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.

Arthritis can affect people at different stages of life, limiting their ability to walk, climb stairs or carry out everyday activities with ease. While treatment largely depends on the extent of joint damage and the patient's condition, treatment approaches ranging from joint-preserving surgery to knee and hip replacement can help restore mobility. Rehabilitation still remains an essential part of recovery.

On World Arthritis Day, doctors explain how arthritis is treated and managed at different ages using real-life cases and highlighting how they assess joint damage, choose strategies and use physiotherapy to help patients return to their routines.

Knee Preservation Before Replacement

A 42-year-old man with grade 3 osteoarthritis in his right knee had been experiencing pain and locking. His symptoms began after a knee injury six years earlier and worsened with time. X-rays revealed marked varus alignment, cartilage and meniscus damage. Earlier consultations had suggested knee replacement, but given his age, doctors opted for knee preservation surgery.

Dr. Tapish Ravindra Shukla, Consultant Orthopaedics and Sports Medicine, Fortis Escorts Hospital, Amritsar, told HealthandMe that he performed three procedures in a single sitting: high tibial osteotomy to correct alignment and shift weight away from the damaged inner compartment, bone marrow aspirate concentrate (BMAC) to treat the cartilage defect, and meniscus repair.

The patient walked with a walker for approximately three weeks, began jogging at six weeks and was running by three months.

The case brings us to an important point, i.e., assessing whether a damaged joint can be preserved, especially in younger patients who may otherwise face joint replacement early in life.

Also read: Arthritis Day: Stanford Researchers Explore Possibility To Treat Osteoarthritis Without Knee Replacement Surgery

When Hip Replacement Becomes Necessary?

In another case, a patient developed pain in both hips after recovering from a major head injury. During prolonged rehabilitation, he had received steroids and anti-epileptic medication for an extended period. He was subsequently diagnosed with bilateral avascular necrosis, a condition in which compromised blood supply damages bone and can lead to joint destruction.

Initially, doctors performed core decompression to relieve pressure within the affected bone and attempt to preserve the joints. The patient experienced relief and continued his routine activities for nearly two years.

However, following a minor slip and fall, the pain returned. Further evaluation and X-rays showed significant progression of arthritis, prompting a recommendation for total hip replacement.

Dr. P Keerthivasan, Senior Consultant and Spine Surgeon, Kauvery Hospital, Alwarpet, Chennai, explained to us the importance of understanding the condition, accepting when treatment needs to change and planning for recovery. Following hip replacement, the patient began mobilising the next day and progressed well during the immediate recovery period.

The case illustrates that joint-preserving procedures may provide relief in selected patients, but progressive joint damage can make replacement necessary.

Also read: Joint Pain In Your 30s And 40s: When Should You Worry?

Knee Replacement To Improve Quality Of Life

A 65-year-old woman with osteoarthritis in both knees had severe pain and difficulty walking, climbing stairs and performing daily activities. She had become dependent on painkillers, raising concerns about potential kidney damage with prolonged use. Doctors recommended total knee replacement.

Dr. Rishabh Tiwari, Consultant (JR), Orthopaedics, and Dr. Vivek Allahbadia, Consultant, Orthopaedic Surgery, P.D. Hinduja Hospital & Medical Research Centre, Khar, treated the patient using a minimally invasive technique in which the tendon was lifted rather than cut. The posterior cruciate ligament (PCL) was also preserved.

According to the doctors, these approaches can help reduce postoperative pain, limit bone loss and provide a more natural feel to the replaced knee.

The patient could lift her leg on the night of surgery. The following day, she was walking with full weight-bearing, bending and straightening her knee, and using the washroom independently. Training to climb stairs began on the second day, and she was discharged that day.

At one-and-a-half months, she could perform daily activities without pain and travel independently to nearby friends and relatives. The case stresses upon how surgical technique and early mobilisation can contribute to a patient's return to everyday activities.

In another case of knee replacement, a 62-year-old woman with severe osteoarthritis in both knees had spent nearly four years avoiding stairs, temples and long walks with her grandchildren. Pain, stiffness and fear of falling had increasingly restricted her activities. “She stopped joining family outings because I couldn’t keep up,” she told her doctor.

Dr. Bhushan Shitole, Consultant Orthopaedic Surgeon and Director at Vencer Hospital, told us that he recommended robotic-assisted total knee replacement using an imageless robotic system. The technology creates a three-dimensional plan of the joint before surgery and helps the surgeon plan implant positioning according to the patient's anatomy.

“Robotic planning lets us match the implant to the patient’s unique anatomy so the first steps after surgery are already better aligned,” Dr. Shitole said. “That first confident walk is often the real turning point.”

Following surgery, the patient began walking with minimal support within days. Structured physiotherapy focused on strength, balance and gait training. By the end of the first month, she was moving independently at home. Three months later, she boarded a cruise she had postponed.

“The robot didn’t just replace my knee. It gave her back the confidence to live the life she wanted,” Dr. Shitole said.

The case highlights that recovery involves more than replacing the damaged joint. Regaining balance, strength and confidence is also central to returning to normal activities.

Severe Arthritis In Children

Arthritis and joint destruction are not restricted to older adults. A 15-year-old boy with Morquio syndrome, a rare genetic disorder affecting skeletal development, developed severe arthritis in both hips. Pain and complex hip deformities made walking and everyday activities difficult.

Because of his small skeletal anatomy and the complexity of the deformities, doctors opted for staged bilateral hip replacements. The surgical team used CT scans to create a three-dimensional printed model of the pelvis and specialised R.I Hip software to simulate the procedures virtually. This helped them select correct sized implants, plan positioning and anticipate physiological challenges.

The two hip replacements were performed three days apart. The boy was able to stand and walk with support the day after each procedure.

The treating doctor, Dr. Vaibhav Bagaria, Director, Orthopaedics- Sir HN Reliance Foundation Hospital, Mumbai, told us that rehabilitation played a huge role.

“A successful joint replacement restores the mechanics of movement, but rehabilitation helps restore the confidence to move. Both are equally important for meaningful recovery, ” he said.

Physiotherapy focused on progressive walking, muscle strengthening, balance and functional independence, with the programme tailored to the boy's underlying skeletal condition.

The case also highlights the additional considerations involved in treating young patients, including implant longevity and the possibility of revision surgery in the future.

Across these cases, treatment ranged from procedures intended to preserve a joint to partial or total replacement of severely damaged joints. The choice depended on the patient's age, the extent of joint destruction, associated conditions and the likelihood of preserving function.

Rehabilitation was central to each case. Early mobilisation helped patients use their joints after surgery, while physiotherapy helped with strength, balance, walking and daily independence.

With flu season setting in across countries, including the US and the UK, doctors are urging people to get their annual flu shots. October offers an opportunity to build protection before winter flu activity increases.

The UK Health Security Agency (UKHSA) reported above-average flu activity and urged at-risk groups to get vaccinated. England's flu vaccination program last winter is estimated to have prevented about 100,000 hospital admissions and 7,000 deaths.

The US Centers for Disease Control and Prevention (CDC) recommends annual flu vaccination for everyone aged six months and older. The seasonal vaccine targets influenza A(H1N1), A(H3N2) and B/Victoria viruses.

In September, the Indian Medical Association (IMA) also highlighted annual influenza vaccination and gaps in adult immunization.

Why Is October A Good Time To Get Vaccinated?

Also read: Flu Activity Rises Early In US, UK And Japan: Why Experts Urge Vaccination Before Winter

The flu vaccine takes about two weeks to build protection, making October a good time to get vaccinated before winter, Dr. Bhawna Malik, Senior Consultant-Neonatologist and Pediatric Intensivist at Motherhood Hospitals, Greater Noida, told HealthandMe.

In India, flu activity can increase between January and March. Vaccination in October allows time for immunity to develop before this period.

However, October is not the only option. Dr. Vikas Maurya, Senior Director and HOD, Pulmonology, Fortis Hospital, Shalimar Bagh, told HealthandMe that vaccination can also be taken between April and mid-June, ahead of another period of flu activity from July to September.

He said one dose annually is generally sufficient, with timing depending on local flu patterns and the vaccine used.

Who Should Get The Flu Vaccine?

Healthy adults and children, as well as people with underlying conditions, can benefit from flu vaccination. Influenza can cause pneumonia, hospitalization and other severe complications.

Older adults, particularly those aged 65 and above, and people with diabetes, heart disease, kidney or liver disease, asthma or chronic obstructive pulmonary disease (COPD) face a higher risk of complications.

“Flu vaccination doesn't protect just yourself against the risk of having influenza but it also prevents transmission of infection to other vulnerable people around ourselves like little ones, elderly family members and people with medical conditions,” Dr. Malik said.

Dr. Mohit Bhardhwaj, Consultant, Pulmonology, PB Health, Gurugram, told HealthandMe that annual vaccination helps protect individuals and reduce transmission, as flu viruses change and vaccine protection can decrease over time.

Flu Vaccine Schedule For Children And Adults

Read More: Flu 2026: Symptoms To Watch For As New Season Begins

The vaccine can be administered from six months of age. The schedule depends on age and previous vaccination history.

• Children aged six months to eight years: Some children receiving the vaccine for the first time need two doses at least four weeks apart.
• Children aged nine and above: Annual vaccination is generally recommended.
• Adults: One dose each flu season is generally recommended.
• Infants younger than six months: Cannot be vaccinated directly.

Dr. Malik recommends vaccination for parents, siblings and caregivers to help reduce the risk of transmitting influenza to infants who are too young to receive the vaccine.

Are There Any Side Effects?

Most flu vaccine side effects are mild and may include injection-site pain, redness or swelling, fever, headache, body aches and tiredness. These generally settle within a few days, Dr. Bhardhwaj said.

A cooling pack or an ice pack wrapped in cloth may help relieve injection-site discomfort. Nasal vaccines may cause a stuffy nose, cough or headache, Dr. Maurya noted.

The injected flu vaccine cannot cause influenza. Anyone experiencing persistent fever, breathing difficulty or unusual symptoms should seek medical advice. Those with a history of serious allergic reactions to a previous flu vaccine should consult their doctor before vaccination.

A migraine attack is characterised by nausea, vomiting and sensitivity to light and sound. But early symptoms may surface long before the headache itself. Signs like fatigue, mood changes, food cravings and difficulty focusing may appear hours or even days before the pain.

The symptoms that occur during the attack reflect a complex neurological process that involves several interconnected brain networks, rather than just a headache.

A new Lancet Seminar review, looks deeper into how migraine develops, why its symptoms extend beyond head pain and how the better understanding of its biology are affecting treatment.

The study authors describe migraine as a chronic neurovascular disorder shaped by genetic susceptibility and interactions between the brain’s sensory networks, nerves, and blood vessels.

What Happens In The Brain During A Migraine Attack?

Also read: These Yoga Asanas Could Cure Your Migraine

Migraine is the result of the interaction of multiple systems responsible for processing sensory information and transmitting pain. Researchers are focusing more on other factors that drive migraine rather than just blood vessel narrowing or widening.

An important concept is the trigeminovascular system, which is a network involving the trigeminal nerve, tissues sensitive to pain that surrounds the brain and blood vessels. When this system gets activated, the patient experiences the peculiar head ache.

Chemical messengers called neuropeptides also play a key role. One of the most important is calcitonin gene-related peptide (CGRP), which participates in pain signalling in migraine. Treatments that target CGRP is an important development in migraine treatment and management.

The condition also involves changes in how the brain processes sensory information. This explains why light, sounds or smells can become intolerable during an migraine attack, and why some patients experience nausea, dizziness or difficulty concentrating along with severe headache.

Not an isolated abnormality triggering every symptom, migraine involves interactive neurological and vascular processes whose contributions can vary between individuals and across different phases of an attack.

Symptoms May Begin Before The Headache

Also read: Saba Ali Khan Opens Up About Brain Tumour: Can It Go Unnoticed If You Walk, Talk And Work Normally?

Migraine attacks typically occurs through several phases mostly:

1. Prodrome: Hours or days before the pain

The earliest phase can involve fatigue, yawning, mood changes, food cravings, neck stiffness and difficulty concentrating. The involvement of brain regions linked with homeostasis, including the hypothalamus, may help explain why an approaching attack can affect sleep, appetite, mood and other bodily functions.

2. Aura: Temporary neurological symptoms

Some people experience an aura before or during the headache. This can include flashing lights, zigzag patterns, blind spots, tingling or temporary difficulties with speech. Aura is associated with a phenomenon called cortical spreading depression, a wave of changing electrical activity that moves across the brain’s cortex.

3. Headache: Pain and sensory sensitivity

During the headache phase, activation of the trigeminovascular system contributes to pain signalling. Patients may experience moderate-to-severe, often throbbing pain, alongside nausea, vomiting and sensitivity to light, sound or smells.

Movement can aggravate the pain, making routine activities difficult. The headache phase can last several hours to as long as 72 hours.

4. Postdrome: After the pain subsides

The end of an attack does not necessarily mean the attack is over. Some people experience exhaustion, dizziness, body aches and difficulty concentrating for hours or days afterwards. These phases can overlap, and their timing and severity differ from person to person.

The Lancet review also highlights the role of genetic and epigenetic factors that contribute to migraine risk. They interact with complex neurological networks, helping explain why some people experience occasional attacks while others develop frequent or chronic migraine.

Episodic migraine is characterised by fewer than 15 headache days per month. Chronic migraine involves headaches on at least 15 days per month for more than three months, including migraine features on at least eight days each month.