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.

Irritable bowel syndrome (IBS) is often characterised by digestive symptoms like abdominal pain, bloating, constipation and diarrhoea. However, the condition involves more than the digestive system.

A new review published in The Lancet explains how interactions between the gut and brain, changes in the gut microbiome, immune activity and the body's response to pain can contribute to the development of symptoms.

The review, titled Irritable bowel syndrome and related disorders of gut-brain interaction, brings focuses on biological and psychological evidence behind IBS. Researchers describe it as a disorder of gut-brain interaction, in which signals between the digestive system and the central nervous system affect gut function.

The authors also discuss chronic constipation and functional diarrhoea, which belong to the bigger group of disorders related to gut-brain interaction. These conditions may affect an estimated 20% of the global population.

What Is The Gut-Brain Connection In IBS?

Also read: Olympian Ciara Mageean Dies At 34 After Bowel Cancer Battle: Warning Signs In Young Adults

The gut and brain communicate continuously through a complex network that involves the central nervous system, autonomic nervous system, enteric nervous system and hypothalamic-pituitary-adrenal (HPA) axis.

The brain can influence intestinal movement, secretion and sensitivity, while signals from the gut can affect how the brain processes pain and other sensations.

In people with IBS, this communication may become disrupted. The result can be changes in bowel movements, more sensitivity to normal digestive processes and abdominal discomfort.

The authors said, “These central and peripheral mechanisms can act in an integrated way to cause IBS symptoms, via the gut-brain axis.”

For instance, a person with IBS may experience pain or bloating even when the amount of gas or intestinal movement would not cause discomfort in someone without the condition. This is due to a condition called visceral hypersensitivity, in which the nerves supplying the digestive organs become unusually sensitive to internal sensations.

The review explains that changes in both peripheral mechanisms within the gut and central mechanisms involving the brain can contribute to symptoms.

Gut Bacteria And Inflammation May Contribute To IBS

Also read: Can Coffee Trigger Irritable Bowel Syndrome?

The gut microbiome, which consists of microorganisms living in the digestive tract, is another important part of the gut-brain connection.

Changes in the composition and activity of gut bacteria may impact intestinal function, immune responses and communication with the nervous system. The review identifies the following:

• Gut infections: Gastrointestinal infections can trigger IBS symptoms in some people, even after the initial infection has subsided.
• Altered gut microbiome: Changes in intestinal bacteria may affect digestion, immune activity and gut function.
• Increased intestinal permeability: Changes in the intestinal barrier may allow substances to pass through more easily, potentially contributing to immune activation.
• Low-grade inflammation: Mild inflammation in the intestinal lining and changes in immune function may contribute to symptoms.
• Abnormal gut movement: Changes in gastrointestinal motility can cause food and waste to move through the digestive tract too quickly or too slowly.
• Visceral hypersensitivity: Increased sensitivity in the gut can make normal digestive processes feel painful.

Mental Health And IBS

Psychological health is another component of the gut-brain axis. Stress, anxiety and other psychological difficulties can influence how the brain processes pain and communicates with the digestive system.

The HPA axis, which helps regulate the body's response to stress, plays a role in this process . Changes in stress levels can affect gut movement, secretion and sensitivity.

Currently, there is no single biomarker that can diagnose IBS. Doctors assess symptoms, medical history and clinical findings, while using tests to rule out other conditions.

The review highlights that some underlying mechanisms can already be measured through approved tests and questionnaires. These include abnormal bile acid metabolism, accelerated movement of contents through the colon and psychological conditions.

Does a patient’s chances of serious outcomes differ if they are treated by a female doctor? A recent study looks into this hypothesis to ascertain the difference between chances of a patient dying under a male and a female doctor.

According to the study, hospitalised patients treated by female doctors have a lower risk of dying within 30 days. They are also less likely to be re-hospitalised than those treated by male doctors. The study is published in JAMA Network Open.

"Past research has largely focused on surgical patients and the admitting physician only. Our findings add to the growing body of research examining the relationship between physician sex and patient outcomes, broadening the evidence beyond surgical care to a wider range of medical conditions and other physicians," says Dr. Angela Jerath, an ICES scientist, and Associate Professor, Department of Anesthesiology & Pain Medicine at the University of Toronto's Temerty Faculty of Medicine.

After analysing the health records of 958,150 adults admitted to hospitals in Ontario, Canada, between 2008 and 2022, researchers found that the 30-day mortality rate was 12.3% among patients treated by female physicians, compared to 13.7% among those treated by male physicians.

The findings also show a small difference in hospital readmissions. The 30-day readmission rate was 18.6% for patients treated by female doctors and 18.9% for those treated by male doctors.

The researchers examined outcomes across seven common medical conditions, including heart attacks, pneumonia and other acute illnesses.

They also considered the number of hospital days during which patients received care from female doctors, recognising that several doctors may be involved in a patient's treatment during an admission.

Patients Treated By Female Doctors Are Less Likely To Die In A 30-Day Period

Also read: Manosphere Is A Public Health Concern: Lancet Report Says Online Misogyny Harms Men's Mental Health

After accounting for patient, physician and hospital characteristics, treatment by a female physician was linked with 12% lower adjusted odds of death within 30 days compared to treatment by a male physician.

The researchers also found that for every 10% increase in the proportion of hospital days managed by female physicians, the adjusted odds of 30-day mortality decreased by 7%. This was observed for most medical conditions that were studied. Atrial fibrillation was the only exception.

The difference in mortality was also seen at longer follow-up periods. Patients treated by female physicians had lower mortality at 90 days and one year.

The findings were observed among both male and female patients. Female patients treated by female physicians had the lowest adjusted 30-day mortality rate in the analysis.

Why Patients May Have Better Outcomes With Female Doctors?

The study did not establish why patients treated by female physicians experienced better outcomes. However, the researchers discussed possible differences in clinical practice and communication.

Female physicians may be more likely to engage in patient-focused communication, spend more time with patients, follow clinical guidelines and involve colleagues in decision-making.

These practices could influence how symptoms are studied, treatment decisions are made and coordinated during hospitalisation.

"The goal is not to favour one group of physicians over another but to identify practices and behaviours that may help improve care across the health system," says Jerath.

"An important strength of this study is that, unlike surgical care, patients admitted to hospital for medical conditions are generally assigned physicians based on rotating schedules rather than patient or referring physician preferences, helping to minimize referral bias."

Eli Lilly's experimental weight-loss drug retatrutide, being referred to as ‘Godzilla’, continues to outperform its rivals like Ozempic.

According to a recent head-to-head Phase 3 clinical trial involving adults with type 2 diabetes, it delivered more than twice the average weight loss achieved with Ozempic.

Ozempic Vs Retatrutide

Participants who took the highest dose of retatrutide lost an average of 20.9% of their body weight over 80 weeks, compared to 9.4% among those receiving Ozempic's highest approved dose for type 2 diabetes.

The trial, called TRANSCEND-T2D-2, involved more than 1,000 adults with type 2 diabetes. It compared once-weekly injections of retatrutide at doses of 9 mg and 12 mg with semaglutide, the active ingredient in Ozempic, at 2 mg.

At the end of 80 weeks, participants taking retatrutide 9 mg lost an average of 44.3 pounds (20.1 kg), while those receiving the 12 mg dose lost 47.4 pounds (21.5 kg). The Ozempic group lost an average of 20.9 pounds (9.5 kg).

The findings mark the first Phase 3 head-to-head comparison of retatrutide with another medicine in this class.

Also read: ‘Godzilla’ Drug Retatrutide Reverses Sleep Apnea In 1 In 4 Diabetes Patients

Retatrutide Also Improved Blood Sugar

The trial found that retatrutide also resulted in produced greater reductions in HbA1c, a measure of average blood glucose over approximately three months.

At 80 weeks, participants taking either dose of retatrutide recorded an average HbA1c reduction of 2.2%, compared to 1.8 % among those receiving Ozempic.

The experimental drug also resulted in greater improvements in cardiovascular risk factors like non-HDL cholesterol, triglycerides and systolic blood pressure.

Also read: Could GLP-1 Drugs Help Prevent Rupture Of Abdominal Aortic Aneurysm? Study Finds 46% Reduction In Risk

Side Effects Of Retatrutide

The most commonly reported side effects of retatrutide were gastrointestinal symptoms like diarrhoea, nausea, constipation, vomiting and indigestion.

Diarrhoea was reported in 28.3% of participants receiving the 9 mg dose and 32.7% receiving 12 mg, compared to 26.4% in the Ozempic group. Nausea occurred in 21.2%, 23.8% and 21.3% of participants, respectively.

Researchers also reported a higher incidence of dysesthesia, an abnormal sensation that can include tingling, burning or skin sensitivity, among participants taking retatrutide.

Treatment discontinuation because of side effects occurred in 4.8% of the 9 mg group and 7.9% of the 12 mg group, compared to 2.7% of the Ozempic group.

More About Retatrutide

Retatrutide is a once-weekly injectable drug that targets three hormone receptors involved in regulating appetite, blood sugar and metabolism. They are GLP-1, GIP and glucagon.

GLP-1 helps regulate appetite and blood sugar while slowing the process of stomach emptying. GIP also plays a role in glucose regulation and insulin release. Glucagon is involved in controlling blood glucose and energy metabolism.

Ozempic, manufactured by Novo Nordisk, acts on the GLP-1 receptor. Eli Lilly's Mounjaro and Zepbound, which contain tirzepatide, target both GLP-1 and GIP receptors.

Retatrutide remains an investigational drug and has not been approved by the US Food and Drug Administration (FDA) or other regulatory authorities.

Eli Lilly plans to submit the drug for FDA approval in early 2027. The company said detailed results from the trial would be presented at a future medical meeting and published in a peer-reviewed journal.