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.

We have all had that mini meltdown finding a clump of hair in the shower drain or a brush full of hair after combing hair. While blaming stress or the changing seasons feels comforting, experts warn that your body might be sounding a nutritional alarm. Yes, your hair loss might be less about the weather and more about what is missing from your plate.

Listen to What Your Body’s Saying

“Seeing a lot of hair strands on your pillow cover feels distressing,” says Dr Khushboo Jha, MBBS, MD, Chief Dermatologist Consultant at Metro Hospital and Founder of One Skin Clinic, Faridabad, “but you need to listen to your body. It’s the way it communicates that your body is struggling with some deeper concern, probably nutrient deficiency.”

Hair, it turns out, is a high-maintenance tissue. It’s fast-growing and metabolically active, demanding a steady supply of nutrients. But it’s not considered essential for survival. So in times of nutritional crisis, your body reroutes vitamins and minerals to more important organs like your heart or brain, leaving your hair stranded without support.

“If your diet is insufficient, especially lagging in iron, vitamin D, Vitamin B complex such as vitamin B12 and biotin, zinc, protein, etc., hair will be the first one to suffer,” says Dr Jha.

Why Vegans, Crash Dieters, and IBS Patients Should Pay Extra Attention

The hair-nutrition connection is especially crucial for those following restrictive diets. Dr Jha warns that vegetarians and vegans “may unknowingly miss out on essential nutrients, particularly iron and protein, leading to diffuse thinning or excessive shedding.”

Dr Ameesha Mahajan, Cosmetic Dermatologist and Founder of Eden Skin Clinic, agrees. “Vegetarians or vegans are more prone to deficiencies, especially when it comes to vitamin B12, iron and protein deficiency,” she says. And it’s not just about what you eat, but also how well your body absorbs it. “Impaired gut absorption disorders such as coeliac disease or IBD… can lead to extreme hair thinning,” Dr Mahajan adds.

Crash diets and eating disorders like bulimia nervosa don’t do your strands any favours either. These behaviours disrupt the body’s nutritional balance and can prematurely push hair into the shedding phase.

The Medical Jargon You Didn’t Know You Needed: Telogen Effluvium

One particular fallout of nutrient shortfalls is telogen effluvium, a name for hair falling out sooner than it should. Dr Mahajan points to iron deficiency anaemia as a common trigger. “It is strongly associated with telogen effluvium, a condition where hair prematurely enters the shedding phase,” she explains.

In other words, if you’ve been feeling unusually tired and your hair is thinning, it might be more than a coincidence; it could be low iron or another nutrient throwing your hair growth cycle off track.

Don’t Pop Just Any Pill

Before you go on a supplement shopping spree, both experts urge caution. “Before self-prescribing supplements, experts urge a full nutritional workup to identify what’s missing,” says Dr Jha. Overloading on certain vitamins can do more harm than good.

Dr Mahajan agrees. “It’s best to get blood parameters checked for any nutrient deficiencies before beginning any supplement to be sure.”

So yes, multivitamins are tempting but flying blind could backfire. Know what you’re low on before topping up.

Eat for Your Hair: What to Load on Your Plate

Both dermatologists suggest nourishing your scalp from within. Dr Jha recommends “a diet loaded with whole grains, legumes, millets, dairy products, nuts, seeds, etc.,” noting these support not only hair health but also overall wellbeing.

Dr Mahajan says that these foods “help to restore the lost nutrients, making the hair denser and thicker.” Think of them as edible armour for your follicles.

Still Losing Hair? Time to Dig Deeper

If your hair continues to vanish despite eating all the right things, don’t ignore it. “If still you face symptoms, consult a dermatologist for ruling out hormonal or other health conditions,” advises Dr Jha.

Dr Mahajan adds, “If you still suffer from hair fall, despite making changes in your diet, it’s time to consult a dermatologist, as it might be due to some hormonal disruption or any other autoimmune-related cause.” Because sometimes, hair loss isn’t just about what’s missing but what’s going wrong beneath the surface.

Heart disease remains one of the leading causes of death globally, and while technology has evolved to the point where predicting heart attacks is possible, the medical world still struggles to put this into practice. Experts point to both promise and pitfalls in predictive cardiology, revealing why such life-saving tech is not yet a mainstream reality.

The Tech Is Here, But We Are Not Using It Enough

Dr. Vikrant B. Khese, Cardiologist at Jehangir Hospital, Pune, says the idea that we can predict heart attacks before they happen is both “exciting and frustrating, because while the technology exists, its real-world implementation remains limited.”

He explains that artificial intelligence (AI) and machine learning (ML) have incredible potential in this field. These tools can analyse vast datasets, such as blood pressure, lipid profiles, ECGs, imaging, and even genetic markers, to uncover patterns that might be invisible to the human eye. “These tools can detect subtle risk factors that may be missed in routine clinical practice. However, several challenges continue to hold us back,” he says.

One of the biggest concerns is the source of the data feeding these algorithms. “The majority of AI models are trained on Western datasets that do not reflect the unique genetic, environmental, and lifestyle factors of Indian or Asian populations. This creates a mismatch, resulting in lower accuracy and reliability for non-Western patients.”

Dr. Khese adds that cardiovascular disease is deeply multifactorial. It is not just about clinical metrics. “Stress, socioeconomic status, cultural diet patterns, air pollution, and unstructured physical activity all influence risk but are difficult to quantify in a dataset. AI still struggles with these intangible but crucial variables.”

And even when predictive tools are developed, another hurdle lies in the healthcare system’s ability to use them. “Data-driven predictions can only be as good as the data input. In India, inconsistent electronic medical records, underreporting, and fragmented healthcare systems make it harder to gather high-quality longitudinal data, limiting the AI's learning potential.”

Crucially, there is also a behavioural gap. “Even when prediction tools exist, they are not routinely used by clinicians due to scepticism, lack of training, or workflow disruption. Bridging the gap between innovation and implementation is a major hurdle.”

According to Dr. Khese, technology must complement clinical judgement, not replace it. “AI is a powerful tool but not a standalone solution. Until we combine high-quality, representative data with clinical wisdom and system-level integration, the promise of predicting heart attacks before they happen will remain underutilised. The future lies in synergy; technology must empower doctors, not replace them.”

Prediction Tools Exist—But We’re Waiting for Symptoms

Dr. Vijay D'Silva, Medical Director of White Lotus International Hospital and Clinical Advisor and Mentor of Heartnet India, backs this view and draws attention to major international trials. “Research from the University of Oxford has suggested that a global trial of an AI tool that can predict the 10-year risk of heart attack has shown that in about 45 per cent of patients with chest pain, treatment could be improved,” he shares.

“Early detection of cardiac risk allows timely treatment and monitoring that can help reduce the mortality rate,” he says, explaining that most coronary blockages are asymptomatic. “Some present with chest, arm or jaw pain on exertion (angina pectoris). Few present as a heart attack or sudden death. People seek treatment after a heart attack when the damage is already done.”

According to Dr. D’silva, “With the help of the right tools, it is now possible to predict a heart attack before it occurs.” Among these tools are blood tests, ECGs, and advanced risk calculators such as the AHA PREVENT calculator, ASCVD Risk Calculator Plus, QRISK3, and SCORE2.

He points out how the 2023 AHA PREVENT calculator estimates 10-year cardiovascular risk in individuals aged 30 to 79, and 30-year risk in adults aged 30 to 59. “Early-stage detection of CVD minimises the cost and also reduces the CVD mortality rate,” he says.

This tool divides patients into four risk categories, each with its own treatment strategy:

• Low risk (<5%): Maintain healthy lifestyles and reassess every five years.
• Borderline risk (5–7.4%): Lifestyle changes and monitoring of risk-enhancing factors like BP, sugar, weight and lipids. CAC scoring can further stratify risk. Annual reassessment recommended.
• Intermediate risk (7.5–19.9%): Calls for lifestyle management, preventive medication (statins or aspirin), stress testing and CT coronary angiogram. Yearly reassessment is needed.
• High risk (≥20%): Requires intensive lifestyle changes, pharmacotherapy, imaging and close follow-up.

Despite these advances, Dr D'Silva says, “The gap lies in implementation. Most people still wait for the symptoms to appear before seeing a doctor. Heart attacks, unfortunately, strike without any warning, especially in women and younger patients, where symptoms can be atypical.”

He stresses that predictive cardiology is not yet standard in clinical practice. “People who are at risk seek care when symptoms arise. But in cardiology, symptoms often come too late. Up to 50 per cent of heart attack victims had no prior warning signs.”

Why Risk Calculators Are NotFoolproof

While risk calculators are promising, Dr. D’silva also points out their limitations. “The risk calculator may underestimate the risk in the following situations,” he says, listing specific high-risk groups such as:

• Patients with LDL cholesterol ≥190 mg/dL
• Those with familial hypercholesterolemia
• Patients with type 1 diabetes
• People with other risk-enhancing factors like family history of early cardiovascular disease, metabolic syndrome, chronic kidney disease, chronic inflammatory diseases (psoriasis, RA, lupus), or early menopause

The Way Forward

Both experts agree: predictive tools are no longer science fiction, but adoption is patchy. As Dr. Khese puts it, “The future lies in synergy; technology must empower doctors, not replace them.”

Dr. D'silva concludes, “The ability to predict heart attacks is advancing continuously, but we need public awareness and equitable access to make predictive cardiology more standard.”

In short, we can predict heart att but until we normalise risk screening, improve data systems, and bridge the clinical gap, too many heart attacks will continue to catch people and systems off guard.

When strands clog your shower drain or your brush looks full every time you run it through your hair, panic is a natural response. Hair loss, or alopecia, is not just a cosmetic concern; it often hints at something deeper. And yet, thanks to internet half-truths and old wives’ tales, myths about alopecia spread faster than a viral meme. On World Alopecia Day, we turn to experts to separate fact from fiction while spotlighting the hidden medical conditions that might be behind the hair fall.

It is Not Just "Shedding Season": Medical Reasons Behind Hair Loss

Alopecia does not always pop up on its own. According to Dr Jijith K Ravindran, Chief Cosmetologist and Dermatologist at Cosmalife Skin Clinic in Bengaluru, alopecia often walks hand in hand with other medical conditions, and sometimes, it is your body’s way of waving a red flag.

Autoimmune Disorders (Alopecia Areata):

Dr Ravindran explains, “In this condition, the immune system mistakenly attacks healthy hair follicles, leading to patchy hair loss on the scalp or other body parts.” It is unpredictable, affects people of all ages, and may be triggered by stress or genetics. If you have noticed coin-sized bald patches cropping up suddenly, your immune system could be the rogue agent.

Hormonal Imbalances (Thyroid Disorders and PCOS):

Blame it on your hormones? Sometimes, yes. “Both hypothyroidism and hyperthyroidism can disrupt the hair growth cycle, causing diffuse hair thinning,” says Dr Ravindran. Women with PCOS are especially vulnerable. “Elevated androgen levels in PCOS weaken hair follicles, leading to noticeable hair fall.” It is not uncommon for women with irregular periods or acne to also see their hair thinning.

Nutritional Deficiencies:

Crash diets might help you drop pounds, but they can also drop your hair count. “Low levels of iron, vitamin D, and essential proteins can contribute to excessive hair shedding,” warns Dr Ravindran. If your plate lacks balance, your scalp might pay the price.

The good news? “Early diagnosis and treatment of these conditions can help restore hair growth and prevent permanent damage,” he assures.

Wigging Out Over Myths

Even as more people talk openly about hair loss, alopecia still suffers from a major PR problem, mostly due to persistent myths. Dr Roopam Gangurde, a dermatologist with an MD in Skin & VD, breaks down the most common fallacies that often do more harm than good.

Myth 1: “Only men experience alopecia.”

“While male pattern baldness is more commonly discussed, women are equally susceptible to alopecia due to hormonal imbalances, thyroid issues, and nutritional deficiencies,” says Dr Gangurde. Yes, ladies lose hair too and not just from brushing too hard.

Myth 2: “Stress alone is responsible for hair loss.”

While stress is definitely not good for your scalp’s health, it is not the lone cause. “Alopecia usually has multiple triggers, including genetics, autoimmune conditions, and underlying medical issues,” explains Dr Gangurde. Translation: stressing about stress causing hair fall might make things worse.

Myth 3: “Alopecia is always permanent and untreatable.”

This one might be the most damaging myth of all. “Many forms of hair loss, especially those caused by hormonal or nutritional factors, are reversible with timely medical intervention,” says Dr Gangurde. PRP therapy, medications, and lifestyle changes can all turn things around if you act early enough.

Do Not Just Shed Tears, Seek Help

If your hair has been thinning or falling out in clumps, resist the urge to DIY it with oils, serums, or social media hacks. “If you experience sudden or persistent hair loss, consult a dermatologist or trichologist promptly,” advises Dr Gangurde. “Early intervention can address the root cause, prevent progression, and in many cases, restore healthy hair growth.” Remember that alopecia is not just a surface-level issue. And with the right diagnosis, it is often more fixable than you think.