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.

India faces a substantial hepatitis C burden, with the World Health Organization (WHO) estimating that 5.5 million to 12 million people are living with chronic hepatitis C virus (HCV) infection.

Untreated chronic HCV infection can lead to liver scarring, cirrhosis and liver cancer. Could shortening treatment by four weeks help more patients access a cure?

A multi-center trial led by researchers from the Indian Council of Medical Research (ICMR) found that an eight-week course of a commonly used antiviral combination was as effective as the standard 12-week regimen in patients without cirrhosis. Published in The Lancet, the findings could have implications for treatment costs and access to care.

The treatment combines sofosbuvir (400 mg) and velpatasvir (100 mg), two direct-acting antivirals that target the hepatitis C virus.

What Did The Indian Trial Find?

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The RESOLVE trial, led by researchers from Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, evaluated whether eight weeks of sofosbuvir and velpatasvir could match the effectiveness of the standard 12-week course.

The trial enrolled 880 patients without cirrhosis across five publicly funded hospitals in Lucknow, New Delhi and Varanasi. Half received the combination for eight weeks, while the other half received it for 12 weeks.

Among participants who completed treatment and follow-up, 98.8% in the eight-week group achieved a sustained virological response, compared with 99% in the 12-week group. This means the virus remained undetectable after treatment, indicating a cure.

The researchers found that the shorter regimen was non-inferior to the standard course, meaning it was not less effective beyond the trial's prespecified statistical margin.

The study also reported no drug-related serious adverse events or treatment discontinuations due to adverse events.

How Shorter Treatment Help Reduce Hepatitis C Burden In India?

Direct-acting antivirals transformed hepatitis C treatment nearly a decade ago, making it possible to cure most patients with relatively few side effects. However, treatment costs and access remain important considerations for large public health programmes.

A 12-week course of sofosbuvir and velpatasvir costs approximately ₹15,000. Shortening treatment by four weeks could save around ₹5,000 per patient.

If adopted for a population of 60 lakh people requiring treatment, the shorter regimen could potentially save ₹3,000 crore. However, these are projected savings, and the actual impact would depend on patient eligibility, treatment costs and adoption in clinical practice.

Who Can Receive The Shorter Treatment?

The findings apply to patients without cirrhosis, as the trial excluded those with the condition. Patients with cirrhosis may require different treatment approaches depending on the severity of their liver disease and other clinical factors.

The trial's results do not mean that everyone with hepatitis C can switch to an eight-week course. Further evaluation and changes to relevant clinical guidance may be needed before the shorter regimen becomes routine practice.

Patients should consult their treating physician before making any changes to their prescribed treatment.

How Does Hepatitis C Spread?

Hepatitis C can cause illness ranging from mild infection to serious, long-term liver disease. Although some acute infections resolve spontaneously, chronic infection can progress to cirrhosis and hepatocellular carcinoma, a type of liver cancer.

The virus can spread through infected blood, including via shared needles and unscreened blood transfusions.

Perinatal transmission is an important route of HCV acquisition in children. Early detection can help identify infected infants and ensure appropriate follow-up.

Colorectal cancer (CRC), a term encompassing cancer of the colon and rectum, is not only a growing burden in India, but a significant proportion of patients are now being diagnosed at a young age. While colorectal cancer is more common in older adults, Indian clinical studies have identified the phenomenon of young onset colorectal cancer (YO-CRC), typically diagnosed before the age of 50. An experts’ review on epidemiology of colorectal cancer with special emphasis on India, an article in 2025 was published in the Indian Journal of Gastroenterology. The review found that there has been an annual rise of 2-3% in the incidence of colorectal cancer over the past two decades.

In the area of Young Onset Colorectal Cancer, an editorial in 2024 in the South Asian Journal of Cancer noted that one quarter to one-third of colorectal cancer patients in India were below 40 years, and many were diagnosed at stage III or IV. Titled Clinicopathologic Profile and Treatment Outcomes of Colorectal Cancer in Young Adults, A Multicenter Study from India, an article published in JCO Global Oncology studied colorectal cancer among adolescents and young adults. The study revealed 62.70% had colon cancer and 37.30% rectal cancer, with 67% being aged 30-39 years and no significant gender predisposition, though females had a higher metastatic burden.

Why is colorectal cancer affecting younger Indians?

There is no single explanation. Researchers have studied factors like dietary changes, obesity, physical inactivity, altered metabolism, alcohol consumption, smoking, and environment as possible contributors. Increasing urbanisation and changing food habits could also be playing a role in India’s shifting colorectal cancer profile. But not all patients present with conventional risk factors, and in many patients, the causes remain unclear.

Genetic predispositions need special mention. Conditions such as Lynch syndrome and familial adenomatous polyposis (an inherited genetic condition that causes precancerous polyps to form in the large intestine) can raise the risk of colorectal cancer at a young age, but most young-onset cases are not explained by an inherited cancer syndrome.

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The problem of missed symptoms

One of the biggest problems in cancer treatment is delayed diagnosis. Because cancer is associated with older age, the symptoms in younger people may be mistaken for piles, constipation, diet-related problems or even irritable bowel syndrome. Rectal bleeding, persistent changes in bowel habits, unexplained weight loss, abdominal pain, iron-deficiency anaemia, persistent fatigue, or a feeling of incomplete bowel evacuation is usually dismissed as minor issues in younger people.

What should young Indians do?

Colonoscopy is not a solution that can be recommended for every young adult. Symptoms- and risk-based screening is a more reasonable approach. People with persistent symptoms, a strong family history of colorectal cancer, hereditary cancer syndromes, inflammatory bowel disease, or unexplained anaemia may require more intensive evaluation (including colonoscopy) if clinically indicated. This are high risk group, and they need regular screening lifelong. India’s colorectal cancer burden is rising, and younger patients are important segment of this burden.

The evidence available does not prove a nationwide explosion of colorectal cancer in under-50 age groups in India, but it does demonstrate an increasing overall incidence, a significant presence of young onset colorectal cancer, and frequent late presentation. If someone have a first degree relative with colon or rectal cancer like parents, ideally, they should have a colonoscopy done by the age of 45. For younger Indians, early recognition of warning signs may be one of the most critical steps for timely diagnosis and improved outcomes.

By Dr. Abhishek Gangopadhyay, Consultant - Surgical Gastroenterology, Surgical Oncology, Narayana RN Tagore Hospital, Mukundapur, Kolkata

At 42, Danielle Ripley-Burgess of Kansas City, Missouri, has survived colon cancer three times, at 17, 25 and 39.

The disease often begins as noncancerous growths called polyps in the colon or rectum. Early-stage cancer and precancerous polyps may cause no noticeable symptoms. Ripley-Burgess spotted her first symptom at the age of 14 but ignored.

Her First Symptom At 14

At 14, Ripley-Burgess noticed specks of blood in her stool but hid them out of embarrassment, believing red foods might be responsible.

“I thought, I’m eating something red and that’s probably what I see,” she told Today. “So I put myself on a ‘no red foods diet’ and stopped eating anything that was red in color: everything from candy to pizza to salsa to raspberry popsicles.”

After two years she eventually told her mother, who believed it to be a case of hemorrhoids. As her bleeding worsened, and she developed fatigue and severe stomach pain, she was taken to a gastroenterologist.

Colon Cancer Diagnosis At Age 17 And 25

A few weeks after her 17th birthday, Ripley-Burgess was diagnosed with stage 3 colon cancer. She underwent chemotherapy, radiation and surgery. But years later, a follow-up colonoscopy revealed another cancerous polyp.

“I thought I had beaten cancer. I was getting colonoscopies every three years, and after one of them, I woke up and saw the very same look on the doctor’s face that I had seen eight years prior,” she said. “He saw a polyp that later turned out to be cancerous. I had no symptoms. At 25, I had stage 1 colon cancer.”

The second diagnosis was emotionally difficult as she feared losing the life she had built with her husband and the future they had planned.

Lynch Syndrome Increased Her Cancer Risk

Further testing revealed that Ripley-Burgess had Lynch syndrome, an inherited condition that increases the risk of colorectal, uterine and other cancers, according to the Mayo Clinic.

She underwent a preventive hysterectomy and subtotal colectomy, which removed all but about 13 inches of her colon.

Despite these measures, a colonoscopy in 2023 yet again detected a recurrence. At 39, she opted to have the remaining colon removed and a permanent ileostomy.

“I wasn’t expecting it, but I also wasn’t completely shocked,” she said, explaining that living with Lynch syndrome meant knowing cancer could return.

Why Blood in Stool Should Not Be Ignored

Ripley-Burgess now shares her story to encourage people, especially younger adults, to seek medical attention for unusual symptoms.

“If I could go back and tell my younger self something, it would be: Don’t be embarrassed about your body,” she told the outlet. “If you’re seeing something with your body that’s uncomfortable and weird, and you’re not ready yet to tell a doctor, tell somebody — a friend or family member. Don’t sit in that place of: something is wrong with your body, and you don’t know what it is. Don’t sit there alone. Don’t downplay what you’re seeing,” she

Colorectal cancer is expected to cause 158,850 new cases and 55,230 deaths in the US in 2026, according to the American Cancer Society.

Dr. Sajjan Rajpurohit, medical oncologist at BLK-Max Super Speciality Hospital, said, “Blood in the stool is one of the most common and concerning signs. While it might be due to hemorrhoids or fissures, it’s important not to assume. A proper evaluation is critical.”

Rectal bleeding can have several causes, but it should not automatically be attributed to hemorrhoids. Timely medical evaluation can help identify the cause and ensure appropriate treatment.