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.

As artificial intelligence (AI) continues to transform healthcare worldwide, concerns about technology replacing doctors remain a topic of debate.

Dr. Santosh Sivaranjani, popularly known as "The ORS Lady of India," addressed these concerns at the Times Now India Health Summit 2026 – South Edition in Hyderabad.

The renowned pediatrician and social activist emphasized that AI can only assist doctors and cannot replace the core human qualities that define medical care.

Dr. Sivaranjani acknowledged that doctors are increasingly embracing innovations such as artificial intelligence to improve patient care and health education. However, she stressed that technology has clear limitations.

"No matter how much AI advances, it can only complement us. It cannot replace the human touch, clinical acumen, or the genuine empathy that doctors have towards their patients," she said. "We should be proud of being doctors" because such qualities cannot be replicated by machines, she said.

The Privilege and Challenge of Being a Doctor in India

Speaking before an audience of healthcare professionals, Dr. Sivaranjani also highlighted the unique challenges and rewards of being a doctor in India. She described the profession as both a privilege and an extraordinary challenge, citing the immense patient load, demanding work schedules, and personal sacrifices made by medical professionals every day.

"Our journey demands countless sleepless nights, missed birthdays, missed anniversaries, and even caring for other patients when our own loved ones are unwell," she said. "Yet the moment we see a patient recover and smile, all those sacrifices seem worthwhile."

Changing Perceptions of the Medical Profession

Dr. Sivaranjani also reflected on the changing perception of doctors in India. She noted that physicians were once regarded with deep respect and seen as pillars of strength during families' most difficult moments. While many doctors continue to uphold these values, she expressed concern that rising healthcare costs and changing public expectations have altered doctor-patient relationships.

"Most doctors work to the best of their ability and according to their conscience, not to please patients but to provide the right treatment," she said.

Concerns Over the Consumer Protection Act

The pediatrician further highlighted concerns about the inclusion of doctors under the Consumer Protection Act, arguing that it has contributed to a more defensive doctor-patient relationship.

"Medicine often requires difficult and sometimes risky decisions to save lives. However, fear of legal consequences can make doctors hesitant to take those necessary risks," she said.

Rebuilding Trust Through Empathy and Ethics

Calling for efforts to rebuild public trust, Dr. Sivaranjani urged medical professionals to prioritize empathy, transparency, ethical practice, and patient education. She emphasized that medicine is not only a science but also an art that requires compassion and effective communication.

"The moment a patient enters your consultation room, half of their illness should disappear because of the confidence and reassurance you provide," she said. "Arrogance has no place in our profession."

She also stressed the need to strengthen public healthcare infrastructure to ensure equitable access to quality medical services across the country.

Concluding her address, Dr. Sivaranjani paid tribute to healthcare workers across India for their dedication and resilience.

"It is a privilege to be a doctor in this great country and to make a difference in so many lives," she said. "At the same time, it is an extraordinary challenge to protect ourselves from violence, navigate legal pressures, and help people understand that we are here not to please them, but to heal them."

As oncologists, we often meet patients at some of the most difficult moments of their lives. Yet there are times where a patient's journey reminds of the extraordinary resilience that people can show while facing the challenges that cancer presents

I recently treated a 38-year-old woman whose story has stayed with me.

Having just welcomed her baby into the world, her demanding yet joyful routine revolved around feeding schedules and sleepless nights. It was during this period that she noticed a hard lump in her breast.

Breast Lumps Can Cause Aggressive Breast Cancer

A sonomammography revealed a suspicious BIRADS 4A lesion. A biopsy confirmed Triple-Negative Breast Cancer (TNBC), which is one of the more aggressive forms of breast cancer. It was classified as a Stage III disease after evaluation through PET-CT which showed involvement of the axillary lymph nodes. The tumor also had a high Ki-67 index, indicating that it was growing rapidly.

Facing Cancer While Caring for A Newborn

The untimely diagnosis found the mother facing difficult questions about cancer treatment, her future and her ability to care for her child. One of the immediate challenges was that she had to stop breastfeeding.

Under the guidance of her pediatrician, her baby was transitioned to bottle feeds. This can be an emotionally challenging process for mothers as the feeling of guilt tends to seep in when breastfeeding plans are disrupted by illness.

A Modern Treatment Approach

After detailed and prolonged discussions with the patient and her family, we initiated treatment with neoadjuvant immunotherapy using pembrolizumab in combination with chemotherapy. This approach has emerged as one of the more prominent advances in the treatment of high-risk Triple-Negative Breast Cancer, having significantly improved outcomes for many patients.

Motherhood is a physically and emotionally taxing experience but the patient showed incredible strength during her cancer therapy, driven by her child and the unwavering support of her family.

Following completion of neoadjuvant therapy, repeat PET-CT imaging showed a near-complete response. She subsequently underwent surgery, and the final pathology report revealed a pathological complete response, meaning no residual invasive cancer had been detected.

This was the desired outcome for the treating team as well as the patient. She later completed the remaining course of immunotherapy, bringing her total treatment duration to one year. Today, both mother and child are doing well.

Breast Cancer Can Occur During Pregnancy

This tremendous journey highlights an important message. The fact that breast cancer can occur during pregnancy and the postpartum period deserves wider attention. Any breast lump that persists or feels unusual should be evaluated by a healthcare professional, as early diagnosis remains one of the most important factors in achieving positive outcomes.

The process is reflective of the advances in cancer treatment that are changing the outlook for patients with aggressive cancers. These advances are done through the integration of immunotherapy into treatment protocols which is helping more patients achieve improved long-term outcomes. The mother’s story is a reminder that cancer and motherhood are not mutually exclusive journeys.

Her ability to navigate this path is due to her timely diagnosis, access to appropriate treatment, family support and personal resilience. What began as a frightening diagnosis soon after childbirth ultimately became a story of hope, courage and survival. This is a powerful reminder to every new mother who might discover an unusual breast lump, that listening to your body and seeking medical advice early can make all the difference.

Constipation is one of the most common digestive complaints affecting people of all ages. It is generally defined as having fewer than three bowel movements per week, passing hard stools, excessive straining, or a feeling of incomplete evacuation.

While occasional constipation is usually not a cause for concern and can often be managed through lifestyle changes, persistent or severe constipation may sometimes indicate an underlying health condition that requires medical attention.

Common Causes of Constipation

Several factors can contribute to constipation, including inadequate fiber intake, insufficient water consumption, lack of physical activity, stress, changes in routine, and certain medications. In many cases, improving dietary habits and maintaining an active lifestyle can help restore normal bowel function. However, when constipation becomes chronic or is accompanied by other symptoms, it should not be ignored.

Warning Signs

One of the most important warning signs is a sudden change in bowel habits, particularly in adults over the age of 50. Persistent constipation associated with unexplained weight loss, loss of appetite, fatigue, abdominal pain, bloating, or blood in the stool may indicate a more serious condition, such as colorectal cancer. Early detection is crucial, making timely medical evaluation essential.

What's Behind Chronic Constipation

Chronic constipation may also be linked to several medical disorders. Conditions such as hypothyroidism, diabetes, Parkinson’s disease, multiple sclerosis, and certain neurological disorders can affect the normal movement of the intestines. In some individuals, constipation may result from pelvic floor dysfunction, where the muscles involved in bowel movements do not coordinate properly.

Irritable Bowel Syndrome (IBS), particularly the constipation-predominant type, is another common cause of ongoing bowel difficulties. Inflammatory bowel diseases, intestinal narrowing, or bowel obstruction can also present with severe constipation and abdominal discomfort.

Many people rely on over-the-counter laxatives for relief. While these medications can be effective when used appropriately, long-term or excessive use without medical supervision may mask an underlying problem and can sometimes worsen bowel function over time.

How To Maintain Good Digestive Health

To maintain good digestive health, individuals should consume a fibre-rich diet that includes fruits, vegetables, whole grains, and legumes. Adequate hydration, regular exercise, and responding promptly to the urge to pass stools are equally important.

Constipation is often harmless, but persistent symptoms should never be dismissed. If constipation lasts for several weeks, becomes increasingly severe, or is associated with alarming symptoms such as bleeding, significant weight loss, or severe abdominal pain, seeking medical advice is essential. Recognizing these warning signs early can help identify serious health conditions and ensure timely treatment.

(By Dr. Pradeepta Kumar Sethy, Director Gastroenterology, Manipal Hospital EM Bypass & Mukundupur)