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.

While US has already reported record breaking flu cases, with hospitalizations and deaths continuing to rise, the Centers for Disease Control and Prevention (CDC) says that the flu activity may not have peaked yet. Around 40,000 people were admitted to the hospital with flu during the week ending with January 3. The CDC published the data that showed around 10% more than the 36,000 hospitalizations from the week before. There were 12 flu hospitalizations for every 100,000 people in the US last week.

CDC has also noted that vaccination "has been shown to reduce the risk of flu and its potentially serious complications". However, only 130 million doses of vaccine have been distributed, which covers less than 40% of the US population.

While the CDC data showed an increase in flu-like activity, and that the records have reached the highest since the initiation of the agency's tracking around 30 years ago, some indicators this week have fallen. CDC says that this does not mean the season has reached its peak, rather the downtick "could be due to changes in healthcare seeking or reporting during the holidays." CDC says more flu cases may come in the weeks ahead.

The Worst Flu Season Could Become Worse

This year's flu came after the flu vaccination was made, which means the current vaccination does not align with the mutation, however, experts have pointed out that it still continues to offer protection against the illness. This season's flu is a mutation of H3N2 or influenza A, called the subclade K, or what people are calling 'super flu'.

This is the culprit in rising flu cases, globally. The World Health Organization (WHO) on its website said that K variant marks "a notable evolution in influenza A (H3N2) viruses". Some are also questioning the effectiveness of this season's influenza vaccine against the strain.

The flu virus is highly contagious and spreads easily in crowded places, especially during the colder months.

In some cases, the infection can progress to the lungs, which could lead to complications like bronchitis or pneumonia. Yale Medicine too notes that this virus could attack the respiratory system, including throat, nose, and lungs.

What Are The Common Symptoms This Season For The Flu?

K variant causes more intense flu symptoms, they include:

• Fever
• Chills
• Headache
• Fatigue
• Cough
• Sore throat
• Runny nose

Are The Old Vaccines Effective Against This New Variant?

"The vaccine remains the most effective means to prevent disease. We still want to encourage people to get the vaccine," said Professor Antonia Ho, Professor and Honorary Consultant in Infectious Diseases at the University of Glasgow. Experts have stressed enough on the immunity that one can receive from the vaccine that that these flu jab remain the best defense against the flu, even though the current strain circulated may have drifted away from the strain included in this year's jab.

Data from the UK Health Security Agency (UKHSA) also show that vaccines is performing as expect, despite the emergence of subclade K.

We know of the Japanese way of walking, and the Chinese way of losing weight by getting yourself enrolled in "Fat Prison", but did you know that there is a Korean Way of doing things. And no, this is not skincare. We are talking about the Korean way of brushing, using the 3-3-3 rule.

This method recommends brushing thrice a day, within three minutes of eating, and for at least three minutes of duration.

This is especially for when we eat sugary foods or snacks in between the meals. Korean cuisine uses a lot of spices, especially garlic. This is why, Koreans believe brushing their teeth is important so the smell does not linger.

In fact, many Koreans carry a toothbrush and toothpaste at work.

The Korean Way Of Brushing: A Study

A study conducted between 2012 and 2014 by the Division of Chronic Disease Surveillance, Cheongju, Korea, under the Korean Centers for Disease Control and Prevention and the Korean Ministry of Health and Welfare, Sejong, Korea, assessed the association between oral health and periodontal disease. The study used nationally representative data from the Korean National Health and Nutrition Examination Survey (KNHNES).

The study used a detailed, multi-stage survey method designed to fairly represent the non-institutionalized civilian population. Trained health workers visited participants in their homes and carried out standardized health examinations.

Initially, 23,626 people were considered for the KNHANES survey. The analysis focused on 18,382 adults aged 19 and above. After excluding participants with no data on periodontal health, the sample dropped to 15,754. The final analysis included 14,527 individuals with complete information. The study was approved by the Institutional Review Board of the Korean Centers for Disease Control and Prevention and followed the ethical principles outlined in the Helsinki Declaration.

Researchers recorded when participants brushed their teeth—before or after breakfast, lunch, dinner, after snacks, or before bedtime—and whether they used additional oral care products such as dental floss, mouthwash, interdental brushes, electric toothbrushes, tongue cleaners, or denture-specific tools. Daily brushing frequency was calculated based on how many times teeth were brushed each day. Information on tooth pain, past orthodontic treatment, and dental checkups within the past year was also collected.

The findings showed that people who brushed after lunch and before bedtime had lower rates of periodontal disease, while brushing after dinner was linked to fewer severe cases. Using additional oral care tools, especially dental floss and powered toothbrushes, was also associated with better periodontal health.

In many countries, it is a norm to brush your teeth at least twice a day. However, in Korea, the 3-3-3 brushing technique is more than a norm.

Is Brushing Three Times A Day Too Much?

While brushing is a great habit, one may be worried if brushing too much can lead to enamel erosion. However, brushing three times a day may not be excessive, as the American Dental Association recommends brushing teeth after every meal as ideal for optimal oral health.

The reason is that bacteria and food particles can accumulate on our teeth within minutes of eating or drinking. If left uncleaned, this could also lead to plaque buildup and tooth decay. This could lead to cavities and other dental issues.

People troubled by increasing forgetfulness are being advised to have their vitamin levels checked, as a shortage of one essential nutrient can cause symptoms that closely resemble dementia. According to the NHS, a deficiency in a key vitamin may lead to neurological issues that affect the nervous system, including problems with memory.

As per Mirror, Dr Eric Berg, DC, has also drawn attention to what he calls the “leading vitamin deficiency that mimics dementia,” identifying vitamin B12 as a major concern. Adequate levels of this nutrient are vital because it helps form red blood cells that carry oxygen through the body, supports DNA production and regulation, and converts food into usable energy.

Dr Berg, well known for promoting healthy ketosis and intermittent fasting, is the author of the bestselling book The Healthy Keto Plan and runs Dr Berg Nutritionals. He has since moved away from clinical practice to focus on sharing health information through online platforms.

Why Is Vitamin B12 Important?

Vitamin B12 is essential for the healthy functioning of the central nervous system and plays a key role in maintaining clear thinking and memory. When levels drop, people may experience weakness, numbness, difficulty walking, nausea, unintended weight loss, irritability, extreme tiredness, and a fast or irregular heartbeat.

Bones, hair, skin, and nails may also suffer. Dr Berg explains: “Vitamin B12 is essential for normal brain function. Without it, symptoms similar to dementia can develop. This vitamin is mainly found in animal-based foods, although some microbes can produce it. Low intake of animal products is the most common reason for vitamin B12 deficiency.”

Research suggests that low B12 levels can impair nerve function and may contribute to conditions such as dementia, peripheral neuropathy, or subacute combined degeneration. A deficiency can also interfere with DNA synthesis and cause homocysteine levels to rise.

What Does The NHS Say?

On its official website, the NHS states: “Most cases of vitamin B12 or folate deficiency can be treated easily and effectively, so complications are uncommon. However, complications may sometimes occur, particularly if the deficiency has been present for a long time. If neurological problems develop, they can occasionally be permanent.”

The NHS explains that a lack of vitamin B12 may lead to neurological symptoms such as:

• vision problems
• memory loss
• pins and needles
• loss of physical coordination (ataxia), which can affect speech or walking
• damage to parts of the nervous system (peripheral neuropathy), especially in the legs

A study published in 2020 found a “clear association between low vitamin B12 levels and progressive cognitive impairment.” Researchers added that more large-scale studies are needed to confirm these findings and to see whether correcting the deficiency can slow cognitive decline.

More than one in ten older adults are estimated to have low vitamin B12 levels. In addition to memory problems, a deficiency may cause other neurological and psychological symptoms, including:

• confusion
• difficulty with thinking and reasoning
• tingling or numbness in the hands and feet
• poor balance and coordination
• fatigue
• weakness
• vision disturbances
• peripheral neuropathy affecting the nervous system
• depression, anxiety, paranoia, and delusions
• incontinence
• loss of taste and smell

Can A Vitamin B12 Deficiency Be Treated?

If a vitamin B12 deficiency is diagnosed, treatment usually involves high-dose supplementation, either through injections or oral supplements. GPs may arrange regular blood tests to monitor B12 levels over time.

As per The Mirror, the longer the deficiency goes untreated, the higher the risk of permanent damage. That said, it is often reversible, with many people noticing marked improvement within three to six months. Other signs of vitamin B12 deficiency may include:

• numbness, tingling, and pins and needles in the arms and legs
• pale skin
• unsteady walking or balance problems
• a rapid heartbeat
• shortness of breath
• a swollen tongue

“As we get older, HCL levels naturally decline. They can also drop if you take antacids or medications like Metformin. Interestingly, acid reflux can actually be a sign of low HCL, and antacids may worsen the problem. Betaine hydrochloride is one way to support normal stomach acidity.”

What Else Is Worth Being Aware Of?

Deficiencies in other nutrients may also cause symptoms that resemble dementia. Dr Berg highlights vitamin B1, which is often linked to high sugar and carbohydrate intake. Zinc deficiency, sometimes related to phytic acid found in grains, and low vitamin D levels due to limited sun exposure, may also play a role. “Nutrient deficiencies can shrink the hippocampus, which is linked to Alzheimer’s disease,” Dr Berg said.