https://www.marham.pk/online-consultation/neuro-physician/peshawar/dr-azrung-fayaz-67023

Dr Azrung Fayaz, Peshawar (2026)

05/10/2026

Hint: You must not skip #6.

Vestibular migraine is one of the most missed diagnoses I see.

Because there is no single test for it.

Instead, I diagnose it by listening to your story.

And I check for these features...

➡️ 1️⃣ Vertigo or Dizziness that Lasts 5 Minutes to 72 Hours. (My Rating: 9/10).

This can feel like the room is spinning.

Or like you're lightheaded.

Or off balance.

But the duration matters.

If episodes last under 5 minutes, I start thinking about seizure-like disorders.

If they last longer than 72 hours, or never really stop...

I start thinking about other conditions.

So the timing alone narrows things down a lot.

➡️ 2️⃣ You've Had At Least 5 episodes. (My Rating: 9/10).

And these should be moderate or severe.

In other words, they stop you from doing your normal daily activities.

One single episode of dizziness is usually not vestibular migraine.

In that case, I think more about problems with the inner ear balance system.

Vestibular migraine is a pattern diagnosis.

So it has to repeat.

This is why the diagnostic criteria requires at least 5 episodes of moderate or severe symptoms.

➡️ 3️⃣ You Have a Migraine History. (My Rating: 6/10)

Patients must have a current migraine history or from the past.

Because vestibular migraine is not a separate disease.

It's one way migraine shows up.

Unfortunately, most patients with vestibular migraine don't remember their migraine history.

Because the headaches are often few and far between. Maybe once or twice a year.

And the headache is usually NOT the dominant symptom.

So patients forget them.

Or never think of them as "migraine."

➡️ 4️⃣ Migraine Features with At Least Half of Your Episodes. (My Rating: 9/10).

You need at least one of these...

- A migraine-type headache = One-sided, pulsating, moderate to severe, and worse with physical activity

- Sensitivity to light AND sound

- A visual aura

When someone has repeated vertigo episodes, of the right length...

Plus a migraine history...

Plus these features...

I'm very confident that they have vestibular Migraine.

Because very few other conditions tick all these boxes.

➡️ 5️⃣ You feel normal between episodes. (My Rating: 8/10).

This is a big one for me.

Even with chronic vestibular migraine, there should be (or at least once was) a symptom-free gap.

But if you tell me you're dizzy on most days and never fully clear...

I start worrying about PPPD (persistent postural-perceptual dizziness).

It's a different condition.

And this matters because the treatment is different.

Treat the wrong one and you won't get better.

➡️ 6️⃣ Other Causes Are Ruled Out. (My Rating: 10/10)

This is the one I never skip.

Because other conditions can look exactly like vestibular migraine.

And you cannot afford to miss these.

So, I specifically look for 3 things...

First = Weakness in your arm, leg or face? Or trouble swallowing?

This is a stroke until proven otherwise.

Please don't think "vestibular migraine" at this stage.

Just go to the ER

Second = Hearing loss or ringing in the ears.

This points more towards Meniere's disease.

It also comes in episodes, with a similar length.

So I have to rule it out before calling it vestibular migraine.

And third = Nystagmus...

Nystagmus is quick, jerky eye movements.

And these fits better with other brain disorders than with vestibular migraine.

So, if you have this I am definitely getting a scan.

P.S. Do you Get Vestibular Migraine Attacks?

P.P.S. Still getting dizzy spells? WhatsApp me on 0321 5615880 for my Free Migraine Check. I'll personally review your symptoms and highlight what's not working.

Dr Azrung Fayaz
Neurologist

03/10/2026

This is a story I can't stop thinking about...

She was 43 years old...

A mother of three and a hardworking office employee.

And she'd had migraine for 25 years...

Roughly 3 attacks a week and 20 headache days a month.

Her treatment strategy = Only painkillers.

Either paracetamol-caffeine combinations or triptans...

About 10 to 12 times a month.

She spoke about her migraine like someone who had done her homework...

She knew the terms.

And she had read the research.

So I asked her something I don't usually ask...

"Why didn't you get help before this? You've suffered for 25 years."

And her answer stayed with me...

She had seen multiple doctors in the last 10 years.

Some dismissed her symptoms.

Some labelled her "dramatic."

And when she tried to discuss a treatment plan, or a side effect she was noticing, she was asked...

"How do you know it's the migraine causing this?"

Or...

"Don't play doctor."

Her husband came to most of these appointments.

And slowly, even he started to doubt her.

Because if the doctors weren't taking her seriously, why should he?

So she stopped going to doctors.

And she stopped explaining herself.

Not because she didn't need the help.

But, because she was scared of being dismissed.

And scared of being belittled again.

That's 25 years lost.

Not because there was no treatment.

But because no one was willing to listen.

Here's what I want you to understand...

When patients get dismissed, they don't just lose one appointment.

Instead, they lose trust.

And then they stop asking questions.

Sadly, the migraine keeps going.

Luckily, for her...

She responded really well to a first-line preventive.

We started a very low dose of nortriptyline.

And two months later she told me she'd had only 1 attack since starting.

Yes, only one!

She said she felt like a new person.

Not a new medicine. Not a miracle.

Just the right treatment and someone willing to listen.

So if you've been dismissed before, here's what I'd do at your next appointment...

1️⃣ Bring numbers, not just feelings.

How many headache days a month?

How many painkiller days?

Write it down.

2️⃣ List what you've already tried.

Every medicine, every dose, and what happened.

3️⃣ Ask one direct question: "What is our plan to reduce how often I'm getting these?"

A doctor who values your input will welcome this.

And if yours doesn't, that tells you something too.

You are not dramatic.

You are not "playing doctor."

You are the one living in your body every single day.

And you deserve a doctor who listens.

P.S. Do you have a doctor who listens?

P.P.S. Struggling with Migraine? WhatsApp me on 0321 5615880 for my Free Migraine Check. I'll personally review your approach and pinpoint what's not working.

Dr Azrung Fayaz
Neurologist

01/10/2026

Sometimes, the answer isn’t simply: “Try something stronger...”

She had migraines for over 20 years.

At first they were rare.

But, by the time I spoke to her...

She was having 8 to 10 migraine attacks every month.

And each one lasted 2 to 3 days.

So, she had almost no headache-free days.

Also, she had already tried three preventive medicines...

Topiramate didn't help...

Propranolol caused breathing issues...

And valproate made her gain weight.

On top of that, two rounds of Botox only helped 10 to 15%.

So naturally, she asked: “What else can we do?”

The newer CGRP medicines were an option.

But they are costly, and they were out of her budget.

This is where I think it’s important NOT to look at migraine treatment as a simple checklist.

So, I went back through her history to make sure nothing was missed.

She'd already had two MRI scans of her brain.

But I still made a point to look at her optic disc to exclude high pressure headaches...

Because these are not always picked on an MRI.

Her optic discs were normal and her history was consistent with chronic migraine.

But there were a few things that stood out...

First, her high blood pressure.

She needed medicine for it anyway.

So I chose Candesartan because it also helps with Migraine as well.

Second, her anxiety and poor sleep.

I recommended low-dose Nortriptyline because it helps with Migraine and anxiety.

And lastly, we worked on the less glamorous—but extremely important—part...

Lifestyle, sleep, consistency, and education.

It took time.

But about 2½ months later, she reported that her headache days had fallen by approximately 80%.

And she felt like a different person.

She still gets migraine attacks because migraine is genetic.

And there is no cure.

But her attacks are so infrequent that they no longer affect her life.

This does NOT mean Botox “doesn't work.”

Because Botox can be highly effective for many people with chronic migraine.

And if someone has had a partial response after the first couple of treatments (like this patient)...

I may advise additional sessions before deciding whether it's truly ineffective.

But finances didn't allow it in this case.

P.S. Did Botox help with your Migraine?

P.P.S. Struggling with frequent migraine attacks? WhatsApp me on 0321 5615880 for my Free Migraine Check. I'll personally review your approach and pinpoint what's not working.

29/09/2026

“Stop eating high-histamine foods and your migraine will go away.”

"Your migraine attacks are caused by histamine intolerance.”

You may have seen claims like these online.

Because "histamine intolerance" is now a big social media trend.

Histamine is best known for allergies.

Your body releases it in response to allergens.

It makes your nose run and your skin itch.

But histamine also acts in the brain and nervous system.

And it can affect the blood vessels and pain pathways involved in migraine.

In fact, an old research found that giving histamine to people with migraine could trigger attacks.

Likewise, in newer studies...

Lower DAO levels led to more migraine attacks.

DAO is a helper enzyme in the gut.

And its job is to break down histamine from food.

So, if your DAO is low, more histamine may get into your blood.

Other smaller studies found that a low histamine diet helped some patients.

Is this to say histamine causes your Migraine?

No...

Histamine can trigger an attack. Studies have shown this more than once.

But a trigger is not a cause.

Migraine is a genetic neurological condition.

This is to say your genes make your brain more sensitive to change.

And yes, sometimes histamine, can push that brain over the edge.

But it's not the reason why your brain is so sensitive.

In other words, you can eat zero high-histamine foods and still get migraine attacks.

It's important to understand this because many patients go too far.

I see people who cut out cheese, tomatoes, leftovers, nuts, and more.

And their food list gets tiny.

They feel scared to eat.

And yet the migraine attacks are still there.

So they cut their food lists further.

Result = Migraine attacks.

In other words, this is a vicious circle.

That robs you of the joy of eating.

Here's what I suggest you do instead...

Keep a simple headache diary for 3 to 4 weeks.

And look for patterns...

If a certain food keeps triggering your attacks...

Cut only that food from your diet.

And see how you get on.

It may make a difference or it may not.

Just make a note and then you can try the same with another food item.

This way you're not guessing.

Rather you're following a step by step process.

And don't please don't take antihistamines every day on your own.

They are not a proven migraine cure.

And actually may make things worse.

P.S. Does histamine trigger your Migraine?

P.P.S. Still getting frequent migraine attacks? WhatsApp me on 0321 5615880 for my Free Migraine Check. I'll personally review your approach and pinpoint what's not working.

28/09/2026

From weakest to strongest...

➡️ 1️⃣ Foods. (My Rating: 2/10)

One of the biggest migraine myths.

People used to think certain foods (like chocolate or cheese) caused migraine.

But, now we know the truth...

Cravings for sweet or salty food are part of the migraine predrome.

The migraine starts first.

And the craving comes after.

➡️ 2️⃣ Weak Eyesight. (My Rating: 2/10)

Some people blame their eyes for every headache.

But, migraine is a genetic neurological condition.

In other words, poor eyesight can strain the eyes.

But it rarely explains repeated attacks on its own.

➡️ 3️⃣ Excessive Screen Use. (My Rating: 3/10)

Surprisingly, screens themselves aren't a problem.

But prolonged screen time brings...

Eye strain, poor posture, missed meals and bad sleep.

Together, these can trigger a migraine.

➡️ 4️⃣ Dehydration. (My Rating: 5/10)

Not as strong a trigger as poor sleep or stress (see below).

But, staying hydrated does help.

Especially because sudden changes in fluid intake...

Can cause migraine attacks in some people.

➡️ 5️⃣ Bright Lights. (My Rating: 6/10)

Some migraine patients are sensitive to bright light.

And, they're also more likely to get...

Visual aura, blurred vision, or trouble concentrating.

➡️ 6️⃣ Temperature Changes. (My Rating: 7/10)

Sudden temperature changes can trigger migraine attacks in some people.

In fact, these people can feel the temperature change before everyone else.

We think it's due to the changes in atmospheric pressure...

That the sensitive Migraine brain picks up very quickly.

➡️ 7️⃣ Smell. (My Rating: 7/10)

Some patients are very sensitive to smell...

For example, perfume, petrol or pungent odors.

This is not common.

But when it hits, it's disabling.

➡️ 8️⃣ Poor Sleep. (My Rating: 8/10)

One of the strongest triggers there is.

Poor sleep makes the brain less able to handle daily life.

And in migraine patients, that's often enough to start an attack.

That's why migraine attacks usually hit after night shifts, or a late night out.

➡️ 9️⃣ Oversleeping. (My Rating: 8/10)

Too much sleep can trigger migraine attacks too.

Because, the migraine brain hates sudden changes in routine.

So, whether you sleep too little or too much...

It's a change in routine.

That's why migraine attacks often strike on weekends...

After oversleeping post a late Friday night.

➡️ 1️⃣0️⃣ Missing Meals. (My Rating: 8/10)

The migraine brain doesn't like sudden changes in meal timing, food intake, or hydration.

Sadly, this happens often during...

Busy workdays, long meetings or travel.

➡️ 1️⃣1️⃣ Travelling. (My Rating: 9/10)

A major trigger because it stacks so many triggers at once...

Before travel = Poor sleep and stress.

During travel = Dehydration, missed meals and weather changes.

Anyone who travels often and has migraine knows exactly how bad this gets.

➡️ 1️⃣2️⃣ Stress. (My Rating: 9/10)

One of the most important migraine triggers.

Because stress affects everything...

Sleep gets worse...

Eating habits change...

Routine gets disrupted.

And all of this can make a migraine attack more likely.

This is also one reason people with Migraine also struggle with mental health issues.

➡️ 1️⃣3️⃣ Hormonal Changes. (My Rating: 9/10)

Many women get migraine attacks around the start of their menstrual cycle.

This is linked to hormonal changes...

Particularly the drop in estrogen around menstruation.

And the migraine brain can be very sensitive to sudden hormonal shifts.

P.S. What triggers your migraine?

P.P.S. Does everything trigger your Migraine? WhatsApp me on 0321 5615880 for a Migraine Check. I'll help you find at least 3 areas where your treatment is getting stuck.

Dr Azrung Fayaz
Neurologist

26/09/2026

Hint: They're not more medicines.

In recent years, focus in Migraine treatment has shifted towards medicines.

And yes, medicines matter...

And for many people, they are life-changing.

But they are not the whole treatment.

Your sensitive Migraine brain also cares about what you do every day.

In fact, the migraine brain loves routine.

➔ 1️⃣ Sleep — Same time, Every Day.

It's not about getting 8 hours.

Instead, it's about going to bed and waking up at the same time...

Every single day.

Yes, that means even on weekends.

In other words, sleeping too little or too much can both bring on a Migraine.

A study followed over 60,000 people.

And it found the same pattern...

Inconsistent sleep is a bigger trigger than lack of sleep.

➔ 2️⃣ Eat (Healthy) — On a schedule.

First, please don't skip meals.

And don't go from eating at 8 am one day to 2 pm the next.

Because, the Migraine brain loves a consistent eating routine.

And second, adopt a healthy diet you can actually stick to.

I personally like the Mediterranean or DASH-style diet.

A randomized trial of the DASH diet in women with migraine...

Found fewer and less severe migraine attacks after 12 weeks.

Studies of Mediterranean-style eating have reported similar results.

But, whichever you diet you pick...

You should be able to follow it for years.

That's where you get the real results.

In other words, it should fit your budget and taste preferences.

So, you don't need a “perfect migraine diet.”

Instead, you need a healthy diet you follow consistently.

➔ 3️⃣ Move.

A well-known Swedish study put migraine patients on a stationary bike...

For 40 minutes, 3 times a week.

And after 3 months, it worked just as well as a Migraine prevention medicine.

Other reviews of exercise studies back this up.

In other words, regular exercise lowers migraine days.

And, it doesn't matter if you pick walking, cycling, strength training or yoga.

Just be consistent with it.

➔ 4️⃣ Keep a Headache Diary.

One study found that a simple daily diary, kept for just one month...

Raised headache diagnostic accuracy from 75% to 92%.

And it also helps you spot triggers, instead of guessing.

Apps like Migraine Buddy make this easy.

And it just takes two minutes a day.

➔ 5️⃣ Manage your stress — Without Pills.

Stress doesn't cause Migraine...

But it can set one off an attack...

Especially the day after a stressful event.

Luckily, you don't need medicine for this.

Instead, any of the following can help...

Deep breathing...

Mindfulness or Meditation...

Or journaling.

And if you need more help...

Therapy is a great option.

A major trial found that stress management helped migraine patients cut headache days...

And it did even more for their quality of life, mood, and how well they coped with pain.

P.S. What's one thing you do every day that helps your Migraine?

P.P.S. Getting frequent Migraine attacks? WhatsApp me on 0321 5615880 for a Migraine Check. I'll help you find at least 3 areas why you're not getting better.

Dr Azrung Fayaz
Neurologist

24/09/2026

This patient was 26 years old...

And she'd had migraines for 8 years.

Sadly, for the last 3 years she was averaging about 20 headache days every month.

Her headaches were typically migrainous...

One side of the head, bad nausea, vomiting, and light and sound made it worse.

And before every attack, she'd get brain fog.

After it, she would be extremely tired.

The result = She was taking 15 to 20 painkillers a month.

Yet, her life was a mess.

She had already tried flunarizine and amitriptyline.

Both helped the headaches, but they made her so sleepy she couldn't function.

She was a student, so she couldn't afford that.

When we first spoke, I knew I had to do two things to help her...

First, break the medication-overuse cycle.

Taking the same painkiller too often can make headaches worse.

So, I switched her painkiller (panadol migraine) to eletriptan.

And the second was to start a preventive treatment (to control her headaches).

I started propranolol.

It worked well. And her headache days dropped from 17 to just 1 or 2 a month.

But she needed a fairly high dose.

So, she started having low blood pressure and dizziness in the late afternoons.

And despite lowering the dose, the side effects were still too much.

So we decided to switch to topiramate.

And this is where I messed up...

She had already struggled with other medicines.

And I wanted to win her trust fast, so I pushed the topiramate up quickly...

Zero to 100 mg a day within a month.

Her headaches went away. But the brain fog and slow thinking were unbearable.

She was sliding into depression and couldn't even explain why.

When we spoke again, I knew what I'd done.

Topiramate wasn't the problem...

My speed was...

So, I brought her down to 50 mg a day.

And now she has barely any headache days, and no side effects.

She's still on it and doing great.

So this is the lesson I want to give you...

With topiramate, I don't rush the dose anymore.

I usually start low — often 25 mg — and increase gradually.

For example, I may give 25 mg for the first couple of weeks...

Then increase to 50 mg...

And only increase further if the patient needs it and is tolerating it.

The exact schedule has to be individualized.

So, topiramate for migraine: Yes or no?

For me, the answer isn't that simple...

Because sometimes the drug isn't the wrong choice...

The dose may be wrong.

The speed of escalation may be wrong.

The timing may be wrong.

Or we may simply not have given the treatment enough time.

This patient is a good example.

Topiramate was actually a very good choice for her.

I just didn't introduce it the right way the first time.

And that's what I do differently today.

P.S. What treatment are you on for your Migraine?

P.P.S. Struggling with Migraine? WhatsApp me on 0321 5615880 for a Migraine Treatment Check. I'll help you find at least 3 areas where your treatment is getting stuck.

Dr Azrung Fayaz
Neurologist

22/09/2026

Pro Tip: Pick one that you can stick to for a long time.

A lot of patients ask me...

"Can food really change my Migraine?"

The short answer is yes...

Because, when blood sugar levels swing up and down...

Your brain becomes more sensitive to pain.

In additon, certain foods also affect the blood vessels and nerves around your brain.

So the right diet can calm things down.

And the wrong diet can set off an attack.

➡️ 1️⃣ Ketogenic Diet. (My Rating: Good)

Keto = Very low carbs and high fat.

This one has the strongest data behind it.

For example, in one study...

74 out of 100 people cut their migraine days in half on a keto diet.

Compared to only 6 out of 100 people on a normal diet.

But keto is hard.

And most people cannot eat this way for years.

So, great data, but harder to live with.

➡️ 2️⃣ Low-GI diet. (My Rating: Good)

The idea is simple...

Choose foods that cause a slower rise in blood sugar.

This means a diet rich in...

Oats, beans, lentils, vegetables, whole grains and nuts.

And, eliminate large amounts of refined carbs and sugary foods.

This steadier supply of glucose may help keep the brain more stable.

For example, one study followed 350 people with migraine...

After 3 months, those following a low-GI diet had fewer attacks and lower pain scores...

Than the group on a normal diet.

The evidence is not as strong as keto.

But the diet is simple.

And you do not have to give up carbs.

That makes it much easier to live with than keto.

➡️ 3️⃣ Low-fat diet. (My Rating: Good)

This diet does what it says...

You reduce the amount of fat in your diet.

And there is some interesting migraine research here...

For example, in one randomised crossover trial...

83 people with migraine followed a low-fat diet.

And their Migraine attacks reduced from 6.8 → 2.9 per month.

That is a big change.

But there is a catch because fat is necessary for a lot of healthy body functions.

So, I would not tell every migraine patient to eat an ultra-low-fat diet.

The better lesson may be to reduce excess saturated fat and highly processed food.

➡️ 4️⃣ Gluten-free diet. (My Rating: Great, if you have coeliac disease)

If you have coeliac disease, a strict gluten-free diet is important.

And this may improve your migraine too...

For example, a study of people with coeliac disease found...

That following a gluten-free diet led to a 48% improvement in headache frequency.

Similarly, a review of 40 studies found...

That headaches linked to coeliac disease improve on a gluten-free diet.

But, if you do not have coeliac disease...

There is limited evidence that simply removing gluten will help your migraine.

And gluten-free does not automatically mean healthy.

Not to mention, gluten-free foods can be expensive and highly processed.

So don't remove gluten just because someone on Instagram told you so.

➡️ 5️⃣ DASH Diet. (My Rating: Great)

This means whole grains, fruits, vegetables, low-fat dairy, fish, and chicken.

And less salt, fat, and sugar.

In a 12-week study, 102 women on this diet dropped from about 6 migraine attacks a month to about 3.

While, the group on a normal diet experienced no improvement.

It is a little more work than my favourite diet (see below), but still livable long term.

Overall, a great pick.

➡️ 6️⃣ Mediterranean diet. (My Rating: Great).

Lots of fish, olive oil, nuts, fruits and vegetables.

And less meat and dairy.

In one study, people who ate more of this style of food had 4 fewer headache days every month.

That is close to what some migraine medicines can do.

And it tastes good.

So, it is easy to keep up for years.

This is why I recommend it to most of my patients.

P.S. What Diet Helps Your Migraine?

P.P.S. If you’re struggling with migraine, WhatsApp me on 0321 5615880 for my Migraine Treatment Check. It will give you clarity on why you’re not getting better.

21/09/2026

Migraine is a full-body storm.

And it disables people in all its phases...

➔ Phase 1: The Warning (Prodrome).

Hours before the pain even starts, the brain is already misfiring.

And patients can feel it coming...

Neck stiffness...

Yawning again and again...

Sudden mood changes...

Craving sugar or salt out of nowhere...

And trouble finding words.

This happens because the hypothalamus starts acting up.

And this is the brain's control center for mood, hunger, and sleep.

So, the patient is not "being dramatic."

Instead, their brain chemistry is already changing.

➔ Phase 2: The Aura

Some patients see zigzag lines...

Others go blind in one part of their vision...

Some feel numbness creep up an arm...

And some cannot speak properly for a few minutes.

All these are caused by cortical spreading depression.

This is a wave of electrical activity that spreads slowly across the brain.

It is a real, measurable brain event.

➔ Phase 3: The Headache

Blood vessels around the brain become inflamed.

And a key nerve called the trigeminal nerve gets irritated.

This causes the release of a chemical called CGRP.

CGRP makes pain signals louder and blood vessels more swollen.

This is why light feels blinding.

And sound feels like knives.

And even a normal smell can trigger vomiting.

In other words, this is NOT "just a bad day."

Instead, the brain's pain system is stuck on high volume...

For hours or even days.

➔ Phase 4: The Postdrome (The Hangover)

Even after the pain fades, many patients feel unusually tired.

Exhaustion, like they ran a marathon lying in bed.

This is called the "migraine hangover."

It can last a full day.

And during this time...

Work, parenting, driving, all of it becomes hard.

Sadly, because migraine does not show up on blood tests and MRIs...

And there is no visible cast or wound...

So, people assume it's an excuse.

While, others call it a weakness.

But we now know migraine is a real neurological disease.

And it has a real biological reason behind it.

So, it deserves the same respect as any other serious medical condition.

P.S. Does Migraine disable you?

P.P.S. If you’re struggling with migraine, WhatsApp me on 0321 5615880 for my Migraine Treatment Check. It will give you clarity on why you’re not getting better.

Dr Azrung Fayaz
Neurologist

19/09/2026

Most people think migraine is just a bad headache. But, that's not even half the story...

Because pain is not the hardest part.

Most attacks last less than a day.

And a good painkiller can help with the pain.

The real problem is everything else that comes with it.

Because Migraine is a whole-body neurological condition.

And an attack has stages.

First comes the warning signs.

This can be yawning, neck pain, stuffy nose, or strange lights in your vision.

Then comes the pain.

After that comes something called postdrome.

This means deep tiredness. No energy. And no drive to do anything.

Naturally, when attacks happen often, people start to feel afraid.

Afraid of the next attack.

So they stop doing things that might trigger an attack.

They skip meals less.

They don't travel.

And they say no to plans with friends.

So, slowly, they stop living a full life.

And here's the hard part...

When someone keeps cancelling plans, people around them get upset.

Friends and family may feel let down.

They may get angry or blame them.

But they don't see what's really going on.

They don't see the illness underneath.

And this creates a cycle...

Frequent attacks lead to more cancelled plans.

Cancelled plans lead to guilt and loneliness.

And the stress can even trigger more attacks.

I've had patients tell me they missed their child's graduation.

They tell me they couldn't be the parent they wanted to be.

Their work suffers.

Their family life suffers.

All while they carry the weight of a hidden illness every single day.

Over time, patient's lose hope.

Because at first, they try small fixes.

They believe things will get better.

They ask around for advice; some helpful, some not.

But when nothing seems to work, hope can start to fade.

That's the hardest part of all.

Imagining years ahead filled with pain.

Filled with tiredness.

Filled with memories they won't get to make.

Hope is one of the most powerful things we have.

And losing it makes everything harder.

So please...

Migraine is a real, physical illness.

It is not a choice.

It is not a weakness.

It is not something someone brought on themselves.

Patients already carry enough guilt about missing out on life.

They don't need more blame added to it.

So next time someone cancels on you, pause before getting upset.

Ask instead of assuming.

Try to understand what they might be carrying.

You may not be able to take their Migraine away...

But you can offer understanding.

And that understanding can help them take the next step...

Whether that's a change at home, seeing a doctor, or simply feeling less alone.

P.S. Have you missed major life events due to Migraine?

P.P.S. If you want to discuss your Migraine with me, feel free to WhatsApp me on 0321 5615880

Dr Azrung Fayaz

05/10/2026

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