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.

NBC News producer Susan Kroll, 58, initially attributed her occasional difficulty remembering words to menopause-related brain fog. However, tests revealed an elevated genetic risk of Alzheimer’s disease and abnormal amyloid levels in her brain.

Her journey began when she sought a diagnosis for her mother, who had started experiencing memory problems at 75. While helping her mother, Kroll decided to investigate her own risk after learning that Alzheimer’s risk can be genetic, she wrote on Today.com.

Genetic Testing Revealed An Elevated Alzheimer’s Risk

Testing showed that Kroll’s mother carried two copies of a gene called APOE4. Everyone inherits one APOE gene from each parent. The three common variants are APOE2, which may reduce Alzheimer’s risk; APOE3, the most common variant, which has a neutral effect; and APOE4, which increases the risk.

According to the Mayo Clinic, people with two copies of APOE4 are eight to 12 times more likely to develop Alzheimer’s.

To understand her own risk, Kroll took a cheek-swab genetic test in October 2024.

"I had an APOE4 and APOE3 gene, making me two to three times more likely to develop Alzheimer’s. I was a bit relieved," Kroll wrote.

Also read: Normal Ageing or Alzheimer's? Doctors Explain Six Key Differences to Watch For

Blood Tests And Brain Scans Revealed More

In May 2025, Kroll took a blood test developed to help diagnose Alzheimer’s disease, which had recently been cleared by the US Food and Drug Administration (FDA).

The test measures certain proteins, including a specific form of tau, that can indicate the presence of amyloid plaques in the brain. These protein deposits are considered a hallmark of Alzheimer’s disease.

Kroll said her "results were well outside the normal range". She had also noticed occasional difficulty remembering words, which she had initially attributed to menopause-related brain fog.

She was given personalised recommendations covering diet, exercise, supplements and sleep.

Diet, Exercise And Sleep Changes To Support Brain Health

Kroll made several changes to her daily routine.

"I cut out artificial sweeteners and limited fried and processed foods, red meat, cheese, sweets and alcohol. Every day, I started eating leafy greens, whole grains, veggies and fruit, and every week multiple servings of fish, walnuts, almonds, avocado and berries."

She also intensified her workouts, doing 45–60 minutes of cardio three to four days a week, alongside strength training. She focused on three muscle groups, completing three sets of each exercise with eight to 10 repetitions. She also started going to bed earlier.

Read More: India Gets Its First Alzheimer’s Drug: Know All About Eli Lilly’s Lormalzi

Kisunla Infusions Reduced Amyloid Levels In Her Brain

In December 2025, Kroll began treatment with Kisunla, an anti-amyloid infusion approved by the FDA in 2024.

A previous brain scan had shown elevated amyloid levels in every quadrant of her brain. Clinical trials have shown that Kisunla can slow cognitive and functional decline in eligible patients.

After six infusions, Kroll underwent another brain scan in May 2026 to assess her progress.

Her amyloid score dropped from 86 to four. The radiologist noted, "The amyloid issue has resolved."

Further blood tests showed that her tau levels were normal. Kroll suggested that her dietary changes may have contributed to this result.

Does She Still Have An Elevated Alzheimer’s Risk?

Kroll currently has neither Alzheimer’s disease nor mild cognitive impairment. However, she continues to have positive biomarkers and an elevated genetic risk. She believes the "early interventions helped slow down or potentially stop the progression of changes years before they could worsen".

Her journey is far from over. She continues to receive care at the Alzheimer’s Prevention Clinic, where her blood and biomarkers are monitored monthly.

Obesity drugs such as semaglutide and tirzepatide may offer benefits beyond weight loss and blood sugar control. Researchers say these medicines could also help protect brain function, including memory and other cognitive abilities.

Researchers from the University of Gothenburg and the University of Copenhagen examined evidence on how these drugs affect the brain and their potential to inform treatments aimed at preserving cognitive function. The review was published in the journal Science.

How Do Obesity Drugs Affect The Brain?

Semaglutide and tirzepatide belong to a class of medicines that act on metabolic pathways involved in appetite and blood sugar regulation. They may also influence biological processes important for brain function.

Animal studies suggest that GLP-1 drugs can affect learning and memory. However, findings from human studies have been mixed.

Studies analysing patient records have linked GLP-1 treatment to a lower risk of dementia among people with type 2 diabetes. However, these findings do not establish whether the medicines themselves are responsible for the reduced risk.

Semaglutide Failed To Slow Alzheimer's Progression

The potential benefits of these drugs have also been examined in people with Alzheimer's disease.

In Novo Nordisk's EVOKE and EVOKE+ clinical trials, semaglutide did not slow disease progression in patients with early Alzheimer's disease, despite producing changes in several biological markers associated with the condition.

However, researchers say these findings do not rule out potential benefits in other groups of patients.

People with obesity or type 2 diabetes may experience difficulties with attention, planning and processing speed. These cognitive problems are often associated with metabolic and vascular health, making them potential targets for treatment.

Stina Börchers, first author of the review and a researcher affiliated with the University of Gothenburg and the University of Copenhagen, said it is important to establish whether these treatments can help preserve cognitive abilities, particularly when started before problems become established.

“We need to find out whether these treatments can help people with obesity or diabetes preserve their cognitive abilities, particularly if treatment begins before cognitive problems become established,” Börchers said.

Could Obesity Drugs Lead To New Brain Treatments?

Researchers are trying to understand whether the potential effects of obesity medicines on the brain result from improved metabolism, direct action on the brain, or a combination of both.

Christoffer Clemmensen, senior author of the review and research group leader at the University of Copenhagen, said advances in obesity medicines offer new opportunities to understand how metabolic regulation influences brain function.

“By disentangling the direct and indirect effects of these drugs on the brain, we may ultimately be able to develop treatments specifically aimed at preserving cognitive function,” Clemmensen said.

Why More Clinical Trials Are Needed

The researchers are calling for clinical trials that assess memory and other cognitive abilities from the beginning of treatment.

They also stress the need to monitor older and frail patients. Rapid weight loss and loss of muscle mass could affect physical function and potentially reduce the benefits of treatment in these groups.

For now, whether obesity drugs can help preserve cognitive function remains an important research question. More clinical evidence is needed before they can be considered treatments for protecting brain health.

For 25-year-old Kaela Knight, a nail artist from Colorado, taking tirzepatide, the active ingredient in Eli Lilly's Mounjaro and Zepbound, brought an unusual side effect: skin so sensitive that even a light touch hurt.

Knight started treatment in September 2024 at 210 pounds and eventually reached 125 pounds. But during her second month, as her dose increased from 2.5 mg to 5 mg, she began experiencing burning sensations.

"I always describe it as feeling like a sunburn without any visible redness or irritation," she told the Daily Mail.

The sensation affected her hips, forearms and neck. Episodes lasted 24–48 hours, although some persisted for about a week.

Other patients taking Novo Nordisk's Ozempic and also Mounjaro have reported similar experiences.

Known as allodynia, this nerve-pain condition makes normally harmless sensations, such as clothing brushing against the skin or a light touch, painful. Patients describe it as a sunburn without visible redness or irritation.

Although it is not an established side effect of Ozempic, Wegovy, Mounjaro or Zepbound, medical reports have documented similar symptoms. A direct link remains unproven.

"I have [areas] all over that are burning. It's driving me nuts," one Reddit user wrote. Another said painkillers and lidocaine gels offered little relief.

Some patients report improvement after reducing their dose or stopping treatment.

Also read: Ozempic Hair: GLP-1 Drug Use Linked To 7% Higher Baldness Risk In Men

Why Could Weight-Loss Injections Cause Burning Skin?

Semaglutide, used in Ozempic and Wegovy, mimics the GLP-1 hormone. Tirzepatide, used in Mounjaro and Zepbound, targets GLP-1 and GIP receptors.

Dr Richard Siegel, an endocrinologist at Tufts Medicine, told the Daily Mail that these drugs could potentially affect nerve signalling through the brain and spinal cord.

Another theory involves changes in the fat layer beneath the skin during weight loss, which could affect nerve sensitivity. Neither explanation has been proven.

What Do Medical Reports Reveal?

An October 2025 report documented two cases:

• A 56-year-old woman developed painful skin sensations after switching to semaglutide 2.4 mg. Symptoms resolved without treatment after six weeks.
• A 75-year-old man with type 2 diabetes developed widespread burning after switching to tirzepatide. Symptoms resolved after he discontinued it and returned to oral semaglutide.

Some patients report improvement over time or after reducing their dose.

Dr Siegel said symptoms can last days to weeks, potentially becoming less noticeable as the body adjusts to treatment, much like nausea and constipation.

"It's possible something similar is happening here, where temporary changes in receptor activity alter nerve signaling at first, but become less noticeable as the body adjusts," he said.

Read More: Stopping Ozempic, Wegovy, Mounjaro Linked To 22% Higher Heart Attack, Stroke Risk: Study

Newer Weight-Loss Drugs May Carry A Higher Risk

Clinical trials have also recorded dysesthesia, a broader category of abnormal sensations, including burning and tingling. It is not necessarily the same as allodynia.

In a high-dose oral semaglutide trial, dysesthesia occurred in fewer than 3% of 334 participants, compared with none receiving placebo.

Phase 3 trials of retatrutide, an experimental drug targeting GLP-1, GIP and glucagon receptors, reported:

• 9 mg dose: 8.8%
• 12 mg dose: 20.9%
• Placebo: 0.7%

Who Is More Vulnerable To Allodynia?

Risk factors remain unclear. Dr Siegel believes higher doses could play a role.

"As best as I can tell, it would mostly be people on higher doses of these medications," he said.

He also suggested that people with greater pain sensitivity, including those with fibromyalgia, might be more susceptible.

What Should Patients Do?

Patients experiencing unusual skin burning or sensitivity should consult their doctor. Dose adjustments or alternative treatments may be considered, but medication should not be changed or stopped without medical advice.

Allodynia can also occur with shingles, migraines and nerve damage, so symptoms should not automatically be attributed to weight-loss drugs.

Dr Siegel recommends recording when symptoms occur, where they appear and what makes them better or worse.

Persistent or worsening pain should be medically evaluated.