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.

The World Health Organization (WHO)'s Montreal meeting focused on wearable technology like smartwatches and activity trackers as a reliable source of health tracking. The meeting discussed that wearables could in fact generate objective real-time data, which helps governments design targeted and evidence-based health interventions.

Physicians in the Montreal meetings discussed that wrist-worn devices are more reliable than traditional self-reported surveys. This is because the self-reported surveys could underestimate the levels of physical inactivity.

“Metrics such as step count, moderate-to-vigorous physical activity and sedentary time directly correlate with cardiovascular disease, diabetes and mental health outcomes. Having population-level data allows for early and preventive strategies,” said Dr Venkat Nani Kumar, consultant in internal medicine.

WHO Montreal Meeting: How Have Doctors Reacted The Shift To Wearables?

Doctors in India have welcomed this shift to wearable devices as a better way to generate data and make policies. Dr Kiran Madhala, professor at Gandhi Medical College, Secunderabad, said WHO’s shift reflects rapid advances in artificial intelligence and digital health tools, calling it a progressive step towards improved monitoring of physical activity worldwide.

City-based doctors also underlined the need for inclusive validation of devices. “Wearables must recognise varied movement patterns and step equivalents, especially in ageing populations,” a physician said, while stressing the importance of data privacy and ethical use of health information.

WHO Montreal Meeting: What Are Wearable Health Devices?

As per a 2022 study published in JMIR MHealth and UHealth, wearables refer to devices that are worn by individuals. In health care field, they assist with individual monitoring and diagnosis. Wearables are “seamlessly embedded portable computers...worn on the body," notes another 2018 study published in Telematics Informatics.

A 2018 study published in the journal Sensors noted that wearable health devices are increasingly helping people to better monitor their health status both at an activity/fitness level for self health tracking and at a medical level providing more data to clinicians with a potential for earlier diagnostic and guidance of treatment.

WHO Montreal Meeting: What Are Some Examples Of Wearables?

Blood Pressure Monitor

This is a blood pressure monitor that consists of a cuff that is placed in upper arm with a digital display that provides real time reading of systolic and diastolic blood pressure.

Glucose Monitoring Device

This device estimates your glucose levels in every few minutes. It can be worn in upper arm, with a phone sensor connected to measure readings. It also includes real time glucose alarms to make informed decisions.

Wearable ECG Monitor

ECG patches are interconnected with smartphones, where one can see their readings. They not only measure electrocardiograms, but also detect any abnormalities.

Fitness Tracker

Smartwatches or fitbits that could be worn on your wrist. They help track real time data of your health, steps, heart rate, calorie consumptions, and even sleep patterns. It can also help keep track of oxygen levels.

Integrated Activewear

These activewears come with microscopic sensors to safeguard wearer's body or assist them in reaching their fitness objective.

Atrial fibrillation (AFib) is an irregular and often very rapid heart rhythm, also called an arrhythmia and can create blood clots in the heart, which can increase your risk of having a stroke by five times.

When a person has AFib, the normal beating in the upper chambers of the heart (the two atria) is irregular and blood doesn't flow as well as it should from the atria to the lower chambers of the heart (the two ventricles).

In this case, the risk of developing blood clots in your heart increases, which can not only cause a heart attack but also damage vital organs such as your brain. An AFib may happen in brief episodes, or it may be a permanent condition.

Common symptoms include palpitations (the feeling that your heart is racing, pounding, fluttering or like you have missed heartbeats), chest pain, finding it harder to exercise, tiredness, shortness of breath, dizziness or feeling faint.

READ MORE: You Can Stop A Heart Attack With This Medicine, Cardiologist Reveals Heart Attack 101

The death rate from AFib as the primary or a contributing cause of death has been rising for more than two decades.

Over 454,000 people with AFib are hospitalized in the US each year, out of which 158,000 die of the cause. It is estimated that 12.1 million people in the US will have AFib in the US will have AFib by 2050.

Who Is At Risk Of Having AFib?

• Advancing age.
• High blood pressure.
• Obesity.
• European ancestry.
• Diabetes.
• Heart failure.
• Ischemic heart disease.
• Hyperthyroidism.
• Chronic kidney disease.
• Moderate to heavy alcohol use.
• Smoking.
• Enlargement of the chambers on the left side of the heart.

Treatment for AFib includes medications to control the heart's rhythm and rate, therapy to shock the heart back to a regular rhythm and procedures to block faulty heart signals.

A person with atrial fibrillation also may have a related heart rhythm disorder called atrial flutter. The treatments for AFib and atrial flutter are similar.

How To Improve Your Heart Health

Experts recommend following the below to reduce yor risk of stroke or developing AFib and maintaining heart health:

• Don't smoke or use tobacco.
• Aim for at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity (or an equal combination of both) each week. Eat a heart-healthy diet.
• Stay at a healthy weight.
• Get quality sleep.
• Manage stress levels
• Get regular health screening tests.
• Eat a fiber, nuts and fish-rich diet
• Limit salt intake
• Reduce saturated fat intake

Changes in your voice, whether in tone, volume, speed or overall quality, can act as early warning signs for a wide range of medical conditions, experts say.

Your voice is produced by the coordinated effort of your respiratory system, vocal cords (also called vocal folds), and the resonating chambers of your throat, mouth, and nose. Even subtle shifts in hormone levels, hydration status or tissue health can noticeably affect how you sound.

Recent research shows that subtle changes in speech, for example, slurring or vocal cord tremors, may be signs of disease or illness like Parkinson’s disease, depression, cardiac and mental health problems, as speech requires coordination with the brain, muscles and respiratory system.

Which Conditions Can You Identify By A Change In Voice?

• Diabetes: High-pitched, raspy voices or vocal strain can be linked to diabetes, with AI studies showing up to 75% accuracy in prediction.
• Cardiovascular Disease: Voice analysis can detect high, fluttering voices associated with coronary artery disease, caused by stress or fluid changes in the vocal cords.
• Hypothyroidism: A deeper, softer, or huskier voice can indicate thyroid dysfunction.
• Respiratory Illnesses: Conditions like COVID-19 or COPD are often associated with a breathy voice, coughing, and short, interrupted sentences.
• Throat Cancer: Persistent hoarseness and raspy voice, especially lasting more than 2-3 weeks, can indicate laryngeal cancer.
• Parkinson’s Disease: Identified by a monotone voice, reduced volume, increased breathiness, and vocal cord tremors.
• Alzheimer’s Disease/Dementia: Characterized by slower speech rates, hesitation, frequent pauses, and simplified vocabulary/sentence structure.
• Stroke or Brain Injury: Indicated by slurred speech or difficulty finding words (global aphasia).
• Cerebellar Disorders (caused by damage to the nerves in the brain's cerebellum): Manifest as loud, staccato speech (bursts of broken sounds).
• Depression: Linked to a flatter, softer, and more monotone voice with a reduced pitch range.
• Anxiety/Stress: Often presents as a higher-pitched, faster, and more tremulous voice.
• Schizophrenia: Indicated by monotone, disorganized speech.

What Else Can Affect Your Voice?

Apart from serious medical conditions, voice changes may also be linked to aging and lifestyle factors. Fluctuations in testosterone, estrogen, progesterone, and thyroid hormone levels may also influence the structure and function of the vocal cords.

Dehydration is one of the most common causes of voice problems, as cords need adequate moisture to vibrate efficiently. Aim for at least 64 ounces of water daily, and more if you use your voice professionally or live in a dry climate.

Smoking irritates and inflames the vocal cords, causing chronic hoarseness and increasing the risk of vocal cord cancer. Even secondhand smoke and vaping can affect voice quality.

Diet also plays a role in vocal health. Caffeine and alcohol are diuretics that can dehydrate your vocal cords. Spicy foods and acidic beverages may trigger reflux, irritating the throat.

Dairy products can increase mucus production in some people, affecting voice clarity. Voice overuse or misuse, common in teachers, singers, and public speakers, can lead to vocal fatigue and damage. The following table compares how different lifestyle factors impact your voice.

How Can You Take Care Of Your Voice?

Whether the cause is hormonal changes, medical conditions, aging, or lifestyle factors, most voice problems can be improved with proper diagnosis and treatment. Here are some things you can do to take care:

• Stay hydrated by drinking water throughout the day and using a humidifier in dry environments
• Warm up your voice before extended speaking or singing with gentle humming or lip trills
• Avoid shouting or whispering, both of which strain the vocal cords
• Take voice breaks during prolonged speaking to prevent fatigue
• Manage stress through relaxation techniques, as tension affects voice quality
• Treat allergies and sinus problems promptly to reduce postnasal drip
• Maintain good posture to support optimal breathing and voice production