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.

Low-dose aspirin could play a key role in lowering the risk of dementia significantly in some older adults, according to a new genetic analysis. However, the benefit does not come without a complication: major bleeding.

The study, led by researchers at Monash University in Australia, is based on data from more than 13,500 participants in the ASPREE trial, which investigated the effects of low-dose aspirin in older adults. The study was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Researchers found that the benefit was mostly seen among people with a specific genetic trait linked with platelet count.

70% Lower Dementia Risk Was Seen Among Older Adults

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Platelets are small blood components that help form clots and stop bleeding. Researchers have previously examined how aggregation of platelets might contribute to dementia, but the role of genetically influenced platelet counts still remains unclear.

The researchers examined genetic scores related to platelet count and compared dementia results among participants who were either assigned aspirin or placebo.

Among people in the highest 20% of platelet count genetic scores, dementia developed in 1% of those taking aspirin, compared with 3.3% of those receiving a placebo. This represented approximately a 70% lower risk.

Lead author Dr Peter Fransquet, a research fellow at Monash University's School of Public Health and Preventive Medicine, said, “Previous trials found aspirin didn't prevent dementia when everyone was considered together.”

“Our findings suggest there may be more to the story,” he said.

Risk Of Bleeding Increased

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The benefit was accompanied by a safety concern. Among participants in the same genetic subgroup, major bleeding occurred in 4.4% of those assigned to aspirin, compared to 2.1% of those given a placebo. That is a difference of 2.3 percentage points in both dementia cases and major bleeding events. In other words, the lower dementia rate cannot be considered in isolation from the increased bleeding risk.

Aspirin reduces the ability of platelets to form clots. This can be useful for certain people who need to take precaution against cardiovascular events, but it can also increase the risk of serious bleeding, including bleeding in the gastrointestinal tract or brain.

The study therefore does not prove that aspirin offers a favourable overall balance of benefits and harms for people with this genetic profile.

Could This Help Personalise Dementia Prevention?

The researchers found that the genetic signal was not linked to established genetic risk factors for Alzheimer's disease and dementia. Instead, it pointed towards platelet factor as a possible direction for further research.

“What's particularly interesting is that the signal wasn't linked to the established genetic risk factors for Alzheimer's disease and dementia,” Fransquet said. “Instead, it's pointing us towards platelet biology and gives us a new avenue to investigate.”

The findings could contribute to more personalised approaches to dementia prevention, in which treatments are tailored to characteristics that influence how individuals respond. But the results need to be replicated in other populations and tested in a clinical trial specifically designed for people with the identified genetic profile.

Fransquet said, “People shouldn’t start taking aspirin to prevent dementia on the basis of this study without consulting with their doctor, particularly given the increased risk of serious bleeding,” he said.

High blood pressure can be managed with medication and dietary changes. But recent research suggests that certain mental health habits can also help fight hypertension.

Mental health practices like mindfulness, optimism and gratitude may also support cardiovascular health, partly by helping people manage stress better and maintain healthier habits.

Hypertension affects nearly half of adults in the United States. While lifestyle changes like reducing salt intake, exercising regularly, maintaining a healthy weight and limiting alcohol remain crucial, the emerging study says that psychological wellbeing can also have a beneficial effect on blood pressure.

“Stress contributes to hypertension,” said Willie E. Lawrence Jr., a cardiologist and spokesperson for the American Heart Association. “It’s hard to get all the stress out of your life, but there are things that you can do to lower blood pressure, like mindfulness.”

According to the researchers, here are three mental health habits that may help:

Mindfulness

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Mindfulness refers to paying attention to thoughts, emotions and physical sensations in the present moment without judging them. It may help alleviate stress and improve behaviours that affect blood pressure like dietary choices and physical activity.

Eric Loucks, professor of epidemiology and director of the Mindfulness Center at Brown University, developed a mindfulness-based blood pressure reduction programme that teaches participants all about self-awareness, attention control and emotional regulation. The programme teaches people to apply these skills to everyday decisions like choosing healthier foods.

“There can be energy that comes up to act on those insights,” Loucks said. “So if we decide we want to eat more healthily, can we be there with that energy in the grocery store, selecting the food for the week?”

Optimism

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Optimism means expecting positive outcomes while recognising that challenges exist. Research has linked an optimistic outlook with better cardiovascular health, but evidence that it lowers blood pressure in people who already have hypertension is limited.

A study based on more than 100,000 active-duty US Army personnel without hypertension found that the most optimistic participants were less likely to develop high blood pressure during an average follow-up of three and a half years.

Julia Boehm, professor and chair of psychology at Chapman University said that practising optimism does not mean ignoring difficulties. Instead, people can identify realistic, achievable actions that support their health, such as choosing nutritious meals or becoming more physically active.

“This might mean something concrete like, ‘Am I going to choose to eat the salad or the french fries at lunch?’ and thinking optimistically that my choices in any given moment are going to translate into measurable effects in the long run,” Boehm said.

Gratitude

Gratitude involves acknowledging the people, experiences and acts one appreciates. Some research suggests it may affect cardiovascular responses to stress.

One study found that writing a gratitude letter changed how systolic blood pressure responded during a stress test. Systolic pressure, the upper number in a blood pressure reading, measures pressure when the heart contracts.

Mindfulness, optimism and gratitude should complement established hypertension treatment, not replace it. Medication, regular physical activity, a balanced diet and screening remain essential.

As Boehm cautioned, “You can’t ignore the doctor’s advice to either take your medications or engage in physical activity or eat fruits and vegetables. It’s just one piece of a larger strategy to bolster health.”

A small, non-invasive device that stimulates nerves through the ear has shown early promise for people whose blood pressure stays high despite medication, according to a new clinical trial led by researchers at Queen Mary University of London.

What the device does

The device uses a technique called transcutaneous autonomic neuromodulation, or tAN, which aims to influence the autonomic nervous system, the network of nerves that automatically controls functions like heart rate, digestion, and blood pressure, according to Queen Mary University of London. Developed by Afferent Medical Solutions, the handheld device uses two small clips placed on the tragus, the flap of cartilage just in front of the ear canal, to deliver mild electrical pulses. Patients can use it themselves at home without visiting a clinic.

How the trial worked

The trial, called SCRATCH-HTN and funded by the National Institute for Health and Care Research, enrolled 63 people with uncontrolled hypertension, all of whom were already taking at least one blood pressure medication but still had readings above recommended levels, per Queen Mary’s release. Participants were randomly split into two groups: one received active nerve stimulation, the other used a sham device as a comparison.

For the first two weeks, participants used their assigned device for 30 minutes daily. For the following ten weeks, that dropped to once a week.

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What the results showed

The treatment was safe and generally well tolerated, and most participants stuck to the prescribed schedule, suggesting it could work for regular home use, according to the findings published in Hypertension, a journal of the American Heart Association. Across the full study group, however, there was no statistically significant difference in blood pressure between the active stimulation group and the sham group.

There was one notable exception. Among participants who entered the trial with more severe hypertension, those receiving active stimulation showed a greater reduction in blood pressure compared to those on the sham device, per a prespecified subgroup analysis in the study.

What the lead researcher said

“This is an exciting, highly patient-acceptable technology that could ultimately provide a cheap, scalable solution for millions,” said Dr. Ajay Gupta, the trial’s chief investigator and a clinical reader at Queen Mary University of London, in the university’s press release. “Although the trial did not achieve significance across the broad unselected group, those with more severe hypertension exhibited a clear blood pressure reduction in the active group compared to sham.”

He added that the study “points towards important new research directions that could help us understand whether non-invasive neuromodulation can benefit particular groups of patients with uncontrolled hypertension.”

Why this matters

High blood pressure is a major driver of cardiovascular disease, raising the risk of heart attacks and strokes over time. While medication helps many patients, a significant number continue to have blood pressure above target even while on treatment, which is part of why researchers are exploring additional, non-drug approaches that could work alongside existing therapies.

What comes next

The researchers are clear that this is an early finding, not proof of an effective treatment. Because the subgroup result came from a relatively small trial, it will need to be confirmed in larger studies before any conclusions can be drawn about how well the device actually works, and for whom.