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 the National Capital is dealing with cold wave, the air quality also continues to worsen. In several parts of Delhi, the air quality reached severe category. The Indian Meteorological Department (IMD) also issued an Orange alert on Tuesday for cold wave. Dense fog also engulfed the city, with air pollution or the particulate matter being trapped in the air, turning the fog into smog.

The condition of air pollution in Delhi has remained concerning and the levels have spiked to 20 to 30 times above the safety levels recommended by the World Health Organization or the WHO. Many studies, including the official website of the Environmental Protection Agency (EPA), US notes that the small particulate matter found in the air pollution is directly linked to health problems. "Small particles less than 10 micrometers in diameter pose the greatest problems, because they can get deep into your lungs, and some may even get into your bloodstream," notes EPA.

The particulate matter could lead to:

• premature death in people with heart or lung disease
• nonfatal heart attacks
• aggravated asthma
• irregular heartbeat
• decreased lung function
• increases respiratory symptoms like irritation of the airways, coughing, or difficulty breathing

What Are Smog-Eating Surfaces And How Do They Help?

The government is pursuing "smog eating" surfaces to deal with the pollution problem in Delhi. While it may sound like a strange thing in India, not to the world. In fact, in the Netherlands these were used to reduce local nitrogen oxide or the NO concentrations in the air, rather than greenhouse gas concentrations.

Smog usually contains a mixture of hydrocarbons, ozone, oxides of nitrogen and sulphur, and particulates. The pollution is caused by both photochemical reactions that involve sunlight, unburned hydrocarbons and nitrogen oxides, along with high concentrations of particulate matter, especially from vehicle exhaust, construction dust and biomass burning.

Environment Minister Manjinder Singh Sirsa announced "smog eating" surface as part of its pollution control plan, for which the government has also signed an MoU with IIT Madras.

The smog eating surfaces will be public surfaces coated with photocatalytic materials like titanium dioxide or TiO2 that is used to degrade pollutants.

The Deccan Herald quoted Dr Pradeep Singh, professor and head at the School of Advanced Chemical Sciences, Shoolini University, who explained: Photocatalytic materials are basically semiconductors. Substances like TiO2₂or zinc oxide are typically used as photocatalysts. When light falls on these semiconductor catalysts, electrons within them jump from one energy level to another, creating a hole. These photocatalytic holes and electrons subsequently form free radicals, which have strong oxidizing properties and can break down certain air pollutants with which they interact."

How Do Smog Eating Surfaces Work?

Smog contains mainly nitric oxide, nitrogen dioxide, sulphur dioxide, ozone, and particulate matter. When all of these interact with photocatalytic materials, gaseous pollutants convert into less harmful compounds, such as nitrogen oxides become nitrates or decompose into ions. This process is also known as pollutant mineralization.

Fun Fact: It was in 2017, when scientists in Italy developed a type of photocatalytic cement that could absorb pollutants and convert it into harmless salts. Palazzo Italia in Milan, opened in 2015, was the first building to use the cement.

How Effective Are These Smog Eating Surfaces?

As per Dr Ashish Moon, Head of the Civil Department at Smt Radhikatai Pandav College of Engineering, Nagpur, the impact depends on environmental conditions. He explained that titanium dioxide can locally reduce certain gaseous pollutants like nitrogen oxides under ideal conditions, rather than absorbing up to 50 percent of all harmful gases.

He also co-authored a paper in 2021, titled: Detailed Case Study on Smog Eating Tile, where he noted, "It is better to use it in liquid form than a powder. I have not come across any harmful interactions between TiO2 and particles or gases in the air." However, he also points out that how it will work in Delhi will depend on its weather conditions and atmosphere. "There should be enough UV light for the nanoparticles to activate," he said.

Will this arrangement really work? That is yet to see, although a 2023 Spanish study found that although this measure showed some improvement, but it only yielded a modest reduction in ambient NO2. We are yet to see how well it will work in Delhi and its neighboring city's pollution problem.

As temperatures fall, a growing number of people are seeking medical advice for sudden, painful rashes and nerve-related discomfort. Superdrug Online Doctor has reported a 50% rise in patients requesting consultations for shingles over recent weeks. Shingles develops when the chickenpox virus, which stays dormant in the body after childhood infection, becomes active again later in life.

What Is Shingles?

Shingles, also known as herpes zoster, is a viral illness that causes a painful, blistering rash, usually appearing on one side of the body. It occurs when the varicella-zoster virus, which causes chickenpox, becomes active again after lying dormant in the nerves for many years. This reactivation is more likely when the immune system is weakened.

Symptoms often begin with burning, tingling, or itching in a specific area, followed by clusters of fluid-filled blisters that eventually dry out and form scabs. Starting antiviral treatment early can help reduce the severity and length of the infection. A shingles vaccine is also available and is recommended, particularly for people over the age of 50, to lower the risk of developing shingles and to prevent complications such as long-lasting nerve pain, known as postherpetic neuralgia.

Who Is Most At Risk Of Shingles?

The condition is more likely to affect older adults and people with weakened immune systems. Dr Babak Ashrafi, Superdrug’s Online Doctor, explained that many patients are caught off guard by how quickly symptoms appear. “Shingles often begins unexpectedly,” he said. “People may wake up with a burning or tingling sensation, followed by a rash that rapidly becomes more painful. We typically see higher numbers during colder months, when immune defences are under greater pressure.”

Winter-related factors such as stress, poor sleep, and seasonal infections can all take a toll on the immune system. When immunity dips, the virus responsible for shingles has a greater chance of reactivating, increasing the likelihood of flare-ups during colder periods.

Shingles Early Warning Signs To Watch For

According to the NHS, early symptoms of shingles often include a tingling, itching, or painful sensation on one side of the body. Some people may also experience headaches or feel generally unwell before a rash appears. The rash usually develops a few days later and is most commonly seen on the chest or abdomen, although it can occur anywhere on the body.

Superdrug Online Doctor has outlined five situations where people should seek prompt medical advice rather than rely on self-care. These include cases where:

• the rash appears on or near the eye
• pain is severe or spreading
• the person has a weakened immune system
• the individual is pregnant
• symptoms are worsening quickly

Shingles Treatment

Superdrug Online Doctor provides an online assessment and photo-diagnosis service, allowing clinicians to review symptoms remotely. Where appropriate, patients can be prescribed antiviral medication without needing to wait for a GP appointment.

Dr Ashrafi stressed the importance of acting quickly, adding: “The most important advice is not to wait and see. Starting treatment early can make a significant difference to recovery and long-term outcomes.”

Doctors are reporting a change in the way the flu is presenting as a new strain spreads across the UK. Hospital admissions linked to the flu rose sharply at the beginning of the year, with an average of 2,924 people a day admitted by January 4. Four hospital trusts have declared critical incidents, citing ongoing and intense pressure on services. These include three trusts in Surrey and one in Kent.

Surrey Heartlands Trust said winter pressures had been made worse by a rise in flu and norovirus cases. NHS national medical director Professor Meghana Pandit said the situation remains difficult, with hospitals seeing another increase in patients admitted with flu and other respiratory infections last week.

She said it is still vital for people to seek medical help when needed and reminded the public that there are many chances to get vaccinated against flu. Health Secretary Wes Streeting also stressed that flu can be dangerous, especially for older adults, young children, and those with existing health problems. He urged everyone who qualifies to get their flu vaccine as soon as possible, calling it the best form of protection.

Doctors Report Unusual Symptoms As New Flu Strain Spreads Across The UK

Doctors say this latest flu strain appears to be causing different symptoms. The virus, known as subclade K, is a variant of the A H3N2 type of influenza.

Dr Mark Loafman told NBC Chicago that many patients are experiencing much higher fevers than usual. He said the fever can last five to seven days, which is longer than people typically expect and is a cause for concern.

In some cases, doctors say the fever does not respond well to common medicines such as paracetamol or ibuprofen. Lung specialist Dr Juanita Mora said this strain is linked to very high temperatures, a severe and persistent cough with heavy phlegm, vomiting, diarrhoea, and widespread joint and muscle pain.

Doctors have also noticed a rise in stomach-related symptoms, including nausea and vomiting, often referred to as gastrointestinal or GI issues. Dr Loafman said that, based on what doctors are seeing, adults infected with the subclade K strain seem to be showing more signs of GI illness than usual.

According to the NHS, flu symptoms usually appear suddenly and tend to be much more severe than those of a common cold. While most people start to recover within about a week, the illness can feel particularly harsh while it lasts.

Key Symptoms of Flu

The main symptoms usually begin abruptly and include:

• A sudden high temperature of 38C or higher
• Body aches affecting muscles and joints
• Extreme tiredness or exhaustion
• A dry cough
• A sore throat
• Headaches
• Problems sleeping
• Reduced appetite
• Nausea, vomiting, or diarrhoea, which are more common in children

How To Treat Flu at Home

Most people can deal with flu symptoms at home without needing to see a doctor. The NHS advises the following self-care measures:

• Rest and Sleep: Allow your body time and energy to fight off the infection.
• Stay Warm: Use extra layers or blankets to maintain body warmth.
• Hydration: Drink plenty of fluids to prevent dehydration. Your urine should be pale yellow or clear.
• Pain Relief: Paracetamol or ibuprofen can help reduce fever and ease aches. Avoid taking combination flu medicines alongside paracetamol tablets, as this can lead to taking too much.
• Sore Throat Relief: Gargle with salt water if you are an adult, or have hot drinks such as lemon and honey to ease discomfort.