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 GLP-1 medications such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) continue to help manage metabolic disorders and obesity, a new trend is rapidly gaining traction on social media - GLP-1 microdosing.

Instead of taking the prescribed doses approved for diabetes or obesity, some users are deliberately taking much smaller amounts, claiming they can lose weight, reduce food noise, avoid side effects, save money, or even improve longevity.

However, experts warn that there is currently little scientific evidence that GLP-1 microdosing is safe or even effective.

What Is GLP-1 Microdosing?

Some people reduce their dose by extending the time between injections, counting "clicks" on injection pens instead of using prescribed doses, or taking customized low-dose formulations.

HealthandMe spoke to Dr. Shehla Shaikh, Consultant Endocrinologist, Saifee Hospital, Mumbai, about the trend of GLP-1 microdosing.

Dr. Shaikh says, "The lowest dose that is supported by evidence for semaglutide is 0 25 mg. While, for tirzepatide, it is 2 5 mg Some people are using much smaller amounts for example using nine clicks on a semaglutide pen which gives about 0 06 mg. Now there are no randomized studies or clear guidelines that show if this kind of micro-dosing is safe or works."

Also read: Can GLP-1 Drugs Like Ozempic, Mounjaro Cause Hair Loss? Study Says It's Rare But Real

Medical experts caution that these practices fall outside approved prescribing guidelines and have not been rigorously studied.

The expert says, "One big worry is how accurate the dose is. These injectable pens are made to give set approved amounts; not amounts based on people counting clicks. Even a small mistake in counting can mean taking too little medicine which may not work well or too much, which could cause more problems. Since these instructions are complicated, they need careful handling good eyesight and understanding of the device."

Why Are People Trying It?

Fewer Side Effects

Lower Cost

These medications are expensive in various countries. So, people stretch a single prescription by taking less medication than prescribed.

Weight Maintenance

Rather than pursuing significant weight loss, some users say they simply want to maintain previous results or reduce constant food cravings without taking full doses.

Longevity Claims

Online influencers have begun promoting low-dose GLP-1s as potential "longevity drugs." While GLP-1 medications show promise for heart and metabolic health, experts stress that these benefits have only been demonstrated using clinically tested doses, not microdoses.

Also read: Novo Nordisk Sues Eli Lilly Over Weight-Loss Drug Ads: Should GLP-1 Users Be Concerned?

The Risks of Microdosing

Reduced Effectiveness

Taking too little medication may fail to adequately suppress appetite, improve blood sugar levels, or achieve meaningful weight loss.

Dr. Shaikh says, "People often choose microdosing because they want to avoid problems reduce appetite with a smaller dose or make a costly medicine last longer. While smaller amounts might help a bit, current information shows that the best and steadiest results come from following the approved ways to take the medicine. Using doses that are too low might not give the results to people who want to lose weight or manage their metabolic health."

Delayed Medical Treatment Or Risk Of Expiration

Experts also say that people with obesity or diabetes could unknowingly receive suboptimal treatment while believing they are protected. Another problem is how long the medicine lasts after it is opened.

Dr. Shaikh explains, "An opened semaglutide pen should be used within 60 days while an opened tirzepatide pen should be used within 30 days. Because microdosing uses the medicine over a longer time, people might keep using it past the time it is safe which could change how good it is."

Inaccurate Dosing

Also read: Could GLP-1 Weight Loss Drugs Help People Take Fewer Sick Days? New Study Says So

Some users manually estimate doses by counting injection pen clicks. Experts warn these devices are designed to deliver specific calibrated doses, making partial dosing unreliable.

The expert says, "Some people think micro-dosing gives similar benefits with fewer problems or lower costs, but this practice has no scientific support and might have several dangers."

A Doppler test is a specialized type of ultrasound that uses sound waves to measure blood flow through blood vessels rather than simply creating images of organs and tissues. Unlike a regular ultrasound, which produces pictures of internal structures, a Doppler ultrasound shows how blood moves through arteries and veins, helping doctors detect circulation problems.

While commonly associated with pregnancy, Doppler ultrasound is also used to investigate conditions such as leg pain, swelling, varicose veins, blood clots, peripheral artery disease, and stroke risk. Understanding when this test is needed can help detect serious conditions early and guide timely treatment.

Why Is Doppler Ultrasound Important During Pregnancy?

During pregnancy, a Doppler ultrasound is often recommended in high-risk cases to assess blood flow between the mother, placenta, and baby.

"It helps doctors monitor whether the fetus is receiving adequate oxygen and nutrients, making it especially important in pregnancies complicated by high blood pressure, diabetes, fetal growth restriction, or previous pregnancy-related complications," Dr. Vandana Mittal, Principal Consultant, Obstetrics and Gynecology, Paras Health Panchkula, told HealthandMe.

Dr. Vandana Jain, Principal Consultant - Obstetrics, Gynecology, Infertility & Advanced Laparoscopic Surgery, Yashoda Medicity, added that the test is commonly recommended in high-risk pregnancies, including fetal growth restriction, preeclampsia, hypertension, gestational diabetes, oligohydramnios, multiple pregnancies, and decreased fetal movements.

"By evaluating how effectively oxygen and nutrients are reaching the baby, the test helps detect signs of fetal compromise at an early stage, enabling timely monitoring, appropriate medical intervention, and informed decisions regarding the timing and mode of delivery."

By identifying potential issues early, Doppler studies help doctors monitor pregnancies more closely and intervene when necessary. However, the test is performed only for specific medical indications and is not a replacement for routine pregnancy ultrasounds.

What Other Conditions Can a Doppler Ultrasound Detect?

According to the Mayo Clinic, a Doppler ultrasound can help diagnose:

• Blood clots
• Venous insufficiency, where poorly functioning vein valves cause blood or fluid to pool in the legs
• Heart valve defects and congenital heart disease
• Arterial occlusion (blocked arteries)
• Peripheral artery disease
• Aneurysms
• Carotid artery stenosis, which increases stroke risk

How Doppler Ultrasound Can Help People With Leg Pain

Dr. Jain said Doppler ultrasound is also commonly advised for patients with suspected Deep Vein Thrombosis (DVT), peripheral arterial disease, carotid artery narrowing, or chronic venous insufficiency.

"It is commonly advised for patients with suspected Deep Vein Thrombosis (DVT), peripheral arterial disease, carotid artery narrowing, or chronic venous insufficiency," she told HealthandMe.

The expert added that people with persistent leg pain while walking, unexplained swelling, non-healing wounds, or symptoms of poor circulation may require a Doppler evaluation.

Recently, gastroenterologist Dr. Pal Manickam highlighted the importance of Doppler ultrasound during a podcast discussion. He urged people not to ignore sudden leg pain or swelling, noting that these symptoms could indicate deep vein thrombosis (DVT) and require prompt evaluation.

How Is a Doppler Test Done?

The procedure is painless, non-invasive, and usually takes 30 to 60 minutes, depending on the area being examined. It is also radiation-free.

A Doppler ultrasound is performed by a trained sonographer using a hand-held device called a transducer. The transducer sends sound waves into the body and measures how they bounce off moving blood cells, allowing the machine to assess blood flow in real time.

A new high-precision radiotherapy treatment introduced by NHS England is set to offer a faster and more convenient treatment option for thousands of men with prostate cancer.

Known as stereotactic ablative radiotherapy (SABR), the treatment delivers high-dose radiation in just five sessions over two weeks, compared with the 20 or more sessions typically required with conventional radiotherapy. This means eligible patients can complete treatment with 15 fewer hospital visits, reducing the burden of travel and time spent in care.

Prostate cancer is the most common cancer among men in the UK. More than 55,000 men are diagnosed with the disease each year, while around 12,300 die from it annually.

According to NHS Chief Executive Sir Jim Mackey, the new therapy will "transform" treatment for thousands of men with localized prostate cancer while enabling the NHS to provide "far more powerful and more convenient" cancer care.

How Does SABR Work?

According to NHS England, stereotactic ablative radiotherapy (SABR) delivers highly targeted radiation to the tumor from multiple angles, helping reduce the risk of the cancer returning or spreading.

The treatment delivers a higher dose of radiation with pinpoint accuracy, minimizing damage to surrounding healthy tissue and reducing the likelihood of side effects.

"This technology lets us focus a powerful and precise beam of radiotherapy directly onto the cancer, limiting the damage to healthy cells – and the fact it can be delivered in 15 fewer doses will help men get back to living their lives far more quickly," said Professor Peter Johnson, NHS National Clinical Director for Cancer.

Also known as stereotactic body radiotherapy (SBRT), SABR is already used to treat certain lung and brain cancers. It is now being offered on the NHS to eligible men with low- and intermediate-risk localized prostate cancer.

Also read: Minimally Invasive Focal Therapy For Prostate Cancer Promises Fewer Side Effects Than Surgery Or Radiotherapy

Who Can Benefit?

Around 17,500 men in England are diagnosed with low- or intermediate-risk prostate cancer each year and could be eligible for SABR.

NHS modeling suggests that nearly one in five of these patients—around 3,500 men annually—may choose the treatment to help reduce the risk of their cancer spreading.

The treatment is expected to be available across all 48 NHS radiotherapy centers in England, with the first hospitals beginning to offer it from next week.

Could Reduce Waiting Times

The NHS estimates that introducing SABR for prostate cancer could free up around 50,000 treatment appointments each year.

By shortening treatment schedules and reducing the number of hospital visits, the rollout is expected to improve capacity across radiotherapy services while helping bring down waiting times for cancer patients.

However, SABR is not suitable for everyone with localized prostate cancer. Experts advise patients to discuss their treatment options with their specialist team, while ongoing research continues to evaluate the therapy in different patient groups.

What Is Prostate Cancer?

Read More: Over 40% Prostate Cancer Patients in India Diagnosed After Cancer Has Spread: ICMR study

The prostate is a small, walnut-shaped gland in men that produces seminal fluid, which nourishes and transports sperm. Prostate cancer develops when abnormal cells begin to grow uncontrollably in the gland.

Experts say not all prostate cancers are life-threatening. Many are slow-growing and may never affect a man's lifespan. In fact, such cancers are found in around one in three men over the age of 50. However, a smaller number of prostate cancers are aggressive, spread quickly, and require prompt treatment, making early detection and regular screening important.

Symptoms of Prostate Cancer

Early-stage prostate cancer may cause:

• Blood in the urine or semen
• Difficulty urinating
• Erectile dysfunction

More advanced prostate cancer may lead to:

• Decreased force of the urine stream
• Bone pain
• Unexplained weight loss.