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.

Heart clips—also referred to as heart valve clips—are part of a minimally invasive medical procedure known as Transcatheter Edge-to-Edge Repair (TEER). Designed to repair leaking heart valves without open-heart surgery, this advanced treatment restores proper blood flow, relieves debilitating symptoms, and helps patients return to their daily lives.

Understanding Valve Leakage and Symptoms

The heart's valves rely on thin flaps of tissue called leaflets to regulate blood flow.

• The mitral valve (located on the left side of the heart) typically has two leaflets.

• The tricuspid valve (located on the right side of the heart) usually consists of three leaflets.

When a valve is leaking, the leaflets fail to close completely, leaving a gap. Blood leaks backward through this opening toward the lungs, increasing lung pressure and directly causing chronic breathlessness and fatigue.

Also read: 100% Blockage At 18, 25% Patients Under 40: On World Heart Day, Cardiologists Reveal An Alarming Heart Attack Pattern

How the Clip Repair Procedure Works

During a Transcatheter Edge-to-Edge Repair, cardiologists repair the valve using a tiny clip delivered through the vascular system:

1. Catheter Access: Guided by continuous echo imaging, doctors insert a catheter into a blood vessel in the groin and navigate it directly to the heart.
2. Targeting the Valve: The catheter goes to the left side of the heart for a mitral valve repair or to the right side for a tricuspid valve repair.
3. Identifying the Leak: Imaging pinpoints the exact spot where the leaflets fail to seal.
4. Deploying the Clip: The doctor positions and deploys the clip across the leaking gap, grasping the two opposing leaflets and pulling them closer together.
5. Evaluating the Seal: Before releasing the clip completely, doctors perform an echocardiogram to confirm that the clip is strongly anchored, that the backward leak is fixed, and that the risk of clip detachment (embolization) is negligible.

Immediate Relief and Long-Term Healing

Once the clip brings the leaflets together, backward leakage stops immediately, allowing the entire volume of blood to pump forward as intended.

• 24-Hour Recovery: Pressure inside the lungs drops rapidly once the leak is sealed. Many patients notice a dramatic improvement in their breathing within 24 hours of the procedure.

• 3 to 6 Month Integration: Over a period of three to six months, surrounding heart tissue naturally grows over the clip (endothelialization), permanently integrating it into the heart structure.

Smooth Hospital Stay and Recovery

Because the procedure is catheter-based rather than open-chest, patient recovery is remarkably swift:

• In-Room Extubation: Patients are taken off the ventilator right on the procedure table.

• Minimal Closure Site: The groin entry point is closed cleanly using specialized sutures (such as ProGlide or a figure-of-eight suture).

• Quick Discharge: Patients typically spend just one day in the Intensive Care Unit (ICU) before moving to a standard room, after which they can return home and resume normal daily activities.

Frequent cannabis use may worsen epilepsy-related symptoms, new research. It discovered that raised that people with drug-resistant epilepsy who used cannabis often had more frequent convulsive seizures and sought advanced epilepsy care much sooner than non-users.

Published in Epilepsia, the study analysed health records of 64 adults with drug-resistant epilepsy. It found that frequent cannabis users reached an intensive epilepsy monitoring stage an average of five years after their first seizure, compared to 18 years reported among non-users.

The difference of 13 years is attention-worthy but it must be noted that the study shows an association, not proof that cannabis worsens epilepsy.

Seizures Doubled In Cannabis Users With Epilepsy

Researchers compared 22 people who used cannabis at least 20 days a month to 42 people who did not.

The frequent users reported to have a heavier burden of seizure, one of the symptoms of epilepsy. They had more than twice as many convulsive seizures per year than non-users.

About 91% of frequent cannabis users experienced convulsive seizures, compared to roughly half of the non-users.

Seizures involve stiffening and jerking of the body and loss of consciousness. They constitute medical emergency as they are associated with sudden death in epilepsy.

Also read: Does Cannabis Really Help You Sleep? Experts Say It Is Complicated

What Does Drug-Resistant Epilepsy Mean?

Epilepsy is considered drug-resistant when seizures continue despite appropriate treatment with two antiseizure medications.

People with drug-resistant epilepsy may need to visit specialised epilepsy centres, where doctors can monitor them and recommend changes in medication, surgery, or other treatment options. In this study, frequent cannabis users reached this stage much earlier.

They were also discharged from hospital after taking an average of 3.05 antiseizure medications, compared with 2.21 among non-users.

Also read: Why Can’t Millennials Sleep? The Crisis Keeping An Entire Generation Up At Night

Cannabis & Epilepsy

This was a retrospective study based on health records of a small sample size. There may be other differences between people who used cannabis often and those who did not that could affect the severity of the seizures.

However, researchers were able to establish the timing of cannabis use for 15 of the 22 users. All 15 had started using cannabis before their first seizure, making it less likely that they had simply begun using cannabis to cope with an already existing seizure disorder.

The researchers say larger studies can determine whether cannabis contributes to worsening seizures.

The association between cannabis and seizures is complicated as CBD (cannabidiol) is reported to have beneficial effect on severe epilepsy.

To understand the seeming contradiction, we must understand the distinction between cannabis and purified cannabidiol (CBD).

A purified form of CBD is an approved treatment for certain severe forms of epilepsy. CBD is different from THC, the psychoactive element responsible for the “high” associated with cannabis. Recreational cannabis products may contain high concentrations of THC.

According to the researchers, animal studies suggest CBD can suppress seizures, while THC may have the opposite effect.

Hence, evidence that a specific CBD-based medicine can help certain epilepsy syndromes cannot be used to conclude that recreational cannabis is an epilepsy treatment.

Researchers suggest that THC acts on receptors concentrated in brain regions involved in seizures, raising the possibility that cannabis could influence how brain circuits fire. But this is a hypothesis that needs further investigation.

A stroke changes the life of a person in an instant, making everyday activities like walking, talking, or even holding a cup difficult. But strokes do not always mean these challenges are permanent. Many people recover lost abilities and enhance their lives with timely treatment, proper rehabilitation and continued support.

A stroke occurs when blood stops flowing to the brain or a blood vessel in the brain bursts, cutting off oxygen to brain cells. It can cause weakness or paralysis, speech problems, poor balance, or memory issues, or trouble swallowing, depending on the part of the brain that is affected.

Tips to Support Recovery from Stroke

• Begin rehabilitation immediately after a stroke
• Attend Physiotherapy and speech Therapy sessions regularly
• Take prescribed medications as directed.
• Keep blood pressure, diabetes and cholesterol under control.
• Have a healthy and nutritious diet to restore energy.
• Stay physically active
• Seeking emotional and psychological support

Also read: 100% Blockage At 18, 25% Patients Under 40: On World Heart Day, Cardiologists Reveal An Alarming Heart Attack Pattern

The Treatment Journey:

Timely Medical Care Makes a Big Difference

Patients who reach the hospital within a certain time may be eligible for clot-busting medications or clot removal procedures. These procedures restore blood flow, reduce brain damage and increase the likelihood of faster recovery.

Rehabilitation starts immediately after stroke

Stroke care extends beyond emergency treatment. Rehabilitation begins within 24 hours after a stroke when the patient is medically stable. A team of specialists, including neurologists, physiotherapists, and speech therapists, works together to help the patient regain function, rebuild confidence and return to everyday activities as soon as possible.

Physical Therapy to Rebuild Body Movement and Independence

When a stroke happens, muscles on one side of the body may become weak or paralysed, affecting the patient's strength, balance, coordination, posture, and walking.

Physiotherapy consists of a series of exercises, muscle training and mobility techniques that enhance mobility of the body and improve functional independence. Many patients can perform activities with greater ease with regular rehabilitation.

Also read: Weekend Workouts: Why Sudden Intense Exercise May Put Stress on Your Heart

Enhancing communication and cognitive skills

After a stroke, some patients have problems talking, speaking, swallowing, remembering or concentrating. Speech and language therapy are used to help with communication and safe swallowing, and cognitive rehabilitation is used to support memory, attention, reasoning and problem solving. These therapies assist patients in re-entering the workforce, social circles and independent living more smoothly.

Modern Rehabilitation Methods for Better Recovery

Advances in rehabilitation have expanded the range of therapies available to support stroke recovery.

Techniques like robot-assisted rehabilitation, functional electrical stimulation (FES), virtual reality-based therapy, constraint-induced movement therapy, balance training systems and computer-assisted gait training complement conventional rehabilitation very well. These methods provide repetitive, targeted exercises that promote functional improvement in the brain and body.

Managing Ongoing Challenges

After a stroke, some patients have muscle stiffness (spasticity), chronic pain or trouble walking or moving their hands. They are treated with medications, injections and continued rehabilitation therapy.

Recovery from a stroke is much better with proper rehabilitation. While some regain most of their abilities, others continue to need support, making patience and consistency just as important as medical help. The right care at the right time makes a big difference in rebuilding your life.

By Dr. (Lt Gen) CS Narayanan, VSM, Chairman - Manipal Institute of Neuro Sciences, Manipal Hospital, Dwarka, New Delhi