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.

A 43-year-old mother from Northern Ireland got diagnosed with an exceptionally rare cancer after months of pain, continual bleeding and abdominal swelling. She said that these symptoms were initially and inaccurately attributed to perimenopause, anxiety and constipation.

Nicola Crymble’s symptoms started in 2024 after she had a copper intrauterine device (IUD) inserted. The bleeding and pain became so severe that she had the device removed while she was in Kenya doing mission work. “I was constantly bleeding, there was so much pain,” Crymble said.

However, her symptoms persisted even after she returned home. She said doctors initially suggested that perimenopause and anxiety could explain what she was experiencing.

By December 2024, Crymble had noticed a lump in her abdomen. It continued to grow, making everyday activities challenging. She said people even thought she was pregnant because of the swelling. She eventually went to hospital and underwent scans, which revealed a mass near her cervix. Doctors initially thought it might be a cyst.

Crymble Got Diagnosed With FATWO, A Rare Cancer

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Crymble underwent major surgery in February 2025 to remove the tumour. She also chose to have her ovaries and fallopian tubes removed during the procedure. A month later, she received the diagnosis that she had female adnexal tumour of probable Wolffian origin, commonly known as FATWO.

The tumour is believed to develop from remnants of the Wolffian duct, an embryonic structure involved in the development of the reproductive and urinary systems. Although these structures usually regress during female development, residual tissue can sometimes pave the way for tumour growth.

FATWO is an exceptionally rare form of cancer. There are only around 150 documented cases recorded worldwide. While many FATWO tumours do not metastatize, some can behave aggressively. In Crymble’s case, the cancer later spread to her liver and vaginal vault, the upper part of the vaginal canal.

She experienced intense pain beneath her ribs before a scan revealed that the cancer had spread. Further surgery was ruled out because the tumour growths were too close to other organs.

Chemotherapy As Surgery Was Not An Option

With surgery no longer an option, Crymble and her doctors decided to proceed with chemotherapy. She began treatment on October 13, 2026, and is expected to undergo six rounds, one every three weeks.

The family is also looking for specialist advice because there is limited information available about the rare disease and the best way to treat it. Her husband, Andrew Crymble, said doctors had little experience with the condition.

“They've never seen it before, they don't know how to treat it,” he said, explaining why the family decided to share her story publicly. They hope it will reach researchers or doctors who may have more information about FATWO.

Crymble has stopped working and has found it difficult to maintain her usual family routines while undergoing treatment. The family is also seeking financial support after discovering that their life insurance coverage will not cover the treatment.

Also read: Amgen & AstraZeneca's New Treatment Combination Cuts Advanced Lung Cancer Death Risk By 58% In Trial

Symptoms That Warrant Immediate Attention

Perimenopause can cause changes in menstrual patterns, like irregular periods. But unexplained bleeding, stubborn abdominal pain, lump or unusual swelling should not automatically be attributed to hormonal changes without seeking medical intervention.

These symptoms can occur due to many causes, and they do not necessarily indicate cancer. But worsening or unusual symptoms demand medical assessment, especially when they do not improve or when new symptoms develop.

The effects of heatwaves, air pollution, noise and overall climate change may extend beyond physical health. According to a new report by the Earth–Brain–Health Commission published in Nature Mental Health recently, they can have a significant impact on mood, cognitive function and overall psychological wellbeing.

The commission warns that environmental changes are altering the conditions in which people live. It also talks about consequences for brain health and mental wellbeing. It also calls for mental health to become a consideration in climate policy, urban planning and environmental decision making, rather than being treated only after symptoms develop.

The findings are relevant to low and middle-income countries, where exposure to environmental hazards can overlap with greater socioeconomic problems like poverty and limited access to healthcare.

“Heat and heatwaves, air and noise pollution, extreme weather and compound events, urbanization, and the loss of green and blue spaces are associated with depression, anxiety, cognitive decline, and impaired emotional and behavioral functioning,” the commission states.

Effects Of Environmental Conditions On Brain

Also read: Lancet Study Finds Air Pollution & Chemical Exposures Could Add To South Asia's Diabetes & Heart Disease Burden

From biological changes like neuroinflammation, disruption of hormones and the body's internal clock to psychological stress and due to isolation and displacement, the commission identifies several ways through which environmental conditions may impact mental health.

Heat exposure is one of the gravest concerns in current times. Heatwaves can disrupt sleep and contribute to physiological stress, while air pollution can lead to cognitive decline. Noise pollution and stressful urban environments may fuel anxiety and depression.

These exposures are compounded by people’s standard of living. A person living in poorly ventilated housing, for example, may face heat, air pollution, financial hardship and limited access to healthcare at the same time. These combined problems can be difficult to measure by studying each exposure separately.

Who Is At Risk?

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Children, older adults, people with disabilities and marginalised communities may face greater exposure to environmental hazards while having fewer resources and help to cope with them.

The commission also highlights low and middle-income countries and small island developing states. These populations may face significant environmental risks but remain underrepresented in research on climate change and mental health.

Dr Vivek Benegal, senior professor of psychiatry and former head of department at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, is among the commission's members. He said NIMHANS has been examining how climate change affects the human brain.

Benegal also pointed to a 2023 study conducted by researchers from NIMHANS and King's College London. The study found that even low levels of arsenic exposure, below World Health Organization thresholds, were associated with changes in brain structure and impaired cognitive abilities among children, adolescents and young adults.

Commission's Recommendations

The report recommends that governments should incorporate brain and mental health measures into environmental policies. Its recommendations include monitoring environmental exposures, identifying risks early in life, and designing healthier urban environments.

“The principal obstacles to action are organisational and financial rather than evidential,” the commission observes, noting that research cohorts, Earth-observation systems and environmental governance tools already exist but are often maintained separately.

COVID-19 vaccines were rolled out during the pandemic, so questions about their safety, how long they protect against infection and whether mRNA technology was tested for long enough continue to dominate public debate.

Dr Paul Offit, paediatrician and director of the Vaccine Education Center at Children’s Hospital of Philadelphia and former member of the CDC’s Advisory Committee on Immunization Practices, says many concerns overlook the the evidence collected before and after the vaccines were introduced.

In an interview with HealthandMe, Offit discussed how long COVID vaccine protection lasts, what scientists have learnt about rare side effects and why the technology behind mRNA vaccines was not as new as many people thought.

“I think it is probably the best studied vaccine in human history,” Offit said. He pointed to the large number of people who received them and the safety-monitoring systems used to look for adverse effects.

Why Are People Still Getting COVID After Vaccination?

Also read: EXCLUSIVE: Ex-CDC Vaccine Advisor Says Measles Outbreak Bigger Than Reported, Slams RFK Jr’s ‘No-See Evil’ Approach

The circulation of SARS-CoV-2, the virus that causes COVID-19, is sometimes used to argue that the vaccines do not work. Offit said this misunderstands the type of infection the virus causes and the protection vaccination offers.

“It’s a short incubation period mucosal infection,” he said. “So, vaccination or natural infection will protect you for about four to six months from mild to moderate disease, should protect you for longer against severe disease.”

He compared the future of COVID to influenza, saying that infections will continue even as vaccines help protect against serious illness.

“Even if everybody in the world were vaccinated every year, that virus would still circulate,” he said. “This virus is now with us forever.”

Offit said the goal of COVID vaccination is not necessarily to prevent every infection. It is to reduce the risk of hospitalisation and death, particularly among people most likely to develop severe disease.

“The goal of the vaccine is to keep you out of the hospital and to keep you from dying,” he said.

He said that people over 75, those with chronic heart or lung disease, pregnant women and people with weakened immune systems are at higher risk of developing severe complications from COVID. He said these groups should receive a vaccine every year.

Dr Paul Offit On COVID Vaccine’s Side Effects

Also read: American COVID Drives Cases And Deaths In UK: Unusual XFG Symptoms To Watch For

When COVID vaccines were first authorised in December 2020, the clinical trials involved approximately 35,000 participants across the Pfizer-BioNTech and Moderna studies, Offit said. Some rare side effects of the vaccine became apparent only after the vaccines were administered to much larger populations.

One such side effect was myocarditis, an inflammation of the heart muscle, and, less commonly, pericarditis, which affects the lining around the heart.

“Very quickly, it was found to be a rare cause, roughly 1 in 50,000 myocarditis,” Offit said, referring to mRNA COVID vaccines. He said cases were seen primarily in males aged 16 to 29 and were generally short-lived.

Current evidence confirms that myocarditis and pericarditis are rare but recognised risks associated with mRNA COVID vaccines. The risk has been observed most often in adolescent and young adult males, particularly within seven days after a second dose.

In June 2025, the US Food and Drug Administration required updated safety warnings for the Pfizer-BioNTech and Moderna vaccines. The FDA also noted that some patients in follow-up studies continued to show signs of heart muscle injury on MRI scans, with improvement in some cases. The long-term significance of these findings remains under investigation.

Offit also cited the example of Johnson & Johnson COVID vaccine, which was associated with a rare but serious condition involving blood clots and low platelet counts. The vaccine was no longer available in the US by May 2023.

“You're always looking and trying to find any rare side effect that's associated with the vaccine,” he said.

He added that concerns about stillbirths and pregnancy outcomes had circulated despite research examining vaccination during pregnancy.

Offit said there was “no evidence of congenital malformations, no evidence of premature birth or spontaneous abortion” in the studies he was referring to.

How Long Were mRNA COVID Vaccines Tested?

Another common concern is that mRNA COVID vaccines were developed too quickly and that the technology had not been studied for long enough. Offit disagreed, saying that the technology was not entirely new.

“I think it was studied for a long time,” he said. He pointed to research into mRNA as a vaccine platform that began decades before the COVID-19 pandemic.

“Drew Weissman and Katie Carrico met in 1997 and started working on mRNA as a vaccine platform, for which they won the 2023 Nobel Prize in Medicine,” Offit said.

He also referred to efforts to develop mRNA vaccines against SARS, the coronavirus that caused an outbreak in 2002 and 2003.

“But we really had, really since 1997, information about this vaccine, so like more than 20 years of studies of that vaccine,” he said. “People think it was a new vaccine, but it really wasn't that new.”

The technology had been studied before COVID-19, although the pandemic vaccines themselves still required clinical trials to establish their safety and effectiveness. After their introduction, researchers continued monitoring them to identify rare adverse events.

Do Benefits Of COVID Vaccines Still Outweigh The Risks?

Offit said the decision to vaccinate should take into account both the risk of side effects and the risk posed by COVID itself. “I'm an older person, so I'm going to get a COVID vaccine every year because I think that the benefits clearly outweigh the risks,” he said.

He argued that COVID continues to cause hospitalisations and deaths, making protection against severe disease an important consideration.

He said that the benefits outweigh the risks, particularly for people at higher risk of serious illness. Individual decisions should also take account of age, underlying health conditions, previous vaccination and current medical guidance.