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.

Of the many medicines that we consume on a day to day basis, we are not aware of how gradually they are actually making our health worse. One medicine that is common in many households, especially in India households, as points Dr Obaidur Rahman, Ortho and Sports Surgeon is pantoprazole, popularly sold under the name PAN40, PAN Top or PAN D. These medicines are used to treat and relieve symptoms of heartburn, which is a common symptom of acid reflux and GERD.

"A patient came to me, he was an 80-year-old male. He has a habit of taking this tablet regularly, and because of that he suffered an osteoporotic fracture. This means he fell while walking and fractured," points out Dr Rahman.

He says that many people, old and young, alike, have a habit of taking this pill like a multivitamin. In fact, they have substituted with pro and prebiotics and assume that it helps with digestion. However, he points out, "If you take this regularly, your gastric mucosa stops responding against proper acid production. And there is also an impairment in digestion."

He says that in clinical practice, it has been found that this common household medicine, which is often procured as over-the-counter or OTC medicine, meaning, without prescription, could cause Vitamin B12 deficiency, and magnesium deficiency.

What Does The Science Say About Pantoprazole Use?

As per a 2023 study published in the journal BioMed Research International, pantoprazole cause bone loss, which could be prevented by adding octreotide.

The study analyzed the serum levels of calcium, phosphorus, and ALP before starting the treatment, and at the end of 12 weeks of treatment on pantoprazole, significant decline in calcium levels were noticed, as compared with other groups. The study also found that octreotide significantly prevented the effect of pantoprazole on the serum levels of calcium and ALP.

The study also found that pantoprazole decreased femoral bone density and femoral BMAD. Besides this, another decrease was found in the femoral bone weight and volume as well as the trabecular volume.

Another study from 2021, published in the European Journal of Clinical Pharmacology pointed out that 12 patients had major fractures and showed changes in serum Mg2+ and Ca2+ levels over a period of 1 month as well as the animal study also showed ionic imbalance over 8-week treatment with pantoprazole. Bone density measured for the patient at the end of the 1-month treatment was found to be in the osteopenic category, together with the animal study which showed a decrease in femur bone strength for the animal treated with pantoprazole over a period of 8 weeks.

Are There Any Safer Alternatives To Pantoprazole?

Pantoprazole contain Proton Pump Inhibitor (PPI), and prokinetic, long-term use of PPIs is associated with the risk of bone fracture. However, alternatives like Histamine H2-receptor antagonists or H2 blockers are effective alternative that do not cause bone loss, notes a 2020 study published in journal Bone, titled Comparative analysis of the risk of osteoporotic fractures with proton pump inhibitor use and histamine-2 receptor antagonist therapy in elderly women: A nationwide population-based nested case-control study.

The safer alternatives are:

Famotidine (Pepcid, Calmicid, Fluxid, Mylanta AR) is a potent H2 blocker used to manage acidity and heartburn. Studies show that famotidine is not thought to raise the risk of osteoporosis.

Other options: Ranitidine (Zantac - where available, as it was withdrawn in some markets due to safety concerns) and Nizatidine are other H2 blockers.

Note: Health & Me do not encourage discontinuance of any prescribed medicine by a doctor. Before making any change in your medicine schedule, please speak to your doctor/GP.

This flu season could be brutal, say the early clues that scientists have gathered. This comes as the world already struggles keeping up with the new variants of COVID, however, the COVID rates in the US appears to be low. Though researchers are expecting the virus to circulate more widely in the coming months as people gather for holidays.

This is also the time for common cold. Dr William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center tells the New York Times that if you feel ill, but your symptoms remain only above the neck, that is, a stuffy nose, a sore throat, then it could just be a common cold.

However, if the symptoms lead to hacking cough, and down the neck, which makes your muscles ache and body tired, that it could be a flu or COVID. Due to the similarities in the symptoms, even infectious disease specialists also struggle to tell the difference.

Symptoms To Take A Note Of

COVID

How it begins: Initially, symptoms of COVID can mimic flu-like symptoms

What are the primary symptoms of COVID?

• Loss of taste
• Loss of smell
• Sore throat: the new variants are also causing razor-sharp pain in the throat
• Diarrhea or stomach upset

The biggest difference here is the dry and persistent coughing, which when you have a cold will not be dry in nature.

How it impacts? The COVID may vary from mild to severe

Since the pandemic, Covid has blurred the lines between seasonal infections. Current strains can trigger flu-like fatigue, fever, and cough. But the loss of taste or smell and digestive issues are stronger indicators of Covid.

For confirming COVID, test is the only key. There are now at-home tests available online and at drugstores too. An at-home test could detect both, a flu and COVID.

Common Colds

How it begins: The symptoms of common cold starts gradually.

What are the primary symptoms of Common Cold?

• Stuffy or runny nose
• Sore throat, but not razor-blade like pain
• You may feel pressure in the ears

Here, the biggest difference is also in cough, which is often mucus-filled and chesty. Whereas in COVID, the cough is dry.

How it impacts? While it is annoying in the beginning, especially due to the blocked nose and ears, the congestion clears up overtime and usually doesn’t stop daily activities.

Colds typically start with a tickle in the throat or pressure in the ears before progressing to nasal congestion and cough. Most people can carry on with their routines despite the discomfort.

Flu

How it starts? In many cases, the flu may catch you out of the blues, many describe the onset as sudden.

What are the primary symptoms of Flu?

• Fever
• Chills
• Muscle aches
• Exhaustion

While the cough here is also dry in nature, which may make one get confused with COVID, there is no razor-blade like symptom, which can be used as a marker to differentiate.

How does it impact? Flu often requires bed rest.

Unlike a cold, flu can leave you feeling completely wiped out. Body aches and high fever are distinguishing features, and recovery often takes several days of rest.

An antibiotic routinely used for acne has been linked to a lower likelihood of developing schizophrenia. A new investigation from the University of Edinburgh found that adolescents receiving mental health care who were given doxycycline had a reduced chance of being diagnosed with schizophrenia as adults, compared with those who were prescribed other antibiotics.

Although these early findings cannot confirm that doxycycline prevents schizophrenia, the researchers suggest that its influence on immune activity, inflammation, and programmed cell death may help protect the brain from changes associated with the disorder. “Because this research relies on observational records, it cannot prove that doxycycline directly lowers the risk of schizophrenia, so more studies are needed,” the authors explain.

“Even so, the results raise the possibility that doxycycline could play a role in lowering schizophrenia risk among young psychiatric patients and open new avenues for prevention-focused mental health research.”

What Is Schizophrenia?

Schizophrenia is a severe psychiatric disorder that affects about 23 million people worldwide, with most cases identified during late adolescence or early adulthood. The illness can appear suddenly and may bring on psychosis. Typical symptoms include ongoing delusions, hallucinations, disorganized thoughts, restlessness, or withdrawal from others. According to the World Health Organization (WHO), more than two out of three people experiencing psychosis lack access to specialized mental health services.

What Is Doxycycline?

Doxycycline is a broad-acting antibiotic commonly given to teenagers for acne. Some recent research suggests it may also offer certain protective effects for the brain, as it is able to cross the blood-brain barrier. In 2024, Science Alert reported on a Danish study showing that this brain-penetrating antibiotic was associated with a lower likelihood of schizophrenia patients later receiving disability benefits, hinting at how the illness might affect their daily functioning.

To explore this further, child and adolescent psychiatrist Ian Kelleher from the University of Edinburgh led a large international team in reviewing data from more than 56,000 people born in Finland between 1987 and 1997. All had used mental health services in their youth and had been prescribed antibiotics during that time.

The analysis showed that those given doxycycline had a 30 to 35 percent lower chance of developing schizophrenia over the following decade, compared with individuals who had taken other antibiotics. The risk dropped from 2.1 percent in the non-doxycycline group to 1.4 percent in those who used doxycycline.

Doxycycline Linked To A Drop in Schizophrenia Risk

The research team found that taking doxycycline was linked to a 30 to 35 percent reduction in schizophrenia diagnoses over ten years. One theory is that doxycycline may clear an infectious agent that contributes to schizophrenia. Another possibility is that it directly affects inflammation and nerve pathways inside the brain.

Other antibiotics offer hints as well. A 2019 study using stem cells from people with schizophrenia and healthy volunteers showed that minocycline can reduce excessive loss of synapses, a process thought to play a part in schizophrenia. Since both minocycline and doxycycline belong to the tetracycline family, they may share similar properties. Using Finland’s health records, Kelleher’s team noted that nearly half of all psychotic disorders in the population occurred in individuals who had visited adolescent psychiatric services.

The researchers believe this stage of life may offer a valuable period for early intervention, where medications like doxycycline might help reduce the chance of the illness progressing. “Nearly half of the people who develop schizophrenia had earlier contact with child and adolescent mental health services for other issues,” Kelleher says.

“At the moment, we do not have any proven ways to lower the risk of schizophrenia in these young people, which makes these findings encouraging.”

Does Doxycycline Have Side Effects?

Doxycycline is available in two forms, doxycycline monohydrate and doxycycline hyclate, though both tend to cause similar reactions. This list does not include every possible side effect, so consult your medical provider if you are unsure about anything you notice while taking the medication.

Mild doxycycline side effects include:

• Nausea or vomiting
• Diarrhea
• Sensitivity to sunlight
• Sore throat or difficulty swallowing
• Vaginal yeast infection
• Itchy skin and rash (urticaria)

Rare but serious doxycycline side effects include:

• Ulcers in the esophagus
• Severe skin reactions
• Liver problems
• Tooth discoloration in children
• Clostridioides difficile (C. diff) diarrhea
• Intracranial hypertension (increased pressure around the brain)
• Low blood cell counts

Always speak with your healthcare professional before starting or stopping any medication.