Dr Azrung Fayaz

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Dr Azrung Fayaz

🧠 | Neurologist Helping You Take Control of Your Condition
💪 | Proper Diagnosis + Medication + Lifestyle = Get Your Life Back

I’m a neurologist with a passion for making neurocare accessible to everyone. I specialize in diagnosing and treating conditions affecting the brain, spine, nerves, and muscles — from headaches, strokes, and epilepsy to neuropathy, memory problems, and movement disorders. My clinical experience spans across renowned institutions, including Virginia, USA, and at St George’s Hospital in London. Thes

e experiences have shaped my approach: combining accurate diagnosis, clear communication, and personalized care to support patients in regaining their health and improving their quality of life. Beyond clinical practice, I’m deeply interested in educating and empowering people with knowledge about neurological health — because understanding is the first step toward access and better outcomes.

01/09/2026

This is one of the biggest gender differences in medicine.

About 1 in 5 women will have Migraine in their lifetime.

Compared to only about 1 in 15 men.

Because Migraine is a genetic neurological disorder.

In other words, Migraine runs in families.

And some of the genes linked to it appear to be more active in women.

But that is not the full picture...

Because before puberty boys and girls get Migraine attacks at the same rate.

So, this is not ONLY about being a woman...

Instead, it's also about estrogen.

In the brain, there is a nerve pathway called the trigeminovascular system.

When this is triggered, it causes a migraine attack.

Estrogen controls how easily this system turns on.

In other words...

When estrogen levels are high and steady, the system stays calm.

And when estrogen drops suddenly, the system activates.

This is why many women get Migraine attacks right before their period.

Estrogen falls fast in those 2 to 3 days.

It is also why migraines get worse for some women during perimenopause.

Because this is when estrogen levels rise and fall without warning.

In simpler terms...

Hormone change → Lower migraine threshold → Trigeminal activation → Migraine attack.

So, it is not that women are simply “more sensitive to pain.”

Instead, the female brain and migraine pathways are affected by changes in estrogen.

And let's not foget about sleep and stress load...

Women often get less restful sleep and carry more daily stress.

Because, in many families, women do most of the caregiving.

Many also work shifts that break up normal sleep.

And both poor sleep and high stress are well-known Migraine triggers.

That is why migraine is 3 times more common in women.

And also why women with migraine experience attacks that are...

Longer, more disabling, and more likely to include nausea and vomiting.

P.S. Do you get Migraine attacks around your hormonal cycle?

P.P.S. If you need help with your migraine or would like a second opinion, feel free to WhatsApp me on 0321 5615880

Dr Azrung Fayaz
Neurologist

31/08/2026

This was the first time I spoke to her.

And she came in with a long history behind her.

Years ago, she had tried a migraine medicine called topiramate.

It can work well for many people.

And it did help with her migraine.

But it also caused some problems.

She got brain fog.

And, she had trouble with her memory.

She also felt confused a lot.

It got so bad that she stopped taking Topiramate.

This is actually pretty common...

Because topiramate calms down some of the "excitement" in the brain.

And that is how it helps prevent migraine attacks.

But that same calming effect can also slow down thinking.

This leads to brain fog.

And it happens more than people think.

In fact, about 1 in 4 people on topiramate have some kind of thinking-related side effect.

Luckily for her...

Once she was off topiramate, her brain fog had improved.

But the migraine attacks were back.

And she needed help.

Before starting her on another medication I wanted to make sure she actually needed it.

So, as always, I went over her story to confirm the diagnosis.

Then, I looked at how much migraine was affecting her daily life.

For her, the attacks were getting in the way.

For example, she was missing out on outings with friends.

And on top of the pain, she was starting to feel anxious about her health.

Because, she kept worrying about the next attack.

So, we talked about two options for daily prevention...

First was Propranolol. This is a heart medicine that also helps prevent migraines.

Many people tolerate it well. And it has a fairly mild side effect profile.

Second was Memantine. This is an off-label choice for migraine.

But, I use it for hard-to-treat migraines...

Especially in patients who have had memory or brain fog problems with other drugs.

I did not promise her a life with zero migraine attacks.

That is not realistic for most people.

Instead, we set a real goal = Fewer attacks, and a life she could enjoy again.

Also, she had been going to the ER a lot for her migraine attacks.

And her pain medicine was tough on the stomach.

So we talked about switching to something mild.

Still effective for stopping an attack, but easier to live with day to day.

And lastly, medicine is only part of the plan.

We also talked about simple daily habits that can reduce migraine attacks over time.

Together with the right medicine, they can lower how often attacks happen.

This patient's story is a good example of something I see often...

Migraine care is not one-size-fits-all.

It takes time. It takes listening.

And sometimes the "textbook" first choice is not the right choice for the person in front of you.

Her plan was not about finding a perfect cure.

It was about giving her back her life...

Her plans, her time with friends, and some peace of mind.

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

P.P.S. If you need help with your headaches or would like a second opinion, feel free to WhatsApp me on 0321 5615880

29/08/2026

"What's the best treatment" doesn't have one answer.

Because not everyone with migraines needs medicine.

For some people, certain lifestyle changes work as well as medicine.

For some, if attacks are rare, a good pain relief plan is enough.

For others, supplements help.

Even two patients who look identical on paper...

They can respond completely differently to the same treatment.

One person might rate it a 10. The other, a 3.

Why?

Because migraine is genetic.

And right now, we don't have a way to change your genetics so the migraines stop happening in the first place.

So instead, we focus on prevention...

Through lifestyle, supplements, medicine, or a solid pain management plan.

And here's the key part...

Whatever you choose, you'll likely need to stick with it.

Day after day. Year after year.

Possibly for life.

So the "best" treatment is really the one you can actually keep taking.

That means...

First, it fits your schedule.

Some people do better with once-a-day dosing. Others prefer twice a day.

And second, the side effects are ones you can live with.

Weight gain is a dealbreaker for some patients.

In fact, they'd rather deal with migraines.

Others prioritize sleep or mental health above all else.

And some patients have other conditions to think about too...

For example, asthma, kidney stones, constipation.

Because, these can rule certain treatments in or out.

In other words, the sacrifice has to make sense for YOU.

Because every migraine preventive comes with a sacrifice.

So, it has to make sense...

Not for me. Not for the textbook.

But, for YOU.

So, instead of asking "what's the best migraine treatment," the real question is...

"What's the best migraine treatment for ME?"

That's a different conversation.

A more personal one.

And it's one worth having...

Because you deserve to feel better.

P.S. If you need help with your headaches or would like a second opinion, feel free to WhatsApp me on +923215615880

Dr Azrung Fayaz
Neurologist

27/08/2026

Hint: #6 is often missed by doctors

Not every child with migraine says...

"My head hurts."

Instead, some children show migraine in other ways.

And looking back, you may suddenly realize...

"Wait that was happening to me..."

➡️ Sign 1️⃣ Motion Sickness

You would feel sick or vomit during long car rides.

Sometimes even short trips were enough.

This is called motion sickness.

And it is strongly linked with childhood migraine.

In fact, in one study of children with migraine about 40% had a migraine-associated symptom.

Of these, motion sickness was one of the most common.

Sadly, children with motion sickness are often told...

"You just have a weak stomach."

"Don't look out the window."

"You'll grow out of it."

You may have been one of those children.

➡️ Sign 2️⃣ Stomach Pain (Without a Cause)

You would suddenly get bad pain in your stomach.

And then, after hours, you would be fine again.

Each time, doctors would find nothing wrong.

So you were told...

"He's making it up."

"She's trying to skip school."

"It's just gas."

"It's anxiety."

Instead, it was abdominal migraine.

Studies estimate abdominal migraine affects about 0.2%–4.1% of children.

And up to 70% of children with abdominal migraine later develop migraine headaches.

➡️ Sign 3️⃣ Vomiting Attacks

Not normal vomiting from an infection.

Instead, you would have episodes where you vomited again and again.

Then you would recover.

And between attacks, you could feel completely normal.

This is called cyclic vomiting syndrome.

And one study found it in about 1.9% of children.

And in one study of children with cyclic vomiting...

82% were diagnosed as having migraine-associated vomiting.

➡️ Sign 4️⃣ Dizzy Spells

You would suddenly feel like the room was moving.

And you struggled to balance yourself.

Then the attack would stop.

So you were told...

"You're just dizzy."

"Stand up slowly."

"You're being dramatic."

Instead, you were experiencing benign paroxysmal vertigo of childhood, a migraine-associated condition.

➡️ Sign 5️⃣ You Always Needed Sleep

You would suddenly become quiet.

And wanted a dark room to rest.

And after sleeping, you were much better.

But people around you said things like...

"He's lazy."

"She doesn't want to study."

"He sleeps too much."

In reality, children with migraine can also have sleep-related symptoms between attacks.

These include excessive sleepiness, sleep talking, sleepwalking and teeth grinding.

➡️ Sign 6️⃣ Arm & Leg Pain

Growing pains?

Or at least that's what everyone told you.

But some children with migraine have recurrent limb pain.

In fact, in one study of children...

Limb pain was more common in children with migraine.

Similarly, in another large study...

43.9% of children with migraine reported limb pain as a migraine-associated symptom.

➡️ Sign 7️⃣ Bright light, Loud Noise & Smells Bothered You ALOT

You hated bright sunlight. And you wanted the lights turned off.

Crowded, noisy places were exhausting.

And strong smells could make you feel sick.

And you may have thought...

"Why am I the only one bothered by this?"

These are classic migraine features.

Children can have migraine with nausea, vomiting, and sensitivity to light and sound...

Even when the headache itself is not obvious.

Instead, people saw it as...

"You're too sensitive."

"Stop complaining."

"Everyone else is fine."

But migraine brains can process sensory input differently.

P.S. Did you have undiagnosed Migraine as a child?

P.P.S. If you need help with your headaches or would like a second opinion, feel free to WhatsApp me on +923215615880

Dr Azrung Fayaz
Neurologist

25/08/2026

50% of people with migraine get pain on one side.

And new research shows that migraine symptoms change depending on which side is involved.

Things like nausea, vomiting, and light sensitivity stay the same.

But, left-sided migraine attacks are more painful.

In fact, people with left-sided migraine have about 25% more severe headaches.

And their attacks also last longer.

In other words...

They have fewer headache-free days.

And more severe headache days.

They're also more likely to have small white dots on their MRI.

Because the left side of the brain is dominant in most people.

And the dominant side processes pain differently.

Having said that...

This does NOT mean that left-sided migraine damages the brain.

These MRI findings are usually nonspecific.

And we don't yet know exactly what they mean clinically.

On the other hand, right-sided migraine affect thinking.

So, people with right-sided migraine struggle with...

Brain fog, poor concentration, and memory problems.

They ask questions like...

“Why can't I think clearly?”

“Why am I struggling to concentrate?”

“Why does my brain feel slow?”

In other words, the pain is not always the main issue.

This makes them easy to miss.

Because both patients and doctors may not realise it's a migraine.

But here's the part I don't want you to misunderstand...

Your migraine being on the left does NOT automatically mean it is worse.

And having a right-sided migraine does NOT mean you have a problem with your memory.

These are associations seen in research groups.

And not rules that apply to every patient.

So why might the two sides behave differently?

We don't fully know.

The old idea that...

“Left brain = logical” and “Right brain = creative” is far too simplistic.

Because both constantly communicate and work together.

What researchers are now asking is a much more interesting question...

Could the side of migraine pain...

Reflect differences in how the brain processes pain and sensory information?

Possibly.

But we need more research before we can say exactly why.

P.S. What side does your migraine affect?

Dr Azrung Fayaz
Neurologist

24/08/2026

A patient (over 50, from the U.S.) reached out for a second opinion.

Side note: Yes, that's something I offer to patients anywhere in the world.

And here's her story...

She had migraines for 40 years.

They came with visual "auras" — flashing lights, blind spots.

Then pain, nausea, sensitivity to light and sound.

But they were rare.

Maybe once every few months.

So she never worried much.

But, this year everything changed.

The attacks jumped to 8-9 times a month.

And the scariest part was the visual aura would hit her while driving.

Or while working out.

The first question I had was is this a seizure?

This matters because seizures and migraine auras can look similar.

But there are clues that tell them apart...

First, her episodes lasted about 40 minutes. Seizures are usually much shorter, often under 2 minutes.

Second, seizures tend to look the same every time. Hers didn't. Sometimes the light moved left to right. Sometimes right to left. Sometimes it spread out. Sometimes it closed in.

Third, the prodrome. In this case, she'd feel irritable and grumpy before it started. This fits with migraine.

In other words, this was migraine...

But more frequent and more disabling than before.

Next, I began digging for the "why"...

Because, something changed in her life this year.

We talked it through and found some likely triggers.

Sometimes, though, migraines simply get worse and there's no clear reason.

Lastly, these were my recommendations to her...

1️⃣ She was taking magnesium oxide on her own. It wasn't dosed right. And it was upsetting her stomach. So, I switched her to magnesium glycinate. And optimized the right dose for migraine prevention.

2️⃣ She also had SVT (an irregular heart rhythm), and was already on a beta blocker called atenolol for it. But she didn't know that some beta blockers also prevent migraines. So instead of adding a new drug, I simply asked her cardiologist to consider switching her to propranolol or metoprolol. Same job for her heart, extra benefit for her migraines. Two problems, one pill.

3️⃣ Her caffeine intake was higher than she realized. And that can cause "rebound" headaches. So we discussed strategies to help taper this off.

4️⃣ She was using paracetamol. But, that's not strong enough. And honestly, not even the main problem — since her main struggle wasn't pain, it was the aura itself. So our focus shifted from treating pain to preventing attacks altogether.

Migraines can change over time.

And more frequent attacks deserve a fresh look, not just more painkillers.

Sometimes the answer isn't a brand-new medicine...

Instead, it's using what you already have, the right way.

P.S. Do you get Migraine with Aura?

Dr Azrung Fayaz
Neurologist

22/08/2026

“Sunlight triggers your migraine? Avoid sunlight.”

“Perfume triggers it? Avoid perfume.”

“Missing a meal triggers it? Don’t miss meals.”

Sounds simple...

But migraine is not that simple.

Because triggers are different for every person.

And they can even change in the same person.

Think about this...

Can you control the weather?

Can you control if someone near you is wearing perfume?

Can you control your monthly cycle?

Can you always eat on time when you have work & kids?

No. You can't.

In other words, life is full of triggers.

And you cannot avoid life.

Here's what happens when patients try...

They stop going out with friends, in case they miss a meal.

They skip events, in case the lights are too bright.

They stay home, in case the noise is too much.

Slowly, they stop living.

And that becomes more disabling than the migraine itself.

Here's how I explain this to my patients...

Imagine a glass of water.

It's filled all the way to the top.

Now add a few drops.

Those drops are your triggers.

One drop might not spill the glass...

But drop by drop, they add up.

And one day, the water spills over.

That's your migraine.

Most people spend all their energy trying to avoid the drops.

But they never ask the real question...

Why is the glass so full?

Because if your glass wasn't full to begin with, those same drops wouldn't spill anything at all.

The answer = Genetics. Simple as that.

Your brain is wired to be on edge, more sensitive than others.

And that is what real migraine treatment should target.

Because here is the thing...

Life will always have drops.

You will have stressful weeks.

You will lose sleep sometimes.

You will miss a meal here and there.

Your monthly cycle will come.

Someone will wear perfume near you.

The weather will be too hot, too cold, or rainy.

These are normal parts of life.

You cannot erase them.

So stop trying to eliminate every drop.

Start lowering your water level instead.

Telling a patient "just avoid your triggers" is not advice. It's a disservice.

Life is about living.

Not about hiding in a corner, avoiding everything.

Dr Azrung Fayaz
Neurologist

20/08/2026

This is VERY common...

In one large US study, about 73% of people with migraine reported nausea.

And about 29% reported vomiting.

Other studies have found even higher numbers...

For example, nausea in 60–95% of people with migraine...

And vomiting in 50–62% of attacks.

This is because during a migraine...

Nerves in your brain become over-active.

One of these nerves, the vagus nerve, links your brain to your stomach.

So, when it fires too much, your stomach slows down.

As a result, food and acid sit there longer.

And this makes you feel sick.

At the same time, your brainstem has a "vomit center."

Migraine can turn this center on.

That is why some people vomit during an attack.

The good news is that this is treatable.

Early migraine treatment, anti-nausea medicine, and staying hydrated can help.

P.S. Do you feel like vomiting with your migraine?

Dr Azrung Fayaz
Neurologist

18/08/2026

#5 is why you're always on edge.

➡️ 1️⃣ Memory Problems. (My Rating: 9/10)

I hear this one all the time...

Patients who've had migraines for years or even decades tell me their memory just isn't what it used to be.

They forget simple words or names.

They walk into a room and forget why.

They forget what they were talking about.

And they start thinking...

"Is something wrong with my brain?"

Here's how I explain it...

Think about your phone when you have too many apps open at once.

It starts to lag.

And it starts closing things.

That's your brain with migraines.

In other words, your brain is dealing with a lot of things at the same time...

Obviously, there's the pain...

But your brain is also processing...

"Is this going to trigger my headache?"

"What if I get a headache at work?"

"When will this headache get better?"

"Will I be able to function today?"

And then there are side effects from medications.

So yes, memory problems can be a BIG part of the migraine experience.

And the answer isn't to panic about your memory.

The answer is to get the migraine under control.

➡️ 2️⃣ Difficulty Concentrating. (My Rating: 8/10)

Same idea as above...

Your brain only has so much room, and migraines take up a lot of it.

So, patients tell me...

"I feel slow."

"I can't think properly."

"Simple work takes me much longer."

"I used to breeze through this stuff. And now I have to really concentrate."

➡️ 3️⃣ Deep Tiredness. (My Rating: 8/10)

This is not just...

"I didn't sleep well last night."

This is a different kind of tired.

Instead, you have no drive...

No motivation...

And you don't feel like doing anything.

Even though, you sleep 8 or 9 hours...

And you rest...

You try to take care of yourself.

But, you're STILL tired.

Because migraine isn't just head pain.

Instead, it's a whole-brain event.

In fact, a wave of electric activity spreads across your brain during an attack.

And if this keeps happening, your brain's energy runs low.

The result = Your brain and body are always exhausted.

➡️ 4️⃣ Neck Stiffness. (My Rating: 6/10)

Neck stiffness is a well-known early warning sign of migraine.

A lot of patients think their neck is causing the migraine...

But it's usually the other way around.

So, over time, with repeated attacks...

The muscles in your neck, shoulders, and upper back start to tighten.

That tightness brings soreness and pain.

Gentle physio, massage, and trigger point release in the neck and upper back can help with this.

But, you have to get your migraine under control.

➡️ 5️⃣ Mood Changes. (My Rating: 7/10)

Patients with frequent migraines can become irritable.

Annoyed by bright lights.

Annoyed by normal sounds.

Annoyed by things that normally wouldn't bother them.

And if this keeps happening for months or years...

It starts affecting your life.

Your family notices.

Your friends notice.

Some people may start avoiding you.

And sometimes you start avoiding people.

But here's the thing...

Your brain and body are being squeezed every few days.

You have pain.

You can't tolerate light.

You can't tolerate sound.

You can't work properly.

You can't do the things you want to do.

And then someone around you says..

"Why are you always so irritated?"

Because, they're not seeing what you're going through.

So, over time, you become defensive.

You downplay your symptoms.

The result = You are always on edge.

And all of that can affect your mood.

So what looks like a "mood problem" is actually part of a much bigger migraine problem.

➡️ 6️⃣ Sleep Issues. (My Rating: 5/10)

This one's less common, but it happens.

Pain can keep you up at night or wake you from sleep.

And some migraine medicines make you sleepy during the day instead of at night.

This throws off your sleep schedule.

And then you get into a cycle...

Poor sleep → more migraine → more poor sleep → more migraine.

The result = Your physical and mental health suffers.

P.S. Is your mind & body exhausted from Migraine?

Dr Azrung Fayaz
Neurologist

17/08/2026

Hint: It's free and takes less than 2 minutes.

There are two kinds of headaches...

Think of your brain like a computer.

Some headaches are hardware problems.

In other words, something is physically wrong inside the brain.

Could be a bleed. A tumor. High pressure. Or an infection.

Other headaches are software problems...

In other words, the brain is working fine, but it's misfiring.

Migraine is one of these.

But, the tricky part is that both kinds of headaches can feel the same.

Nausea and vomiting...

Light hurts your eyes...

Neck feels stiff...

And pain that won't go away.

Said differently, a hardware problem can look just like a software problem...

That's why I never guess...

Instead, I check for the dangerous "hardware" headaches...

For example, if you've never had headaches and this one came on suddenly...

That's a red flag for me.

You need a hospital...

You need scans...

And maybe even a lumbar puncture (a small needle test that checks the fluid around your brain and spine).

But most headaches aren't that...

So, for the slower headache that keeps coming back...

I look at the back of your eye.

There's a small structure back there called the optic disc.

It's actually part of your brain.

So, if pressure inside your skull is high, this disc swells.

This is called papilledema.

It takes less than two minutes to check.

And it costs nothing.

This is important because some patients with high pressure in the brain...

Don't get all the obvious warning signs early on.

When they do appear more damage may already be done.

So, by checking your optic disc I catch it early.

And catching it early can save you money and time...

And more importantly, it can save your vision and your health.

If your optic disc looks normal, and your story fits a pattern like migraine...

I don't send you for an MRI.

Because you don't need it.

But, if the optic disc is swollen, we move straight to other tests.

Your story always comes first. It's the biggest clue.

But that quick eye check is my safety net every single time.

P.S. Have you had your optic disc checked?

Dr Azrung Fayaz
Neurologist

Address

Peshawar

Telephone

+923215615880

Website

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

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