatwaves and the risk of stroke.

How does a heatwave affect stroke risk?

Dr Das said that in very high temperatures, the body does not always cope in predictable ways. The brain is particularly sensitive to these shifts. One of the concerns is stroke. In the heat, people tend to lose fluids without realising how much. Blood volume drops, and circulation is affected. In some cases, the blood becomes more prone to clotting. At the same time, blood pressure can fluctuate. This combination increases the chances of a disruption in blood flow to the brain.

Can extreme heat give you a seizure?

Seizures are another risk, especially in those who already have epilepsy. Even when the condition has been stable, heat can unsettle things. Dehydration and changes in electrolyte balance make the brain more reactive than usual. A person who has been well-controlled for months may still have an episode during a prolonged heatwave. What makes this difficult is that these changes are not always gradual. Symptoms can appear suddenly.

What are the symptoms of a stroke?

A stroke refers to a potentially fatal medical emergency. It can be sudden or gradual, and it is characterised by a blockage in blood circulation to the brain. It can result in rapidly dying brain cells and requires immediate medical attention. The symptoms of stroke can be identified as FAST:

1. Face: Face drooping on either side
2. Arms: Weakness in the arms or inability to move the arms
3. Speech: Slurred speech
4. Time: Time is an important factor; immediate action can be life-saving for stroke patients

Apart from this, other symptoms of a stroke are:

1. Severe, unusual headaches
2. Confusion
3. Loss of consciousness
4. Dizziness
5. Loss of balance
6. Inability to see clearly from one or both eyes

How to dodge a heatwave-related stroke?

In this weather, small precautions matter more than they seem. Some of the best ways to dodge a stroke amid a heatwave are:

1. Drinking water regularly helps, even before you feel thirsty
2. Staying indoors during peak afternoon hours reduces strain on the body
3. Living spaces need some form of airflow, even if it is basic ventilation

It also helps to keep an eye on people who may not notice these changes early—older adults, those living alone, or anyone with an existing medical condition.

Should you be worried?

Some people are more prone to stroke risk than others. Therefore, it is important to be aware of the risk factors, especially during a heatwave. If you are dealing with any of the following comorbidities, think twice before stepping out amid a worsening heatwave:

1. Hypertension
2. Diabetes
3. Irregular heartbeat
4. Sleep apnoea
5. High cholesterol

Furthermore, people who are 65 years and above must avoid stepping out from 12 noon to 4pm. Even people who have a family history of stroke must not step out during these hours.