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.

India is only second in the world to have people with chronic kidney diseases in 2023, said The Lancet study. In 2023, China recorded 152 million patients with chronic kidney disease (CKD), while India was at 138 million.

The study, led by researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, along with collaborators in the U.S. and the U.K., found that CKD was the ninth-leading cause of death worldwide, claiming nearly 15 lakh lives in 2023.

Regionally, the highest prevalence was reported in North Africa and the Middle East (18% each), followed by South Asia (nearly 16%), and more than 15% in Sub-Saharan Africa, Latin America, and the Caribbean.

In fact, senior director and HOD Nephrology at Medanta Kidney and Urology Institute, Dr Shyam Bansal says, "Chronic kidney disease is one of the fastest-growing chronic illnesses in India, mainly because diabetes and hypertension are becoming more common. Diabetes now affects about 10% of the population and hypertension nearly 25%, and together they remain the leading causes of kidney disease."

The report also highlighted CKD’s strong link to heart disease. It contributed to almost 12% of global cardiovascular deaths in 2023 and ranked as the seventh-leading cause of heart-related mortality, ahead of diabetes and obesity.

The researchers outlined 14 key risk factors for CKD, with diabetes, hypertension, and obesity contributing the most to the loss of healthy life. Dietary habits—such as low intake of fruits and vegetables and high sodium consumption, also played a significant role in raising CKD risk.

“Chronic kidney disease is both a major risk factor for other leading causes of health loss and a significant disease burden in its own right. Yet, it continues to receive far less policy attention than other non-communicable diseases, even as its impact grows fastest in regions already facing the greatest health inequities,” said senior author Theo Vos, professor emeritus at IHME.

The findings draw on data from the Global Burden of Disease (GBD) 2023 study, which tracked trends in diseases, injuries, and health risk factors across 204 countries and territories from 1990 to 2023.

Importance of Early Detection Of Chronic Kidney Disease

Importantly, the authors noted that most people with CKD in 2023 were in the early stages, highlighting the urgent need for strong screening programmes and strategies to reduce risk before the disease advances.

This is why its early diagnosis is utmost important. Dr Bansal on the need for early detection says, "“The biggest challenge is identifying people at risk as early as possible. Early diagnosis and timely control of risk factors are essential if we want to slow the progression of chronic kidney disease."

Early detection could also reduce heart-related deaths due to kidney disease and delay one's requirement for replacement therapies, which is usually sought in advanced stages of the disease.

Dr Bansal also points out that early detection could help one live a better life and also in many ways reduce the burden on the Indian healthcare system, and save cost. "We are dealing with a large population at risk, and kidney disease is complex and costly to treat. While infrastructure and specialist availability are improving, managing this growing burden remains a significant challenge," he says.

A GP has raised concern about a key sign that may show you have Covid rather than a cold or flu. Winter illnesses often look alike, which makes it hard to tell them apart, and getting the right diagnosis is important for proper care. Dr Rupa Parmar, GP and medical director at Midland Health, explained that there are certain clues that can help people understand what they are dealing with. She advised that anyone unsure should check with their doctor, as it is safer to ask than ignore a concern.

Why Breathlessness Matters

Dr Parmar noted that shortness of breath stands out as a sign of Covid. It rarely appears in a cold or flu, but it is common with Covid because the infection tends to affect the lungs and cause inflammation. The NHS also lists breathlessness as a sign linked more strongly with Covid than with flu or a cold. This symptom is also seen in conditions such as respiratory syncytial virus. In some cases, people with the flu who do not recover and worsen may develop breathing trouble if they develop complications such as pneumonia.

How Cough Patterns Differ

She added that coughs appear in all three infections, but they do not sound the same. A cold usually causes a light cough, flu tends to bring a dry one, and Covid usually causes a dry, ongoing cough. Many people with Covid cough for more than an hour or have several episodes of coughing through the day.

Loss Of Taste Or Smell As A Warning Sign

Another clue is a change in taste or smell. Dr Parmar said this sign is more specific to Covid. A sudden loss of taste or smell, or even a noticeable change, is more likely linked to the coronavirus. She explained that the pattern of symptoms often helps point to the right illness. A mild cough and sore throat usually fit a cold, a fever and strong fatigue suggest flu, and a loss of smell or taste with a steady cough point to Covid.

How Symptoms Begin And Progress

She also noted that the start of symptoms can differ. A cold tends to appear slowly, flu symptoms usually show up quickly within a few hours, and Covid can begin with mild signs that grow stronger over time. A cold mainly affects the nose and throat, while flu and Covid can cause symptoms across the body.

What To Do If You Have Covid Symptoms

Even though there are no formal self-isolation rules anymore, the NHS advises people to stay home and limit contact with others if they or their children have symptoms and either have a high temperature or feel too unwell to manage daily activities at work, school, or home. The NHS states that people can return to their usual routine once they feel well again or no longer have a high temperature.

As winter settles in, many people sense a shift in their mood. Shorter days and colder weather often leave us feeling a little dull. In some cases, this may be linked to seasonal affective disorder (SAD). Yet there may also be another explanation.

A doctor has cautioned that a very common deficiency could be the reason you have been feeling unusually low. He noted that this problem affects well over a billion people around the world.

Iron Deficiency Might Be The Reason Behind Your Low Mood

In a TikTok video, Doctor Sermed Mezher raised concern about iron deficiency. Iron is a mineral the body relies on to move oxygen through the blood and support several important processes. Dr Mezher explained as per Express, “Low iron is the most common nutritional deficiency in the world, affecting more than one billion people.” He also described how it can influence dopamine, often referred to as the “feel-good” chemical.

He added, “And its effects on dopamine go way deeper than just oxygen transport. Dopamine is made from an amino acid called tyrosine over a couple of steps, and the enzyme involved in the first step needs iron to work properly. It is no surprise, then, that in iron deficiency, studies show problems in dopamine pathways that play a part in happiness, reward, self control and social behaviour.”

The positive news is that this can usually be managed. Dr Mezher said, “Once your iron levels are restored, these pathways return to their normal state, and you can help this process by taking iron with vitamin C and staying away from caffeinated drinks for two hours before and after.”

Symptoms Of Iron Deficiency

The NHS lists several signs of iron deficiency anaemia, including:

• Tiredness and low energy
• Shortness of breath
• Heart palpitations
• Paler skin
• Headaches

If you think you may be low in iron, you should talk to your GP. A simple blood test can confirm it.

How To Boost Iron Levels?

Iron levels can be raised through the foods you eat. These options are naturally rich in iron:

• Dark-green vegetables such as watercress and curly kale
• Iron-fortified cereals and bread
• Meat
• Dried fruits like apricots, prunes and raisins
• Pulses including beans, peas and lentils

The NHS also suggests cutting back on:

• Tea
• Coffee
• Milk and dairy products
• Foods high in phytic acid, like wholegrain cereals, which can prevent your body from absorbing iron from meals and supplements

The NHS notes, “Large amounts of these foods and drinks make it harder for your body to absorb iron. You might be referred to a specialist dietitian if you're finding it hard to include iron in your diet.”

How Much Iron Does One Need?

The daily iron requirement is:

• 8.7mg for men aged 19 and above
• 14.8mg for women aged 19 to 49
• 8.7mg for women aged 50 and above

The NHS adds, “Taking 17mg or less a day of iron supplements is unlikely to cause any harm. But continue taking a higher dose if advised to by a GP.”