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.

As pollution season creeps back in Delhi, N95 masks outdoors and air purifiers are once again most likely to become the primary go-to protective measures for the public.

Both are known to lower exposure to harmful particles significantly, but neither can completely nullify the health risks of polluted air. So before you invest in an air purifier or buy a dozen N95 masks, understand how much you will be protected as you step out during smog everyday.

How Much Protection Does An N95 Mask Offer?

Also read: Delhi Pollution: What Are The Different Types Of Anti-Pollution Masks?

A properly fitted N95 respirator can filter at least 95% of airborne particles under standard environment. That makes it substantially more protective against fine particulate matter like PM2.5 than regular surgical or cloth masks.

But just wearing an N95 does not mean you are breathing toxins-free air. Its effectiveness depends heavily on fit. Gaps around the nose, cheeks or chin can let polluted air to bypass the filter.

An N95 also does not protect equally against every pollutant. It is designed primarily to filter particles, not gases like nitrogen dioxide or ozone. So if you spend most of your time outdoors during severe pollution, wear a well-fitted, certified respirator to reduce exposure.

Protection from PM2.5 is key as these particles are small enough to seep deep into your lungs and, in some circumstances, even cross over to enter the bloodstream. Long-term exposure to PM2.5 has been associated with cardiovascular disease, respiratory disease and other serious health problems.

Is An Indoor Air Purifier Enough To Tackle Outdoor Pollution?

The effectiveness of an air purifier depends significantly on the purifier, the size of the room and how it is used. A purifier equipped with a HEPA filter can remove fine particles from indoor air. When outdoor PM2.5 levels are high and polluted air enters homes through windows, doors and ventilation systems, this could be one of the best ways to protect yourself.

However, simply switching on a purifier in a large room does not guarantee clean air. The purifier needs to have sufficient clean air delivery rate (CADR) for the size of the room.

Keeping doors and windows closed during periods of extreme outdoor pollution can also help reduce the amount of polluted air entering. Filters need to be replaced according to the manufacturer's recommendations because a heavily loaded filter can reduce performance.

Also read: Delhi Air Pollution Is Back: What Days Of Poor AQI Can Do to Your Lungs

One of the limitations is that HEPA filtration primarily addresses particles. A purifier needs additional technologies, like an activated-carbon filter, to reduce some gaseous pollutants, and even then it cannot remove every pollutant completely.

For Delhi's pollution season, these two measures address different exposure issues. N95 masks help reduce inhalation of polluted particles while outdoors. Air purifiers help lower indoor concentrations of particulate matter. Using both can therefore provide greater protection than relying on either measure alone.

People with asthma, COPD, heart disease or other respiratory and cardiovascular conditions, as well as children and older adults, can be more vulnerable to the effects of air pollution.

Even healthy people can experience symptoms like coughing, throat irritation, wheezing, eye irritation and breathing discomfort when pollution levels rise.

Dry eyes are common among people who spend long hours on screens, and lubricating eye drops are often used for relief. But using the wrong drops, keeping an opened bottle for too long or even sharing eye drops can create problems.

Estimates suggest that up to 50% of adults experience dry-eye symptoms, making artificial tears a common part of self-care. But persistent symptoms should not simply be treated indefinitely without identifying the underlying cause.

So, how often can you use eye drops, and what should you keep in mind?

We spoke to Dr. Ritika Sachdev, Director at Centre for Sight, New Delhi, to understand the common mistakes people make while using eye drops.

Eye Drops For Dry Eyes: When Should You See A Doctor?

Dr. Ritika said persistent or bothersome dry eye symptoms should be assessed by a doctor because dryness can have several causes.

These may include:

• Eyelid inflammation
• Allergies
• Contact lens use
• Makeup
• Incorrect spectacle power causing eye strain

“Sometimes even not wearing your right spectacle power contributes to eye strain which can be misread as dry eye,” she said.

Lubricating drops can help support dry eyes, but prolonged use should be discussed with an eye specialist.

Using Eye Drops For Long? Check For Preservatives

Also read: Eye Drop Recall: Nearly 750,000 Products Pulled Over Sterility Concerns in US

Several eye-drop products have been recalled in the US in recent years over contamination and other safety concerns. This makes proper storage, handling and hygiene particularly important when using eye drops.

Dr. Ritika cautioned that some eye drops contain preservatives that may worsen dryness when used for a long time.

“Many of the eye drops have preservatives which if used over a long period of time actually cause more dry eye,” she said.

According to her, preservative-free drops or those with very mild preservatives may be preferable for people who need regular use.

Don't Keep An Open Eye Drop Bottle Forever

"Once opened, an eye drop bottle can become contaminated if it is not handled or stored properly," Dr. Ritika said.

The expert advised:

• Note the date when you open the bottle.
• Follow the product's storage instructions.
• Do not let the bottle tip touch your eye.
• Discard the bottle according to the manufacturer's instructions.
• Do not continue using an opened bottle indefinitely.

“Once the bottle is open, it often may get contaminated,” she said. “If it gets contaminated, it is a source of infection.”

Read More: Andrew Huberman’s Sleep Trick: Can Eye Movements Help You Fall Back Asleep?

How Many Eye Drops Should You Use?

More drops do not mean more relief.

“The capacity of the eye is only one drop,” Dr. Ritika said.

Putting two or three drops at once can cause the excess to spill onto the surrounding skin and simply waste the product. One properly administered drop is generally enough at a time, she said.

Avoid Squeezing Your Eyes After Using Drops

Dr. Ritika said people often squeeze their eyes tightly after putting in drops because they think this will keep the medicine inside. But squeezing can push the drop back out.

Instead:

• Gently pull down the lower eyelid.
• Place the drop into the eye.
• Avoid touching the bottle tip to the eye.
• Do not squeeze the eyes tightly immediately afterward.

Why Do Eye Drops Sometimes Reach The Throat?

Some people experience an unpleasant sensation in the throat after using medicated eye drops.

Dr. Ritika explained that tears can travel from the eye through the tear duct to the nose and then the throat.

She suggested gently pressing near the inner corner of the eye for a while after applying the drop to reduce this drainage.

Never Share Your Eye Drops

Sharing eye drops may seem harmless, particularly within families, but Dr. Ritika advised against it.

If the bottle tip accidentally touches an infected eye, the bottle can become contaminated and potentially transmit infection when used by someone else.

“Eye drop is something that is for your personal hygiene and it should therefore be kept by you and used by you,” she said.

For millions of individuals who are living with diabetes across India, protecting long-term vision can start with a simple, timely retinal screening. However, regular screening remains a challenge for many because access to specialist eye care services can be limited, particularly outside major urban centres.

In 2021, India was estimated to have 101 million people living with diabetes and 136 million with prediabetes, highlighting the scale of the country’s metabolic health challenge. On World Sight Day, we discuss another layer to this challenge. Bringing diagnostic capabilities closer to where patients live and seek care can help bridge the gap between early detection and specialized care.

Why Must Retinal Screening Move Beyond Specialist Clinics?

A significant gap in public awareness continues to hinder early intervention. Data indicates that 85% of people with diabetes are unaware that the condition can impact their vision and have never undergone a retinal examination.

Consequently, many patients reach eye-care facilities only after vision changes have occurred. One study found that 45% of patients suffering from diabetic retinopathy have already experienced vision loss even before being diagnosed. This highlights the significance of screening before symptoms appear. Bringing screening closer to primary-care settings can facilitate earlier detection of retinal changes and allow for prompt referral to an eye-care specialist.

Although diabetic retinopathy significantly contributes to preventable vision loss, retinal health extends beyond diabetes. Retinal conditions frequently advance without noticeable symptoms, making increased awareness, regular screening and timely access to specialist care crucial for safeguarding vision.

Also read: World Sight Day: The Hidden Link Between Diabetes & Blindness - Why Good Vision Doesn't Mean Healthy Eyes

Can Technology Expand Screening Access?

Modern diagnostic technology provides a scalable solution to overcome geographic and capacity constraints. Artificial intelligence enabled retinal imaging can rapidly analyse retinal scans in non-specialist settings, identifying subtle retinal changes that may require further clinical evaluation.

Similarly, Optical Coherence Tomography (OCT) based assessments provides detailed, non-invasive imaging when deeper evaluation is needed provides detailed, non-invasive imaging when deeper evaluation is needed. Integrating appropriate imaging technologies into screening and referral networks can help frontline healthcare teams to conduct preliminary evaluations efficiently, while allowing ophthalmologists to focus their expertise where it is most needed, which is complex diagnoses and advanced care.

Also read: Eye Twitching: Is It Just Stress Or Something Serious?

What Role Do Community-Based Models Play?

Medical technology can fulfil its promise when it meets people where they already are. Placing a diagnostic hub or screening resources closer to neighbourhood health centres, local diabetes clinics and wellness centres can turn routine visits into opportunities for earlier detection.

Local, trained healthcare workers are able to easily catch any red flags in high-risk patients and direct them straight to an eye specialist long before minor issues turn into permanent vision loss. Such community-based models can make screening more convenient, particularly for people who may otherwise face geographical, time or access barriers to specialist care.

Strengthening the Future of Eye Care

The aim of community-based screening is not to take the place of specialists, but to help patients reach them sooner. By combining awareness, portable imaging and technology-enabled screening with clear referral pathways, patients who need further evaluation can be identified earlier and directed to the right level of care.

As India continues to strengthen its approach to eye health, bringing screening closer to communities can make it easier to detect retinal problems early, when there is still an opportunity to protect vision.

By Dr Vishali Gupta, President - Vitreo Retinal Society of India (VRSI) and Head - Retina, PGIMER, Chandigarh