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.

Popular GLP-1 medications such as Ozempic, Wegovy, and Zepbound are well established for improving metabolic health, lowering blood sugar and promoting weight loss. These blockbuster drugs are also known to reduce the risk of conditions such as heart disease and type 2 diabetes.

Now, researchers are exploring whether these medications could also help slow biological aging and potentially increase longevity.

Study Explores Anti-Aging Potential

A recent US National Institutes of Health (NIH)-backed study, published in the journal Nature, found that Ozempic slowed biological aging in people living with HIV and lipohypertrophy, a condition in which fatty deposits develop under the skin.

People with HIV often experience accelerated aging because of the infection, making them an important group for age-related research, said lead author Dr. Michael Corley, associate professor of medicine at the University of California, San Diego's Stein Institute for Research on Aging, according to The New York Times.

Although the trial was preliminary, Dr. Corley said it "provided us an opportunity to say, hey, is there any signal here that warrants all the hype?"

Can GLP-1 Drugs Slow Aging?

Experts believe the findings are promising, but stressed that more research is needed.

Dr. Nicolas Musi, director of the Diabetes and Aging Center at Cedars-Sinai, told NYT that because these drugs reduce the risk of diseases associated with aging, they could potentially improve lifespan as well.

"GLP-1 agonists decrease the incidence of diseases that are related to aging and are associated with decreasing life span. One would assume that they're also potentially going to increase life span and be beneficial for longevity," Dr. Musi said.

Researchers also point to the drugs' anti-inflammatory effects. Chronic inflammation is one of the biological processes linked to aging, said Dr. Thomas Blackwell, professor of general internal medicine at the University of Texas Medical Branch in Galveston.

However, scientists caution that there is currently no evidence showing that GLP-1 drugs provide longevity benefits for people who are already metabolically healthy.

What Are GLP-1 Drugs?

Drugs such as Ozempic and Wegovy contain semaglutide, a GLP-1 receptor agonist, while Zepbound and Mounjaro contain tirzepatide.

These medications are approved for the treatment of type 2 diabetes, and some are also approved for chronic weight management.

GLP-1 receptor agonists work by binding to GLP-1 receptors in the body. This increases insulin production in response to food, suppresses glucagon—a hormone that raises blood sugar—and helps regulate blood glucose levels.

What Does GLP-1 Do in the Body?

GLP-1 (glucagon-like peptide-1) is a hormone naturally produced by the small intestine after eating. It plays several important roles in regulating blood sugar and appetite by:

• Stimulating insulin release from the pancreas.
• Suppressing glucagon secretion, which helps prevent unnecessary increases in blood sugar.
• Slowing stomach emptying allows glucose to enter the bloodstream more gradually.
• Increasing feelings of fullness (satiety), which helps reduce food intake.

On Doctors Day, along with celebrating the valuable contribution and role of doctors, it is also important to take a look at what goes on beyond operation theatres and surgical masks. Amid increasing instances of doctors seeking mental health support, we take a look at what is pushing doctors to seek mental health care.

Why Burnout In Doctors Needs To Be Addressed?

HealthandMe spoke to Neha Cadabam, Senior Psychologist & Executive Director, Cadabam's Hospitals, and Dr. Jagadeesh P.C, Senior Orthopaedic Surgeon and Robotic Joint Replacement at Kauvery Hospitals & Joss Center, about increasing burnout, stress, anxiety, and other mental health issues among doctors in various specialties.

Doctors face grueling work schedules that entail long work hours, demanding patient care, and constant vigilance to provide the best service.

Neha Cadabam explains, “Doctors are often expected to remain composed, resilient, and emotionally available regardless of the circumstances they face. However, the emotional demands at their profession can accumulate over time.”

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She also said that long working hours, repeated exposure to suffering and death, difficult clinical decisions, medico-legal concerns, workplace violence, and the constant pressure to avoid errors can create a significant psychological burden.

Dr. Jagadeesh P.C sheds light on how doctors in the orthopedics specialty face constant physical and emotional stress. He says that as orthopedicians mostly handle traumas and accidents, they undergo added stress due to emergencies and constant patient care.

He says, “Surgeons and physicians work in high-pressure environments where critical decisions need to be made quickly, often after long hours in operating rooms, emergency departments, clinics, and wards. The responsibility of restoring mobility, managing trauma cases, handling complications, and supporting patients through recovery can be deeply demanding.”

He also said that doctors frequently work through physical fatigue, irregular schedules, sleep deprivation, and the emotional weight of patient outcomes. In specialties such as orthopaedics, where many cases involve trauma, pain, disability, and long recovery journeys, the responsibility extends well beyond the operating theatre.

According to the experts, doctors are mainly seeking mental health care for:

• Emotional exhaustion

• Burnout

• Sleep disturbances

• Chronic stress

• Anxiety

• Compassion fatigue

Neha Cadabam says, “Many doctors find it difficult to acknowledge their own emotional struggles because medicine has traditionally valued endurance and self-sacrifice. Seeking help is often perceived as a sign of weakness when, in reality, it reflects insight and self-awareness.”

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A Look At Stark Reality

In a real-life case, a 38-year-old emergency medicine specialist sought mental health support after years of managing trauma cases, and long shifts led to burnout, anxiety, compassion fatigue and sleep problems.

After psychotherapy and stress management, the doctor reported improved sleep, reduced anxiety, and better work-life balance.

In another situation, a 45-year-old obstetrician and gynaecologist sought help for burnout, chronic stress, and anxiety caused by the demands of high-risk pregnancies, emergency procedures, and medico-legal pressures.

Therapy helped improve emotional wellbeing, sleep, and the ability to disconnect from work outside hospital hours.

Heal The Healers

Doctors are often seen as symbols of resilience, but the misplaced resilience is taking a toll on their mental health. Acknowledging that doctors experience stress, anxiety, and emotional fatigue is not commentary on their professionalism.

Dr Jagadeesh P.C says, “The well-being of doctors is closely linked to the quality of care they provide. As healthcare systems evolve, there is a growing need to create environments that support the physical and emotional well-being of medical professionals. On Doctor's Day, it is important to recognize not only the dedication of doctors but also the immense pressures they navigate every day while caring for others."

As conversations around mental health continue to gain exposure, experts say supporting doctors' psychological wellbeing should become an integral part of strengthening healthcare systems.

Every year on July 1, India celebrates National Doctors' Day. This year's theme, "Honor the Calling," is a timely reminder that medicine is not merely a profession—it is a lifelong commitment to service, sacrifice, and human compassion. Behind every consultation, emergency intervention, surgery, and diagnosis is a doctor who has spent over a decade training to save lives. Yet, at a time when healthcare has achieved remarkable advances, trust in doctors appears to be facing one of its greatest tests.

India's Healthcare Landscape

India today has nearly 14 lakh registered doctors, giving the country a doctor-population ratio better than the World Health Organization's recommended benchmark of 1:1000. Yet numbers alone do not tell the full story. India continues to grapple with unequal access to healthcare, overburdened public systems, and significant shortages of specialists in rural and semi-urban regions.

At the same time, the demands on doctors have never been greater.

A physician today is expected to be a clinician, counsellor, communicator, technologist, administrator, and often crisis manager—all at once. Every day, doctors make decisions that can determine whether a patient recovers, survives, or faces lifelong complications. Despite this responsibility, public perception of doctors is increasingly shaped by isolated incidents rather than the reality of millions of successful patient interactions that occur every day.

Rising Workplace Violence and Burnout

The truth is that the overwhelming majority of doctors enter medicine for one reason—to heal.

Yet, increasingly, they do so under immense pressure. According to studies published in leading medical journals and data referenced by the Indian Medical Association, more than 75% of doctors in India have experienced some form of workplace violence, ranging from verbal abuse and intimidation to physical assault. In many cases, the perpetrators are distressed family members struggling to cope with grief, uncertainty, or unexpected outcomes. The impact extends beyond personal safety.

Studies have also shown that over 80% of doctors report significant workplace stress and burnout, fueled by long working hours, rising patient loads, medico-legal concerns, and fear of violence.

The Growing Trust Deficit

No profession can function effectively when fear becomes part of the workplace. Compounding the challenge is a growing trust deficit. Research indicates that nearly 80% of patients search online after visiting a doctor, often seeking validation or clarification about diagnoses and treatments. While informed patients are welcome, the trend also reflects a lack of trust in the healthcare provider, which used to be one of the basic things in the past, and a communication gap that healthcare must urgently address.

Healthcare Has Changed Dramatically

Healthcare itself has changed dramatically. Over the last two decades, advances in neonatal care, robotics, minimally invasive surgery, fertility treatment, artificial intelligence, and precision medicine have transformed once unimaginable outcomes. Patients today have access to world-class healthcare technologies that were unavailable a generation ago.

However, as healthcare has become more specialized and hospital-centric, something valuable has been lost—the enduring relationship between a patient and a trusted family physician.

Why Family Doctors Still Matter

For decades, family doctors formed the backbone of healthcare. They understood not only diseases but also the people behind them. They guided families through preventive care, chronic illnesses, pregnancies, childhood illnesses, and ageing. They represented continuity, trust, and reassurance.

Today, many patients enter the healthcare system only when illness strikes, often bypassing primary care altogether. The result is a system that excels at treatment but frequently misses opportunities for prevention.

This shift has also led to a common misconception—that doctors are responsible for rising healthcare costs. In reality, healthcare expenses are driven by multiple factors, including technology investments, infrastructure, regulatory requirements, advanced diagnostics, and operational costs. Doctors are often the most visible face of a much larger ecosystem and therefore become the easiest target for public frustration.

Rebuilding Trust in Healthcare

The answer lies not in assigning blame but in rebuilding trust. India must strengthen primary healthcare, invest in family medicine, promote preventive care, and create safer working environments for healthcare professionals. Hospitals and healthcare providers must also focus on improving communication, transparency, and patient engagement. Trust is the most powerful medicine in healthcare. Without it, even the best technology cannot deliver its full promise.

Honoring the Promise of Medicine

This National Doctors' Day, as we honor the calling, let us remember the countless doctors who work through nights, weekends, emergencies, and personal sacrifices to care for others.

They are not defined by headlines or stereotypes.

They are defined by the lives they save, the families they comfort, and the hope they restore every single day.

Medicine is not merely a profession. It is a promise—and that promise deserves our trust, respect, and protection.

(By Dr R Kishore Kumar, President- National Neonatology Forum, Karnataka Chapter. The author is also the Founder Chairman & Senior Neonatologist & Paediatrician at Cloudnine Group of Hospitals.)