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.

With less time and more work, chronic fatigue has become a moniker of modern society. However, this not only reduces the quality of life but also constitutes a social issue that affects work efficiency and leads to accidents. On the surface, the cause of fatigue is often attributed to not getting enough rest, but there may be another underlying issue—the lack of proper nutrition.

The world moves at a hectic pace these days. If you feel like you're constantly running on empty, you're not alone. Many people say that they just don't have the energy they need to accomplish all they need to. Sometimes the cause of fatigue is obvious — for example, getting over the flu or falling short on sleep. Sometimes a vitamin deficiency is part of the problem. It might be worth asking your doctor to check a few vitamin levels, such as the three we've listed below.

Key Nutrient Deficiencies That Can Cause Fatigue

- Iron

Anemia occurs when there aren't enough red blood cells to meet the body's need for oxygen, or when these cells don't carry enough of an important protein called hemoglobin. Fatigue is usually the first sign of anemia. A blood test to measure the number of red blood cells and the amount of hemoglobin can tell if you have anemia. The first step in shoring up your body's iron supply is with iron-rich foods (such as red meat, eggs, rice, and beans) or, with your doctor's okay, over-the-counter supplements.

- Vitamin B12

Your body needs sufficient vitamin B12 in order to produce healthy red blood cells. So a deficiency in this vitamin can also cause anemia. The main sources of B12 are meat and dairy products, so many people get enough through diet alone. However, it becomes harder for the body to absorb B12 as you get older, and some illnesses (for example, inflammatory bowel disease) can also impair absorption. Many vegetarians and vegans become deficient in B12 because they don't eat meat or dairy. When B12 deficiency is diet-related, oral supplements and dietary changes to increase B12 intake usually do the trick. Other causes of B12 deficiency are usually treated with regular injections of vitamin B12.

- Vitamin D

A deficit of this vitamin can sap bone and muscle strength. This vitamin is unique in that your body can produce it when your skin is exposed to sunlight, but there also aren't many natural food sources of it. You can find it in some types of fish (such as tuna and salmon) and in fortified products such as milk, orange juice, and breakfast cereals. Supplements are another way to ensure you're getting enough vitamin D (note that the D3 form is easier to absorb than other forms of vitamin D).

What Does Research Say?

Taking this into account, a research group led by Professor Hiroaki Kanouchi at Osaka Metropolitan University's Graduate School of Human Life and Ecology focused on nutritional status and water-soluble vitamin deficiencies found in unbalanced diets. The team hypothesized that a lack of folate (B9) and vitamin B12 may be related to fatigue, and centered their research around homocysteine (Hcy), a biomarker known to increase when these deficiencies are present.

Blood concentrations of Hcy, folate, and vitamin B12 in approximately 600 healthy Japanese participants were measured. Participants' fatigue and motivation were assessed using the Chalder Fatigue Scale questionnaire and the Visual Analog Scale. The initial results showed that individuals with higher blood Hcy levels had lower levels of vitamin B12 and folate, regardless of sex.

The Link Between Homocysteine and Fatigue

The researchers then examined the relationship between homocysteine levels and fatigue separately for men and women. In their analysis, factors that may influence fatigue, such as age, sleep duration, workload, and dietary habits, were simultaneously accounted for.

The results revealed that higher Hcy levels were associated with greater physical fatigue in men, while higher levels were associated with decreased motivation in women.

(Dr Alex Mathew, Senior Consultant – Internal Medicine, Max Super Speciality Hospital, Patparganj)

Advances in hematology, oncology, and blood and marrow transplantation (BMT) have transformed patient outcomes over the past two decades. However, alongside these achievements lies a persistent and often underappreciated threat—Invasive Fungal Infections (IFIs).

Despite significant improvements in diagnostics and antifungal therapies, IFIs continue to contribute substantially to morbidity, mortality, prolonged hospitalization, and healthcare costs among immunocompromised patients. Fungal infections in patients with blood cancers and blood disorders are neither rare nor unpredictable. And yet they continue to be diagnosed too late, too often.

What Happens To The Immune System During Treatment?

The treatments that have transformed the outlook for leukemia, lymphoma, myeloma, and serious bone marrow disorders are genuinely remarkable. Intensive chemotherapy, bone marrow transplantation, and the newer targeted therapies have extended and saved lives in ways that were not imaginable a generation ago. But each of them does something to the immune system that creates a serious risk.

Chemotherapy depletes neutrophils, the white blood cells specifically responsible for recognizing and destroying fungal organisms. A transplant requires conditioning that leaves patients with almost no immune defenses for an extended period. Prolonged neutropenia, mucosal barrier injury, corticosteroid exposure, graft-versus-host disease, and the increasing use of targeted therapies collectively create an environment where opportunistic fungal pathogens can thrive. Some of the most effective modern therapies in hematology work by modifying immune pathways, leaving patients vulnerable to fungal disease for months after treatment ends. This window can last weeks, sometimes much longer.

The Fungi That Exploit This Window

Aspergillus is a mould found in ordinary dust and soil. In most people, it causes no harm whatsoever. In a patient with severely depleted white blood cells, it can establish a lung infection that progresses faster than most people would expect and carries a mortality rate that remains unacceptably high even with treatment. The earlier it is identified, the better the outcome. But the gap between early and late diagnosis in this context is narrow and unforgiving.

Mucormycosis is less familiar to the public but arguably more aggressive. It invades blood vessel walls directly, cutting off blood supply to surrounding tissue. Patients with blood disorders who require repeated transfusions are at particular risk because excess iron in the body accelerates their growth significantly. India has the highest burden of this infection in the world. That statistic deserves more attention than it currently receives.

Candida lives in the gut of most healthy individuals without causing any problems. When the gut lining is damaged by chemotherapy, it can cross into the bloodstream and reach the liver, spleen, and other organs, causing infections that are difficult to detect and slow to resolve.

Delayed recognition frequently results in disease progression, leading to respiratory failure, disseminated infection, and poor outcomes.

The Problem Is Underdiagnoses

None of these infections begins dramatically. The early signs are a fever that does not settle with antibiotics, a cough without an obvious cause, and breathlessness that seems proportionate to the treatment but lingers too long. In

a patient already unwell from intensive therapy, these signs often get attributed to other causes. Time passes, and the infection progresses.

Specific blood tests can indicate a fungal diagnosis before imaging shows anything definitive. They are not available everywhere in India, and that gap costs lives. Apart from the economic burden of IFIs, it can disrupt cancer treatment schedules, delaying chemotherapy or transplantation and potentially compromising long-term disease control.

What Families Should Know

Preventive antifungal therapy for high-risk patients has strong evidence behind it. Centers that have built awareness of fungal infection risk into their standard care protocols consistently see better outcomes.

For families, the most important thing is simply knowing this risk exists. Asking about it is entirely reasonable. Expecting it to be actively managed is also reasonable. In hematology and oncology, the infections that go unrecognised are the ones that do most of the damage.

Invasive fungal infections are not merely infectious complications; they are major determinants of outcomes in modern hematology and oncology practice. Recognizing the hidden burden of IFIs is the first step toward reducing their impact and improving outcomes for our most vulnerable patients.

Men have been taught for generations that they must be strong, that they are supposed to be self-sufficient, not to feel any impact, and to be emotionally strong when they face challenges.

Resilience is a good trait, but it may also make men feel disheartened about sharing their vulnerabilities or asking for assistance when they need it. Emotional distress can often be seen as a personal failure, rather than a health issue, as many grow up hearing "man up" or "be strong.”

Why Mental Health Crisis In Men Is On The Rise?

Meanwhile, there is still a high demand for men in society. Financial pressures, career expectations, family commitments, and social expectations can become a never-ending burden.

These factors can lead to feelings of loneliness, worry, and sadness, especially when combined with not having enough emotional release and wanting to turn to others for help.

Toxic Masculinity

Men are expected to be a part of the discussion, but not the central point of discussion when it comes to mental health. But the figures don't match. Almost three-fourths of the suicides in India are committed by men, which is a hidden and unaddressed issue.

One of the major issues is that there is a definition of masculinity in society. Boys are taught to be tough and independent from a young age and do not have to show feelings. The traits can both assist people in coping with difficulties and hinder them from admitting to emotional problems or seeking help when it is most necessary.

Read more: Doctors Day: From Burnout To Work Anxiety, The Mental Health Struggle Doctors Rarely Talk About

Lack Of Safe Space

A further issue is that there are not enough safe places in which men can express feelings without risk of condemnation. Stigma can be a barrier to seeking help even when there is help available. This can not only postpone treatment but also increase symptoms of loneliness and hopelessness.

The answer is more than just asking men to "speak up". We need to actively question and combat the stereotypes entrenched in society that equate vulnerability with weakness. Both families and workplaces, schools and communities all have a part to play in promoting emotional literacy and open dialogue amongst men.

Men may not be aware of or express emotional distress in traditional ways, which can be a big problem. Rather, symptoms can be manifested as irritability, withdrawal, substance abuse, or risk-taking behaviour, which can make it difficult for family members and friends to recognise when intervention is required.

It is not enough to raise awareness to solve this crisis. It is important to establish a space of normalisation for expressing emotions, to provide support for mental health and to make it part of the identity to seek help instead of looking weak. Promoting the mental health of men is not only an individual matter, but also a public health issue that can save lives.

For a genuine commitment to the prevention of suicide, mental health status of men needs to be a public health issue. Being sensitive to their challenges, to the idea of seeking assistance, and to establishing environments that are supportive of them can make the difference between life and death.

By Dr. Hamza Hussain, Head of the Department of Psychiatry and Mental Health at Ruby Hall Clinic and Bhavya Shah, Consultant Psychologist at Saifee Hospital, Mumbai