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.

Most people pay little attention to their knees, legs and ankles until something goes wrong. Once pain sets in, even simple things like walking, climbing stairs, or standing for long can become a real challenge. Left unmanaged, lower limb pain gradually affects mobility, independence and quality of life.

What Is Usually Behind the Pain?

Knee pain commonly traces back to osteoarthritis, ligament injuries, cartilage damage, or years of wear. Pain in the leg can be caused by muscle injuries or conditions involving nerves and poor blood flow. The pain in the ankle is commonly caused by sprains, tendinitis, arthritis, or any injury that may have occurred earlier without complete healing.

Age, obesity, sedentary lifestyles, and constant joint injuries contribute silently to the degenerative condition of the joints.

Signs That Should Not Be Ignored

Persistent pain, swelling, stiffness, or discomfort that keeps getting worse deserves attention. If pain is disturbing your sleep, that is a clear signal to see a doctor.

Habits That Help Protect Your Joints

Walking downstairs puts considerable pressure on the knees, so limiting stair use where possible is sensible. Squatting, sitting on the floor and using Indian-style toilets place similar strain and are better avoided.

Staying active matters just as much. Regular household chores, walking, stretching and strengthening exercises, even 15 to 20 minutes a day, keep muscles strong and reduce the load on joints. Focusing on the adductor muscles around the knee is particularly effective in improving joint support.

Non-Surgical Options Worth Knowing

Surgery is not always the answer. Two non-surgical treatments carried out by a pain physician can make a meaningful difference.

Platelet-Rich Plasma therapy, or PRP, involves concentrating platelets from the patient's own blood and injecting them into the affected joint. In osteoarthritis, where cartilage gradually thins, PRP may help support regeneration and ease symptoms.

Radiofrequency Ablation, or RFA, uses a specialized needle to deliver targeted heat that interrupts the nerves responsible for sending pain signals to the brain. Relief typically lasts one to two years. The procedure is done as day care with no cuts, no stitches and no anesthesia required.

A concern many patients raise is that pain stops them from exercising or losing weight. Once pain is controlled through these treatments, walking and light activity become manageable again, which in turn supports weight loss and takes further pressure off the joints.

Custom Knee Supports

Off-the-shelf knee caps have limited effectiveness. A custom-made support, designed to redistribute body weight and reduce joint stress, works considerably better, especially in early arthritis. Many patients notice relief shortly after wearing one. They are an investment, but a worthwhile one that can reduce dependence on medication while the surrounding muscles gradually strengthen.

When to See a Doctor

If pain has lasted several weeks, is worsening, or is getting in the way of daily life, it is time to consult a specialist. Early diagnosis and the right treatment can protect joint function, restore mobility and often avoid the need for surgery.

(By Dr. Aanchal Sharma, Pain Physician, Principal Consultant and Head of Department, Department of Pain Medicine at BLK MAX Hospital, New Delhi)

Doctors in Mumbai are reporting a simultaneous rise in Covid-19, H1N1, commonly known as swine flu, and other respiratory viral infections.

As per the doctors, there is up to a 30 per cent surge in cases of COVID-19 and H1N1 as well as viral infections in the city. The doctors attributed the surge in infectious diseases to seasonal changes.

“We are currently observing a 20-30 per cent surge in Covid-19 and H1N1 (swine flu) respiratory viral infections in the city, mainly due to seasonal changes, increased humidity, and exposure to crowded places,” Dr. Aniket Mule, Consultant Internal Medicine, KIMS Hospital Thane, told HealthandMe.

Dr. Amit Saraf, Director of the Department of Internal Medicine, Jupiter Hospital, Thane, reported a rise in influenza-like illness (ILI) in the hospital.

“There is a seasonal rise in respiratory infection cases in Mumbai. Most of the people have routine viral infections, and around 10-15% of the people who are coming to OPDs have been coming positive for influenza-like illness (ILI) due to the changing weather,” Dr. Amit told HealthandMe.

Dr. Rohit Deshpande, Consultant Internal Medicine, Lilavati Hospital and Research Centre in Mumbai, told HealthandMe that the hospital is seeing a rise in swine flu cases.

“On average, 7 to 8 cases are being detected in the OPD daily. Most patients present with symptoms such as fever, cough, body ache, and fatigue”.

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What Are The Symptoms?

The experts reported that the commonly seen symptoms include:

• persistent fever,
• dry or wet cough,
• sore throat,
• fatigue,
• body ache
• mild breathlessness

Who Is More Vulnerable?

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Dr. Amit noted that people with chronic illnesses, elderly people, pregnant women and young children are still more susceptible to complications.

Dr. Rohit noted that people with diabetes and those with conditions such as COPD, asthma and heart diseases are also at higher risk of infection.

How To Prevent?

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The experts noted that most of the cases now are mild and can be handled with timely consultation, rest and supporting care.

But older people, pregnant women, children, and those with pre-existing health conditions should take extra care. Those with an ongoing fever, cough, sore throat, breathlessness, or extreme tiredness should seek immediate medical advice, Dr. Aniket said.

“Simple preventive measures like hand hygiene, use of masks in crowded places, proper hydration and timely medical consultation can help a lot in reducing the risk of complications,” he told HealthandMe.

Preventive measures for the general population include:

• Avoid self-medication
• If you experience a persistent cough or breathing difficulties, consult a doctor regarding the need for anti-viral or anti-allergy medications.
• Get vaccinated every year to boost Immunity and reduce the risk of infection.
• Avoid crowded and dusty places, redevelopment areas, or places with pigeon droppings.
• Use hand sanitizer, wash your hands frequently and thoroughly, and wear a mask in crowded or dusty environments
• Do warm saline gargles with salt or betadine twice or thrice a day
• Take steam hydration if required too
• Maintain hydration to avoid weakness, fatigue, or headache
• To boost immunity - consume green leafy vegetables & Vitamin C-rich fruits along with Vitamin D supplements

The common perception about varicose veins is that they are merely an aesthetic or cosmetic problem. Varicose veins are indeed enlarged, twisted blood vessels that many people believe are not life-threatening. But the reality is that the condition may be a symptom of something more serious.

The disease manifests itself through insufficient blood supply in the body caused by faulty valves. As the blood vessels cannot effectively move the blood from the veins back to the heart, the blood tends to accumulate in the veins themselves. Other symptoms may include pain, heaviness, swelling, and skin sores in severe cases.

What Are The Causes Of Varicose Veins?

Varicose veins don’t develop overnight; they are usually the result of multiple underlying factors that gradually affect vein health and blood flow:

1. Valve dysfunction and poor circulation: Healthy veins rely on tiny valves to prevent backflow. When these valves weaken, blood starts collecting in the veins, leading to increased pressure and visible swelling.

2. Prolonged standing or sitting: These days, occupations require long hours of standing, which can hinder proper blood circulation and increase the risk.

3. Hormonal changes: Hormonal fluctuations during pregnancy, menopause, or while using hormonal therapies can relax vein walls, making them more prone to dysfunction.

4. Genetics: A family history of varicose veins significantly raises the likelihood of developing them, indicating a hereditary component in vein wall strength and valve efficiency.

5. Obesity and lack of physical activity: Excess body weight puts additional pressure on veins, while a sedentary lifestyle reduces the efficiency of blood circulation, leading to vein damage over time.

6. Ageing: As people age, veins lose elasticity, and valves may wear out, making older adults more susceptible to developing varicose veins.

What Are The Tips To Take Care Of?

People can manage or reverse varicose veins by:

• Making sure blood is circulating well in the body: An inactive lifestyle or standing for long periods can lead to increased risks of vein disease. Exercise and movement, along with raising the legs, will ensure that blood continues circulating well.

• Maintaining a healthy weight: Obesity can lead to increased pressure on the veins of the legs. Maintaining a healthy body weight is important to avoid and treat varicose veins.

• Wear compression stockings: Compression stockings apply gentle pressure to the veins, which enables them to circulate blood effectively and avoid swelling and other conditions.

• See a vein specialist if necessary: In cases of persistent pain, discoloration of skin, severe itching, or sores that don't heal, it is advised to see a vein specialist, as these symptoms could signal something worse.

How Can It Be Treated?

Varicose vein treatment procedures have become much easier in the modern world. Varicose veins can now be treated with minimally invasive procedures that address the problem at its root cause. These minimally invasive treatments include EVLT (Endovenous Laser Treatment), Radiofrequency Ablation (RFA), and glue ablation. A laser fibre is inserted into the varicose vein during this operation, where it effectively closes it off.

Blood is automatically redirected through other veins after this treatment, which is relatively quick and involves local anesthesia. Patients generally recover within one day. However, EVLT is much less painful, safer, and does not involve leaving scars behind.

Varicose veins are often a symptom of vein disease and thus not just a cosmetic problem. They can be a visible sign of an underlying circulatory issue. Paying attention to early symptoms and seeking medical advice can help prevent complications and improve overall vascular health. Preventing further problems is easy when one knows what to do.