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.

A recent study by the Indian Council of Medical Research (ICMR) showed that more than 40 percent of prostate cancer patients in the country are diagnosed after the cancer has spread.

The 43 percent of late diagnosis cases indicates the significant burden of late detection of prostate cancer in the country. This can not only limit treatment options but also lead to poorer survival outcomes.

The study, published in the Indian Journal of Surgical Oncology, revealed that while more than 80 per cent began treatment within two months, but referral patients experienced longer delays.

Researchers from the ICMR’s National Centre for Disease Informatics and Research, in Bengaluru, stressed the need to strengthen referral pathways to ensure timely, stage-appropriate care.

“Our study indicates that over 80 percent of patients commence treatment within two months of diagnosis, but referral systems and delays in care persist,” said corresponding author Prashant Mathur, Director, ICMR-NCDIR, in the paper.

“To address these challenges, the healthcare system must prioritize improving referral efficiency, reducing administrative bottlenecks, enhancing coordination through digital health records, and multidisciplinary tumor boards,” the authors added.

Age, The Strongest Risk Factor For Prostate Cancer

The ICMR study is based on an analysis of 9,347 cases from 96 hospitals under the National Cancer Registry Program.

The researchers found that 75.6 percent of total prostate cancer cases occurred in the age group of 60–80 years, indicating that advanced age remains the biggest risk factor for the condition.

As life expectancy increases, more men reach the higher-risk age group, but awareness and screening practices have not scaled proportionately.

Adenocarcinoma was the most common pathology, constituting 77 percent of cases.

It is the most common form of prostate cancer, accounting for over 95 per cent of all cases. It develops in the gland cells that produce prostate fluid and typically grows slowly over several years.

Further, the ICMR researchers noted that about 57 percent of cases were diagnosed with localized (29.9 percent) or locoregional (27 percent) cancer.

Thirty percent underwent surgical treatment, and 22 percent received radiation therapy. Systemic therapy was the most common single modality treatment.

“Early detection and streamlined referral pathways are essential to improve prostate cancer outcomes in India,” the researchers said.

Prostate Cancer And Its Prevalence In India

Prostate cancer forms in the cells of the prostate -- a gland found only in males and a part of the male reproductive system. It lies below the urinary bladder and in front of the rectum.

Nearly all prostate cancers develop from glandular cells (adenocarcinomas).

Globally, prostate cancer is the most frequently diagnosed cancer among men in 112 countries and the leading cause of cancer death in 48 countries. In 2020, an estimated 1.4 million new cases of prostate cancer and 0.37 million deaths were reported worldwide.

In India, it is the second most common cancer among men, accounting for more than 60 percent of the prostate cancer burden in South-Central Asia. As per the ICMR data, the country reported 34,540 incidences of prostate cancer and 16,783 deaths.

Prostate cancer symptoms include urinary difficulty, a weak stream, or blood in the urine.

As prostate cancer is a slow-developing disease, it often causes no symptoms during the early-stage, leading to delayed medical consultation.

Other reasons for late detection in India include low awareness, limited routine screening -- PSA (prostate-specific antigen) programs; social stigma and hesitation due to embarrassment or cultural taboos.

Lack of access to specialist care, diagnostic facilities, and cancer centers, especially in rural populations, coupled with cost and referral gaps, also leads to delay in diagnosis.

Colon cancer develops from polyps in the colon or rectum, often taking years to show symptoms. The cancer begins when small growths called polyps form on the inner lining of the colon or rectum. Over time, changes in the DNA of these cells can cause the polyps to become cancerous.

As abnormal cells multiply, they replace healthy cells and eventually form a mass known as a tumor. This process develops slowly, often taking up to ten years for a precancerous polyp to turn into cancer and begin showing symptoms.

The American Cancer Society notes that colorectal cancer impacts around 1.9 million people every year.. In India, it is the fourth most common cancer among both men and women. In 2022, there were 64,863 new cases and 38,367 deaths.

Projections suggest that incidence will continue to rise by 2026, reflecting both lifestyle changes and improved detection.

Colon cancer can be difficult to detect because it often develops without obvious symptoms. However, Dr Jordan Karlitz, MD, of Exact Sciences, shared with The American Journal of Managed Care (AJMC) the three fundamentals of CRC prevention and early detection.

What Are The Three Tips For CRC Screening?

According to the expert, these are the three things you should do to protect yourself:

1. Timely risk screening

2. Knowing your cancer family history

3. Acting on early symptoms

"These are the 3 pillars that everybody needs to be aware of, because I think gaps in any of them could increase the risk of developing CRC and, unfortunately, lead to presenting with more advanced-stage disease," said Dr Karlitz.

Why Is Risk Screening Essential?

Timely screening for colon cancer is essential because it detects precancerous polyps early, allowing for their removal before they turn into cancer and identifies the tumors at highly treatable stages when survival rates are about 90 percent.

Screenings (like colonoscopies) can detect and remove pre-cancerous growths called polyps, preventing the development of cancer. The expert suggested that average risk screening now starts at the age of forty-five; you do not have to wait until age 50.

What Early Symptoms Should You Look Out For?

Colon cancer rarely announces its presence with dramatic symptoms. More often, it whispers — through changes in bowel habits, subtle abdominal discomfort, or unexplained weight loss.

Some of the most commonly missed early signs include:

• Persistent changes in bowel movements: Chronic constipation or diarrhea often dismissed as dietary effects.
• Blood in stool: Bright red or dark blood should not be ignored.
• Unexplained weight loss: Especially when unintentional.
• Abdominal cramps or bloating: Misinterpreted as common digestive issues.

Persistent changes in bowel habits, especially if they last more than a few days, must be taken seriously. Narrow or ribbon-shaped stools may indicate a tumor partially blocking the colon.

A Himalayan zoonotic disease, which is transmitted by mite bites, known as Scrub typhus, is re-emerging. However, the attention and recognition to its threat remains poor. A Mongabay report noted the life of Maya Rai, 38, from Dajeeling, who works throughout the day. Her packed schedule does not allow her to stop working. When there is a febrile illness, it is "just another fever".

However, one monsoon, the fever hit her hard, while she thought it will pass too with some rest. She felt too weak to work. She received no clear diagnosis at the local Public Health Center (PHC), and was sent home with just painkillers. However, her condition did not improve. She experienced fever with cough, nausea, breathlessness and discomfort. Being a wage worker, she missed seven days, which meant no money for a week. She was finally taken to a private hospital in town, hours away from her village and the rapid test confirmed 'scrub typhus'.

This is an infectious disease caused by a bacterium Orientia tsutugamushi. Maya was prescribed antibiotics and was able to survive. However, there are many cases where this febrile fever is treated like any other fever, until it is too late. Many cases arise much later in front of a medical healthcare provider, when complications like acute respiratory distress, liver inflammation, kidney failure, and multiorgan dysfunction syndrome (MODS) have already happened.

Another case is from rural west Sikkim, where a 35-year-old Ganga Chhetri also had similar symptoms. However, by the time she was diagnosed, her organs were already critical. Ganga was also breastfeeding her two-year-old child and caring for her four-year-old.

Re-emergence of Scrub Typhus

The disease is locally known as kira le toke ko bimari, which literally translates it as a disease from an insect bite. This is re-emerging in the Dajeeling-Sikkim region of the Indian Himalayas, and is a public health concern in India. The cases have been reported across the country in India, as well as in other Southeast Asian countries. This affects one million people annually around the globe.

Scrub typhus was once confined to the Asia-Pacific’s ‘Tsutsugamushi Triangle’, a geographic stretch from northern Japan to Russia and northern Australia. Today, while this has changed, the disease still poses threat to many, including those living in the Himalayan region.

What Is Scrub Typhus And How Does It Spread?

It is an acute, potentially fatal, rickettsial infection that is caused by Orientia tsutsugamushi and transmitted by larval mites (chiggers) in rural areas.

At its core, scrub typhus in humans is associated with four interconnected elements: small mammals, particularly rats, tiny parasitic mites, the bacterium Orientia tsutsugamushi, and the environment they inhabit together. The disease is spread specifically by the larval stage of trombiculid mites, commonly known as chiggers. Only the larvae transmit the infection, passing it to humans through their bite.

These chiggers feed on the blood of small mammals such as rats, which play a key role in sustaining mite populations. Rats can also carry Orientia tsutsugamushi and pass the bacteria to mites that feed on them. In contrast, the nymph and adult stages of the mite, typically found in soil and vegetation, do not spread the disease.

Humans become infected when they enter areas infested with mites or environments with high rat populations, allowing infected chiggers to shift from rodents to people. The likelihood of such spillover events increases when rodent numbers grow, mite populations expand, or human contact with rats intensifies.

Factors such as land use changes, shifting weather patterns, natural disasters, deforestation, rapid urbanization, and increased garbage accumulation can create conditions that favor rodent and mite proliferation, thereby raising the risk of disease transmission.